Hematological System

KNH 413

the composition of blood looking at the severity of it

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Nutritional AnemiasMacrocytic - Macrocytic -

Decreased ability to synthesize new cells and DNA Decreased ability to synthesize new cells and DNA

low B12, folate, thiamin, and pyridoxine levelslow B12, folate, thiamin, and pyridoxine levels

Microcytic - Microcytic - Impaired heme synthesisImpaired heme synthesis

protein status, iron status, vitamin C, vitamin A, copper, protein status, iron status, vitamin C, vitamin A, copper, manganesemanganese

Hemolytic Hemolytic deficiency or excess of vitamin Edeficiency or excess of vitamin E

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Microcytic AnemiasIron deficiencyIron deficiency

Most common nutritional deficiency in U.S. Most common nutritional deficiency in U.S.

Progression from negative iron balance to overt clinical Progression from negative iron balance to overt clinical iron-deficiency anemiairon-deficiency anemia

first look for decreased red blood cells, then look at first look for decreased red blood cells, then look at hemoglobin levelhemoglobin level

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Normal blood smear Iron-deficiency anemia

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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

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Microcytic Anemias

Iron deficiency - etiologyIron deficiency - etiology

Blood loss; gastric ulceration, dysmenorrhea, inadequate Blood loss; gastric ulceration, dysmenorrhea, inadequate intake…intake…

Functional anemia; oxygen is insufficient for Functional anemia; oxygen is insufficient for erythropoiesiserythropoiesis

insufficient amount of red blood cells (low hemoglobin)insufficient amount of red blood cells (low hemoglobin)

protein energy malnutritionprotein energy malnutrition

Depletion of iron in liver, spleen, other tissues resultsDepletion of iron in liver, spleen, other tissues results

ferritin--iron stored in liverferritin--iron stored in liver

transferrin--the plasma proteintransferrin--the plasma protein

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Microcytic AnemiasIron intake and absorption considerations:Iron intake and absorption considerations:

Poor intake with increased needsPoor intake with increased needs

Food sources – heme vs. nonhemeFood sources – heme vs. nonheme

Vitamin C increases absorptionVitamin C increases absorption

Mineral excesses may bind ironMineral excesses may bind irondrinking too much milk can decrease iron--calcium decreases drinking too much milk can decrease iron--calcium decreases iron absorptioniron absorption

tannins present in tea can decrease absorptiontannins present in tea can decrease absorption

pregnant women--PICA, need to increase ironpregnant women--PICA, need to increase iron

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Microcytic Anemias

Iron deficiencyIron deficiency

Infants and children Infants and children

““Milk anemia”--around 6 months oldMilk anemia”--around 6 months old

Childhood obesityChildhood obesity

Iron-poor food choicesIron-poor food choices

PregnancyPregnancy

Fetal needs precede maternal needsFetal needs precede maternal needs

© 2007 Thomson - Wadsworth

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Microcytic Anemias

Iron deficiencyIron deficiency

ImmunityImmunity

Decreases immune function Decreases immune function

Zinc and vitamin A deficiency are confounding Zinc and vitamin A deficiency are confounding factorsfactors

General malnutrition and repeated pregnancy with General malnutrition and repeated pregnancy with dietary deficienciesdietary deficiencies

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Microcytic Anemias

Disease states associated with iron-deficiency Disease states associated with iron-deficiency anemia:anemia:

H. pylori infectionH. pylori infection

Cerebrovascular or Cerebrovascular or cardiovascular diseasecardiovascular disease

Wounds, sepsis, surgeryWounds, sepsis, surgery

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Microcytic AnemiasDisease states associated with iron-deficiency anemia:Disease states associated with iron-deficiency anemia:

HIV/AIDSHIV/AIDS

alcoholic liver diseasealcoholic liver diseaseiron supplementationiron supplementation

GI diseaseGI disease

Anorexia nervosaAnorexia nervosa

PKUPKUiron is decreased in diet; supplementation needediron is decreased in diet; supplementation needed

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Microcytic AnemiasSpecial conditions that impact iron status:Special conditions that impact iron status:

Athletes – esp. females--the combo of menstruation and Athletes – esp. females--the combo of menstruation and rere

