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

2. 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

4. 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

5. Normal blood smear Iron-deficiency anemia

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

7. 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)

8. 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)

9. 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

10. 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

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

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

13. 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

14. 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

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

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 mg if iron deficient
Pregnant women - 30 mg
Weekly doses vs. daily
Weekly dose initially, then move to daily dose to prevent side effects

19. Microcytic Anemias Nutritional Implications
Fatigue, depression, difficulty in physical exertion – poor intake
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
Folate or B12 deficiency
Pernicious anemia –
Specific to GI disorders
Lining of stomach atrophied or inflamed

24. 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

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

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

28. © 2007 Thomson - Wadsworth
2.4 micrograms per day

29. 400 micrograms per day

30. 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