NUTRITIONAL ANEMIA Dimyati Burhanuddin TERMS : Heme Hemoglobin : iron protoporphyrin in hb : a conjugated protein (globin)-to form heme group

(the oxgen-carrying of the erythrocytes) Chemochromatosis Hemolytic anemia Hypochromic acrocytic egaloblastic &ntrinsic factor icrocytic (ernicious anemia : iron overload (genetically) : - shortened survival of mature rbc : hb deficiency in rbc : rbc larger than normal mcv! mch increases : abnormal product of "BC large! immature-(defic#vit B$% folic acid) : a glycoprotein secreted from gastric 'all (absorption vit B$%) : rbc! smaller! mcv! mch decreases (iron defic#) : -defic#vit B$% -macrocytic -megaloblastic
orphological Classification of )nemia Clinical ,yndromes (ernicious anemia! 3utritional megaloblastic!anemias! ,prue! and other malabsorption syndromes 4rotic aciduria Chemotherapeutic agents! aticonvulsants! oral contraceptives

hepatic damage

orphologic +ype of )nemia acrocytic ( C- . /0! egaloblastic

*nderlying )bnormality CHC . 1$)

+reatment -itamin B$% folic acid )ccording to nature of disorder ,top o offending drug and administer folic acid +reatment of underlying

-itamin B$% deficiency 2olic acid deficiency inherited disorders of D3) synthesis drug-induced disorders of D3) synthesis

3onmegaloblastic disease

)ccelerated erythropoiesis Hemolytic anemia &ncreased membrane surface area 4bscure

Hypochromic-microcytic correction of

( C- 5 67!

CHC 5 1$) iron deficiency

Chronic loss of blood! inade8uate diet! impaired absorption! increase demands +hallasemia (yridoxine-responsive anemia

2errous sulfate and underlying cause 3onspecific pyridoxine

Disorders of globin synthesis Disorders of porphyn and heme synthesis 4ther disorders of iron metabolism 3ormochromic-normocytic ( C- 6%-/%! CHC .17) "ecent blood loss condition 4verexpansion of plasma volume Hemolytic diseases disorder Hypoplastic bone marro' &nfiltrated bone marro' ;ndocrine abnormality disease Chronic disorders disease "enal disease disease 9iver disease disease

-arious (regnancy 4verhydration )plastic anemia (ure red blood cell aolasia 9eu:emia! multiple myeloma! myelofibrosis hypothyroidism! adrenal insufficiency

+ransfusion! iron Correct underlying "estore homeostatis )ccording to nature of +ransfusions )ndrogens Chemotherapy +reatment of underlying +reatment of underlying

"enal disease Cirrhosis

+reatment of underlying +reatment of underlying

)nemia

: -deficiency in si<e and number of rbc -deficiency in the amount of hemoglobin content

3utritional anemia

: the deficiencies result from an ade8uate inta:e of nutrients (iron!protein!vit B$%! folic acid! pyridoxim! ascorbic acid! copper)

IRON DEF.ANEMIA - ,mall erythrocytes (microlytic) - diminished level of circulating hb# ;tilogy: - chronic blood loss peptic ulcer haemorrhoids parasites malignancy - poor iron inta:e - from diet (consumption) - from malabsorption

- increased iron re8uirement - infant - adolescence - pregnancy ,tages of iron deficiency $# Depletion of iron stores (ferritin and hemosiderin) depletion of iron in plasma protein vechicle (transferrin)! reflected &n the measurement of tibc (total iron = binding capacity) %# Deficient erythropoesis (decrease of rbc production) 1# )nemia rbc - hypochromic - microcytic Clinical features malfunction of body systems - muscle function - neurologic involment decrease of 'or: performance fati8ue

- gro'th abnormalities = epithelial disorders (tougue! s:in! nails) - respiratory and cardiovascular changes - cardiac failure Diagnosis : (lasma ferritin = measure iron stores +ransferritin saturation = iron suplly to the tissues total iron binding capacity (tibc) erythopoesis ratio >n (( ? heme hb in hematocrit measurement

Treatment edication : inorganic iron = p#o# 2ails due to : impleasant side effects continuated bleeding lac: absorption in empty stomach g#i side effect

- need p#e administration 3utritional care - )bsorbable iron in food (non heme iron) liver :idney beef egg yol: dried fruits dried peas and beans nuts green leavy vegetables cercals

- biovailability of iron iron inta:e = absorption =stores - heme iron @ meat! fish! poultry ( 2() - ascorbic acid administration
2(-containing! high ascorbic acid +otal &ron (mg) %#B 7#0 7#$ 7#$ 7#% heme factor 7#07 heme iron (mg) $#$ non heme iron (mg) $#C 7#0 7#$ 7#$ 7#% ascorbic acid (mg) 7 $1 $ % %C

2ood Beef-vegetables ste' Beef! lean! coo:ed! 1 o< (6A g) (otatoes! D cup Carrots! % + 4nions! % + Ereen pepper! ra'! % slices

Breadstic:! % medium argarine % tsp (eaches! canned! D cup Eingerbread +otal )scorbic acid (0C mg) eat! fish! poultry coo:ed (6A g) F enhancing factors G$1$

7#1 7 7#0 $#7 A#1 H absorbable iron absorbable iron (mg) total absorbable iron (mg) $#$ %1H7 7#%A 7#A6

7#1 7 7#0 $#7 0#$ 6H7 7#11

trace 7 0 trace 0C

,ummary improve food choices to increase amount of total dietary iron food sources of vit#C food sources of 2( reduce non heme iron absorption avoid large amount of tea or coffee (contain tannin) avoid ;D+) (ethylendiamine tetra acetic acid)

Megal bla!tic anemia - disturbance syntesis of D3) - changes morphologic and functional of blood cells - caused by deficiency of vit# B$% and folic acid nucleoprotein - the depletion of folate stores (folate deficient diet)comes earlier ( % - 0 mths) than to vit B$% ( after several years) - clinical signs - anemia - laboratory findings - megaloblastic cells - macrocytic (pernicious anemia) the deficiency of vit B$% is commonly caused by a lac: of intrinsic factors (&2) @ except diet strict in vegetarians essential to the synthesis of

Diagnosis : - ,chilling test - radioactive vit B$% p#o# - urine B$% I - &#2 #p#o# I

3utritional case - i#m?s#c injection of vit B$% (A7-$77 mg?day) - high protein diet - green leavy vegetables liver meat egg yol: mil: e#t#c 4ther anemia caused by copper deficiency copper = protein ( ceruloplasmin) essential for the formation of haemoglobin (normali<ed the mobili<ation of iron! tissue--plasma) - protein deficiency in (; essential for the proper production of hb and rbc