Space flight – weightlessnessSpace flight – weightlessness

Exposure to chemical or infectious agentsExposure to chemical or infectious agents

compromises iron status--competes for receptors for compromises iron status--competes for receptors for carrying red blood cells (ex: lead)carrying red blood cells (ex: lead)

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Microcytic AnemiasClinical ManifestationsClinical Manifestations

Cold extremities (always cold), pallor, fatigue, malaise, Cold extremities (always cold), pallor, fatigue, malaise, tachycardiatachycardia

Laboratory indices Laboratory indices

Measure of hgb often done alone--can be initial tell-tale Measure of hgb often done alone--can be initial tell-tale signsign

Noninvasive point of care imaging--physical signs and Noninvasive point of care imaging--physical signs and symptomssymptoms

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2/3 of iron is found in hemoglobinthen ferritinthen transferrin

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Microcytic AnemiasTreatment/Nutrition TherapyTreatment/Nutrition Therapy

Iron-dense foodsIron-dense foods

Nutrient-dense diet long termNutrient-dense diet long term

Treat underlying conditionTreat underlying condition

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Microcytic AnemiasTreatment/Nutrition TherapyTreatment/Nutrition Therapy

Supplementation – single vs. multivitaminSupplementation – single vs. multivitamin

Females 15-60 mg if iron deficientFemales 15-60 mg if iron deficient

Pregnant women - 30 mg prescribed; a weekly Pregnant women - 30 mg prescribed; a weekly does initially versus a daily dose.does initially versus a daily dose.

the binding capacity can be better; too much a day the binding capacity can be better; too much a day can cause GI distresscan cause GI distress

Weekly doses vs. dailyWeekly doses vs. daily

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Microcytic AnemiasNutritional ImplicationsNutritional Implications

Fatigue, depression, difficulty in physical exertion – poor Fatigue, depression, difficulty in physical exertion – poor intakeintake

Depressed appetiteDepressed appetite

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Microcytic Anemias

InterventionsInterventionsEnhance absorption with vitamin CEnhance absorption with vitamin C

Increase intake of animal sourcesIncrease intake of animal sources

Bioengineering--some level of supplementationBioengineering--some level of supplementation

Community level--look at studies and what are the Community level--look at studies and what are the trendstrends

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Megaloblastic AnemiasRBCs have decreased capacity for oxygen transferRBCs have decreased capacity for oxygen transfer

Large, irregular, immatureLarge, irregular, immature

Pernicious anemia – Pernicious anemia –

Specific to GI disorders Specific to GI disorders

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Megaloblastic AnemiasElderly, pregnancy, atrophic gastritis, Elderly, pregnancy, atrophic gastritis, chronic alcohol consumption at highest chronic alcohol consumption at highest riskrisk

intrinsic factor is decreasedintrinsic factor is decreased

Gastrectomy and bariatric surgeryGastrectomy and bariatric surgeryIntake, digestion, absorptionIntake, digestion, absorption

InflammationInflammation

Uracil accumulation--due to inadequate Uracil accumulation--due to inadequate amounts of folateamounts of folate

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Megaloblastic AnemiasClinical ManifestationsClinical Manifestations

Irritability, pallor, pale scleraIrritability, pallor, pale sclera

Chromosomal damageChromosomal damage

HomocysteinemiaHomocysteinemia

without folate you don’t have homocystein presentwithout folate you don’t have homocystein present

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Megaloblastic Anemias

Treatment/Nutrition TherapyTreatment/Nutrition Therapy

Oral cyanocobalamin and supplemental folateOral cyanocobalamin and supplemental folate

Treat underlying causesTreat underlying causes

Patient education on nutrient density of folate Patient education on nutrient density of folate and B12and B12

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© 2007 Thomson - Wadsworth

2.5 ug needed/day

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400 ug needed/day

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Megaloblastic Anemias

Nutritional Implications/InterventionsNutritional Implications/Interventions

Elevated homocysteine in children and adultsElevated homocysteine in children and adults

Encourage animal foods if appropriateEncourage animal foods if appropriate

educate on decreasing soft drink intake as it educate on decreasing soft drink intake as it negatively affects calcium absorptionnegatively affects calcium absorption

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