1. Hematological System KNH 413 the composition of blood looking at the severity of it

2. 2 Nutritional Anemias Macrocytic - Decreased ability to synthesize new cells and DNA low B12, folate, thiamin, and pyridoxine levels Microcytic - Impaired heme synthesis protein status, iron status, vitamin C, vitamin A, copper, manganese Hemolytic deficiency or excess of vitamin E

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4. 4 Microcytic Anemias Iron deficiency Most common nutritional deficiency in U.S. Progression from negative iron balance to overt clinical iron-deficiency anemia first look for decreased red blood cells, then look at hemoglobin level

5. 5 Normal blood smear Iron-deficiency anemia

6. 6 look at transferrin iron binding capacity, transferrin saturation, serum transferrin, ferritin levels increase vitamin C to increase iron uptake supplementation teen years, geriatric years, pregnancy, vegans GI disorders: crohn’s, anytime you see blood loss

7. 7 Microcytic Anemias Iron deficiency - etiology Blood loss; gastric ulceration, dysmenorrhea, inadequate intake… Functional anemia; oxygen is insufficient for erythropoiesis insufficient amount of red blood cells (low hemoglobin) protein energy malnutrition Depletion of iron in liver, spleen, other tissues results ferritin--iron stored in liver transferrin--the plasma protein

8. 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 drinking too much milk can decrease iron--calcium decreases iron absorption tannins present in tea can decrease absorption pregnant women--PICA, need to increase iron

9. 9 Microcytic Anemias Iron deficiency Infants and children “Milk anemia”--around 6 months old Childhood obesity Iron-poor food choices Pregnancy Fetal needs precede maternal needs © 2007 Thomson - Wadsworth

10. 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. 11 Microcytic Anemias Disease states associated with iron-deficiency anemia: H. pylori infection Cerebrovascular or cardiovascular disease Wounds, sepsis, surgery

12. 12 Microcytic Anemias Disease states associated with iron-deficiency anemia: HIV/AIDS alcoholic liver disease iron supplementation GI disease Anorexia nervosa PKU iron is decreased in diet; supplementation needed

13. 13 Microcytic Anemias Special conditions that impact iron status: Athletes – esp. females--the combo of menstruation and re Space flight – weightlessness Exposure to chemical or infectious agents compromises iron status--competes for receptors for carrying red blood cells (ex: lead)

14. 14 Microcytic Anemias Clinical Manifestations Cold extremities (always cold), pallor, fatigue, malaise, tachycardia Laboratory indices Measure of hgb often done alone--can be initial tell-tale sign Noninvasive point of care imaging--physical signs and symptoms

15. 15 2/3 of iron is found in hemoglobin then ferritin then transferrin

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

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18. 18 Microcytic Anemias Treatment/Nutrition Therapy Supplementation – single vs. multivitamin Females 15-60 mg if iron deficient Pregnant women - 30 mg prescribed; a weekly does initially versus a daily dose. the binding capacity can be better; too much a day can cause GI distress Weekly doses vs. daily

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

20. 20 Microcytic Anemias Interventions Enhance absorption with vitamin C Increase intake of animal sources Bioengineering--some level of supplementation Community level--look at studies and what are the trends

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22. 22 Megaloblastic Anemias RBCs have decreased capacity for oxygen transfer Large, irregular, immature Pernicious anemia – Specific to GI disorders

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24. 24 Megaloblastic Anemias Elderly, pregnancy, atrophic gastritis, chronic alcohol consumption at highest risk intrinsic factor is decreased Gastrectomy and bariatric surgery Intake, digestion, absorption Inflammation Uracil accumulation--due to inadequate amounts of folate

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26. 26 Megaloblastic Anemias Clinical Manifestations Irritability, pallor, pale sclera Chromosomal damage Homocysteinemia without folate you don’t have homocystein present

27. 27 Megaloblastic Anemias Treatment/Nutrition Therapy Oral cyanocobalamin and supplemental folate Treat underlying causes Patient education on nutrient density of folate and B12

28. 28 © 2007 Thomson - Wadsworth 2.5 ug needed/day

29. 29 400 ug needed/day

30. 30 Megaloblastic Anemias Nutritional Implications/Interventions Elevated homocysteine in children and adults Encourage animal foods if appropriate educate on decreasing soft drink intake as it negatively affects calcium absorption

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