What is Anemia? Anemia is having less than normal number of red blood cells or less hemoglobin than normal in the blood. *Microcytic Anemia: Any abnormal small cells usually resulting from deficiency of Iron. *Macrocytic or Megaloblastic Anemia: is a blood disorder characterized by anemia with red blood cells that are larger than normal, usually resulting from deficiency of B12, and Folic Acid. Hemolytic Anemia: anemia resulting from destruction of reythrocytes (cells that carry oxygen to all part of the body (RBCs)) usually resulting from deficiency of Vitamin E.

Nutritional Anemia 1- Iron deficiency anemia (microcytic anemia) 2- Vitamin B12 and Folate anemia (macrocytic or megaloblastic anemia) 3- Hemolytic anemia (vitamin E deficiency)

Iron deficiency Iron deficiency may developed under the following condition 1- Inadequate intake 2- impaired absorption Vitamin C deficiency, and hypoacidity of stomach (lack of I.F.) intrensic factor Excess dietary oxalates and phosphates in plant foods 3- chronic blood loss Parasitic (hookworms, belharziasis, malaria) pathological conditions associated with chronic bleeding, urinary, gastrointestinal 4- Frequent blood donation

Characteristics Decreased amount of hemoglobin Small (microcytic), pale-colored (hypochromic) red cells Reduced number of red cells Less plasma iron, and depleted iron stores

Manifestation Pale skin and mucous membranes Manifestation of reduced oxygen-carried power of blood: early fatigue and dyspnoea (shortness of breath) on exertion headache, impaired health, lowered efficiency Haemic murmur of heart Dry brittle flat, then spoon-shaped nails Low hemoglobin, diminished red cell count

Susceptible groups. Due to increased iron need Preterm infants growing infants and young children Adolescent girls and females (pregnant and lactation) Elderly

Specific prevention 1- Adequate nourishment of the vulnerable group. 2- dietary supplementation of the vulnerable group to meet their increased needs (enriched powder milk, iron preparation) 3-Prevention and control of parasitic diseases 4- Prevention and control pathological conditions which may be associated with chronic blood loss. 5- Nutrition education for selection of absorbable iron-rich foods.

Megaloblastic Anaemias A macrocytic anemia in which RBCs development in the bone marrow stops at the stage of megaloblasts. It is includes permicious anaemia due to vit. B12, and anaemia of pregnancy due to folic acid deficiency. Susceptible group 1- Folacin deficiency (pregnant, lactating) 2- B12 deficiency Vegetarians subjects of atrophied stomach mucosa, or gastrectomy Infection Cases of malabsorption syndrome

Specific Prevention Of Megaloblastic Anaemias 1- Anemia of pregnancy: *Adequate feeding during pregnancy and lactation, to satisfy increased requirement of B12 and Folic Acid + supplements 2- Pernicious anemia: * Balanced diet, with reasonable amount of animal food. *Supplementing diet of vegetarian with B12. *Compensation for lacking Intrinsic Factor IF which is necessary for absorption of Vitamin B12 in case of atrophic mucosa * Prevention and control of infection.

Normal Values of the hemogram (Figure 1 Men Women Test 13, 5-17, 7 12-16 Hg (g/dl)