Hematological System KNH 413 Composition of blood used as a diagnostic tool, looking at the presence, severity, or risk of disease KNH 413

Nutritional Anemias Macrocytic - Microcytic - Hemolytic Decreased ability to synthesize new cells and DNA B12, folate, thiamin, pyridoxine Microcytic - Impaired heme synthesis Protein, iron, vitamin C, vitamin A, copper, manganese Hemolytic Deficiency or excess of vitamin E

Microcytic Anemias Iron deficiency Decreased red blood cells and hemoglobin Most common nutritional deficiency in U.S. Progression from negative iron balance to overt clinical iron-deficiency anemia Diet change or supplements (clinical), IV in severe

Normal blood smear Iron-deficiency anemia

Transferrin binding, plasma ferritin, serum transferrin, and ferritin iron From normal to iron depletion- diet change

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 Look at ferritin (iron stored in liver) and transferrin (plasma protein)

Microcytic Anemias Iron intake and absorption considerations: Poor intake with increased needs Consider during rapid periods of growth Food sources – heme vs. nonheme Tannins and contaminants inhibit absorption Vitamin C increases absorption Mineral excesses may bind iron Pica- eating non-food items (sign of deficiency)

Microcytic Anemias Iron deficiency Infants and children © 2007 Thomson - Wadsworth Microcytic Anemias Iron deficiency Infants and children “Milk anemia”- when transitioning to solid foods as an infant Childhood obesity Iron-poor food choices Pregnancy Fetal needs precede maternal needs

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

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

Microcytic Anemias HIV/AIDS GI disease Anorexia nervosa PKU Disease states associated with iron-deficiency anemia: HIV/AIDS GI disease Anorexia nervosa PKU

Microcytic Anemias Special conditions that impact iron status: Athletes – esp. females High red blood cell turn over Space flight – weightlessness Exposure to chemical or infectious agents Competing for receptors

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

2/3 of iron found in hemoglobin, then transferrin, then ferritin

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

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 dose initially, then move to daily dose to prevent side effects

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

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

Megaloblastic Anemias RBCs have decreased capacity for oxygen transfer Large, irregular, immature Folate or B12 deficiency Pernicious anemia – Specific to GI disorders Lining of stomach atrophied or inflamed

Megaloblastic Anemias Elderly, pregnancy, atrophic gastritis, chronic alcohol consumption at highest risk Elderly most common due to poor B12 intake and intrinsic factor decreased, or bacterial growth Gastrectomy and bariatric surgery Intake, digestion, absorption Inflammation Uracil accumulation Due to inadequate intake of folate

Megaloblastic Anemias Clinical Manifestations Irritability, pallor, pale sclera Chromosomal damage Homocysteinemia Impacts synthesis of methionine From homocysteine- required for folate enzyme

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

© 2007 Thomson - Wadsworth 2.4 micrograms per day

400 micrograms per day

Megaloblastic Anemias Nutritional Implications/Interventions Elevated homocysteine in children and adults Encourage animal foods if appropriate Educate against soft drinks- displacement of food stuffs that don’t compliment B12