1. Hematological System KNH 413

2. Nutritional Anemias Macrocytic – B12 (folate), B9, B1, pyridoxine Decreased ability to synthesize new cells and DNA Microcytic – pro status, Fe status—most common, vit. C, vit. A, Cu, Mn Impaired heme synthesis Hemolytic—deficiency or excess of vit. E

4. Microcytic Anemias Iron deficiency—decrease RBC count Most common nutritional deficiency in U.S. Look at hemoglobin level Progression from negative iron balance to overt clinical iron-deficiency anemia Want mother to keep a log along with monitoring son’s blood work

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—insuff Depletion of iron in liver (ferritin), spleen, other tissues results Transferrin (plasma protein)

8. Microcytic Anemias Iron intake and absorption considerations: Poor intake with increased needs (esp. during rapid spurts of growth) Food sources – heme vs. nonheme (tannins in tea and decrease absorption) Vitamin C increases absorption Mineral excesses may bind iron (giving a toddler too much milk (Ca) may cause deficiency Pica in pregnant women may decrease iron intake

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

10. Microcytic Anemias Iron deficiency Immunity Decreases immune function and infections can increase Zinc and vitamin A deficiency are confounding factors (cause more complications) General malnutrition and repeated pregnancy with dietary deficiencies

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

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

13. Microcytic Anemias Special conditions that impact iron status: Athletes – esp. females Menstruation + higher RBD turnover Space flight – weightlessness Exposure to chemical or infectious agents Competing for receptors

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 15-60 mg if iron deficient Pregnant women - 30 mg Weekly doses vs. daily—weekly because side effects include GI distress/discomfort and daily compliance difficult

19. Microcytic Anemias Nutritional Implications of low iron status Fatigue, depression, difficulty in physical exertion – poor intake—constantly seen in geriatric population Depressed appetite

20. Microcytic Anemias Interventions Enhance absorption with vitamin C Increase intake of animal sources Bioengineering Community level

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

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

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

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

28. © 2007 Thomson - Wadsworth

30. Megaloblastic Anemias Nutritional Implications/Interventions Elevated homocysteine in children and adults Encourage fortified grains (with folic acid) Encourage animal foods if appropriate (if willing to do a mixed diet) Educate against the consumption of soft drinks because P present may interfere with Ca absoprtion