Hematological System

KNH 413

Nutritional Anemias

Macrocytic –B12, B9, B1, pyridoxine (B??) Macrocytic –B12, B9, B1, pyridoxine (B??)

Decreased ability to synthesize new cells and DNA Decreased ability to synthesize new cells and DNA

Microcytic – Iron, protein, vitamin C, A, copper, Microcytic – Iron, protein, vitamin C, A, copper, manganese manganese

Impaired heme synthesisImpaired heme synthesis

Hemolytic- def or excess of vitamin E Hemolytic- def or excess of vitamin E

Microcytic Anemias

Iron deficiency- decreased RBC countIron deficiency- decreased RBC count

Most common nutritional deficiency in U.S. Most common nutritional deficiency in U.S.

Progression from negative iron balance to overt Progression from negative iron balance to overt clinical iron-deficiency anemiaclinical iron-deficiency anemia

Overt you have to supplement with pills or IVOvert you have to supplement with pills or IV

Normal blood smear Iron-deficiency anemia

Microcytic Anemias

Iron deficiency - etiologyIron deficiency - etiology

Blood loss; gastric ulceration, dysmenorrhea, Blood loss; gastric ulceration, dysmenorrhea, inadequate intake…inadequate intake…

Functional anemia; oxygen is insufficient for Functional anemia; oxygen is insufficient for erythropoiesis, not enough RBC, protein energy erythropoiesis, not enough RBC, protein energy malnutrition, low HnH, ferriten (iron in the liver), malnutrition, low HnH, ferriten (iron in the liver), transferrin (plasma protein)transferrin (plasma protein)

Depletion of iron in liver, spleen, other tissues resultsDepletion of iron in liver, spleen, other tissues results

Microcytic Anemias

Iron intake and absorption considerations:Iron intake and absorption considerations:

Poor intake with increased needsPoor intake with increased needs

Food sources – heme vs. nonhemeFood sources – heme vs. nonheme

Vitamin C increases absorption of iron Vitamin C increases absorption of iron

Mineral excesses may bind ironMineral excesses may bind iron

Microcytic Anemias

Iron deficiencyIron deficiency

Infants and children Infants and children

““Milk anemia”Milk anemia”

Childhood obesityChildhood obesity

Iron-poor food choices, nut def foodstuffIron-poor food choices, nut def foodstuff

PregnancyPregnancy

Fetal needs precede maternal needsFetal needs precede maternal needs

© 2007 Thomson - Wadsworth

Microcytic AnemiasIron deficiencyIron deficiency

ImmunityImmunity

Decreases immune functionDecreases immune function

Infections can increaseInfections can increase

Zinc and vitamin A deficiency are confounding Zinc and vitamin A deficiency are confounding factorsfactors

Can cause more complicationsCan cause more complications

General malnutrition and repeated pregnancy with General malnutrition and repeated pregnancy with dietary deficienciesdietary deficiencies

Hyperemesis Hyperemesis

Microcytic Anemias

Disease states associated with iron-deficiency anemia:Disease states associated with iron-deficiency anemia:

H. pyloriH. pylori infection infectionImpaired thyroid functionImpaired thyroid functionCancersCancersWound healing, sepsis, surgery Wound healing, sepsis, surgery Cerebrovascular or cardiovascular Cerebrovascular or cardiovascular diseasediseaseHIV/AIDSHIV/AIDSALD- (ferritin because it is stored in ALD- (ferritin because it is stored in the liver)the liver)

Microcytic Anemias

Disease states associated with iron-deficiency anemia:Disease states associated with iron-deficiency anemia:

HIV/AIDSHIV/AIDSGI diseaseGI diseaseKidney diseaseKidney diseaseAnorexia nervosaAnorexia nervosaPKU- iron is decreased in the diet, PKU- iron is decreased in the diet, growing years growing years

Microcytic Anemias

Special conditions that impact iron status:Special conditions that impact iron status:

Athletes – esp. femalesAthletes – esp. females

The combination, higher RBD, menstruation The combination, higher RBD, menstruation

Space flight – weightlessnessSpace flight – weightlessness

Exposure to chemical or infectious agentExposure to chemical or infectious agent

Competing with receptors for iron, leadCompeting with receptors for iron, lead

Microcytic Anemias

Clinical ManifestationsClinical Manifestations

Cold extremities, pallor, fatigue, malaise, Cold extremities, pallor, fatigue, malaise, tachycardiatachycardia

Laboratory indices Laboratory indices

Measure of hgb often done aloneMeasure of hgb often done alone

Noninvasive point of care imagingNoninvasive point of care imaging

Microcytic Anemias

• Treatment/Nutrition TherapyTreatment/Nutrition Therapy

– Iron-dense foodsIron-dense foods

– Nutrient-dense diet long termNutrient-dense diet long term

– Treat underlying conditionTreat underlying condition

Microcytic Anemias

• Treatment/Nutrition TherapyTreatment/Nutrition Therapy

– Supplementation – single vs. multivitaminSupplementation – single vs. multivitamin

– Females 15-60 mg if iron deficientFemales 15-60 mg if iron deficient

– Pregnant women - 30 mgPregnant women - 30 mg• GI distressGI distress

– Weekly doses vs. dailyWeekly doses vs. daily

Microcytic Anemias

• Nutritional ImplicationsNutritional Implications

– Fatigue, depression, difficulty in physical Fatigue, depression, difficulty in physical exertion – poor intakeexertion – poor intake

– Depressed appetiteDepressed appetite

• Geriatric population Geriatric population

Microcytic Anemias

• InterventionsInterventions

– Enhance absorption with vitamin CEnhance absorption with vitamin C

– Increase intake of animal sourcesIncrease intake of animal sources

– Bioengineering Bioengineering

– Community levelCommunity level• NHAINStudy NHAINStudy

Megaloblastic Anemias

• RBCs have decreased capacity for oxygen RBCs have decreased capacity for oxygen transfertransfer

– Large, irregular, immatureLarge, irregular, immature

• Pernicious anemia – Pernicious anemia –

– Specific to GI disorders Specific to GI disorders

Megaloblastic Anemias

• Elderly, pregnancy, atrophic gastritis, Elderly, pregnancy, atrophic gastritis, chronic alcohol consumption at highest chronic alcohol consumption at highest riskrisk

• Gastrectomy and bariatric surgeryGastrectomy and bariatric surgery– Intake, digestion, absorptionIntake, digestion, absorption

• InflammationInflammation• Uracil accumulation- due to inadequate Uracil accumulation- due to inadequate

amounts of folate amounts of folate

Megaloblastic Anemias

• Clinical ManifestationsClinical Manifestations

– Irritability, pallor, pale scleraIrritability, pallor, pale sclera

– Chromosomal damageChromosomal damage

– Homocysteinemia- synthesis of methanine from Homocysteinemia- synthesis of methanine from homocysteine requires a folate coenzyme- oral B12, homocysteine requires a folate coenzyme- oral B12, or folate supplement, weekly injections of B12 or folate supplement, weekly injections of B12

Megaloblastic Anemias

• Treatment/Nutrition TherapyTreatment/Nutrition Therapy

– Oral cyanocobalamin and supplemental folateOral cyanocobalamin and supplemental folate

– Treat underlying causesTreat underlying causes

– Patient education on nutrient density Patient education on nutrient density

© 2007 Thomson - Wadsworth

Megaloblastic Anemias

• Nutritional Implications/InterventionsNutritional Implications/Interventions

– Elevated homocysteine in children and adultsElevated homocysteine in children and adults

– Encourage animal foods if appropriateEncourage animal foods if appropriate