1. Hematological System
KNH 413

2. Nutritional Anemias Macrocytic - Microcytic - Hemolytic
Decreased ability to synthesize new cells and DNA
Microcytic -
Impaired heme synthesis
Hemolytic
Composition of blood used as diagnostic tool for disease presence, severity, or risk
Macrocytic-B12, folate, thiamin, pyridoxine
Microcytic- Protein, iron, vitamin C, A pyridoxine, copper, manganese
Hemolytic- Deficiency or excess of vitamin E

4. Microcytic Anemias Iron deficiency
Most common nutritional deficiency in U.S.
Progression from negative iron balance to overt clinical iron-deficiency anemia
Decreased RBCs, hemoglobin

5. Normal blood smear Iron-deficiency anemia

7. Microcytic Anemias Iron deficiency - etiology
Blood loss; gastric ulceration, dysmenorrhea, inadequate intake…
Functional anemia; oxygen is insufficient for erythropoiesis
Depletion of iron in liver, spleen, other tissues results
Iron can be measured from ferritin, hemosiderin, or transferrin

8. Microcytic Anemias Iron intake and absorption considerations:
Poor intake with increased needs
Food sources – heme vs. nonheme
Vitamin C increases absorption
Mineral excesses may bind iron
Periods of rapid growth
Phytates, tannins, polyphenols, may decrease absorption
Contaminants such as lead

9. Microcytic Anemias Iron deficiency Infants and children
© 2007 Thomson - Wadsworth
Microcytic Anemias
Iron deficiency
Infants and children
“Milk anemia”
Childhood obesity
Iron-poor food choices
Pregnancy
Fetal needs precede maternal needs
Lactoferrin in breast milk, iron-fortified formulas—

10. Microcytic Anemias Iron deficiency Immunity Decreases immune function
Zinc and vitamin A deficiency are confounding factors
General malnutrition and repeated pregnancy with dietary deficiencies

11. Microcytic Anemias H. pylori infection
Disease states associated with iron-deficiency anemia:
H. pylori infection
Cerebrovascular or cardiovascular disease
Wounds, sepsis, surgery
Impaired thyroid function
Cancer

12. Microcytic Anemias HIV/AIDS GI disease Anorexia nervosa PKU
Disease states associated with iron-deficiency anemia:
HIV/AIDS
GI disease
Anorexia nervosa
PKU
Alcoholic Liver Disease
Kidney Disease

13. Microcytic Anemias Special conditions that impact iron status:
Athletes – esp. females
Space flight – weightlessness
Exposure to chemical or infectious agents

14. Microcytic Anemias Clinical Manifestations
Cold extremities, pallor, fatigue, malaise, tachycardia
Laboratory indices
Measure of hgb often done alone
Noninvasive point of care imaging

16. Microcytic Anemias Treatment/Nutrition Therapy Iron-dense foods
Nutrient-dense diet long term
Treat underlying condition

18. Microcytic Anemias Treatment/Nutrition Therapy
Supplementation – single vs. multivitamin
Females mg if iron deficient
Pregnant women - 30 mg
Weekly doses vs. daily
Side effects of supplementation- GI upset, constipation, nausea

19. Microcytic Anemias Nutritional Implications
Fatigue, depression, difficulty in physical exertion – poor intake
Depressed appetite

20. Microcytic Anemias Interventions Enhance absorption with vitamin C
Increase intake of animal sources
Bioengineering
Community level
Cook with cast iron
Complimentary foods

22. Megaloblastic Anemias
RBCs have decreased capacity for oxygen transfer
Large, irregular, immature
Pernicious anemia –
Specific to GI disorders
RBCs decrease O2 d/t folate, B12 deficiency
Pernicious-result from stomach lining atrophy and inflammation

24. Megaloblastic Anemias
Elderly, pregnancy, atrophic gastritis, chronic alcohol consumption at highest risk
Gastrectomy and bariatric surgery
Intake, digestion, absorption
Inflammation
Uracil accumulation
Elderly Megaloblastic d/t poor intake B12, lack of intrinsic factor
Gastrectomy- Megaloblastic d/t bacterial overgrowth
Uracil d/t inadequate folate

26. Megaloblastic Anemias
Clinical Manifestations
Irritability, pallor, pale sclera
Chromosomal damage
Homocysteinemia
Neuropathues- B12

27. Megaloblastic Anemias
Treatment/Nutrition Therapy
Oral cyanocobalamin and supplemental folate
Treat underlying causes
Patient education on nutrient density
Weekly IM injections of B12
Pt education on foods high in B12 and folate

28. © 2007 Thomson - Wadsworth

30. Megaloblastic Anemias
Nutritional Implications/Interventions
Elevated homocysteine in children and adults
Encourage animal foods if appropriate
Educate against high soft drink consumption
Increased use of fortified grain products