hematological system knh 413 the composition of blood looking at the severity of it
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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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