Nutrition in immunology and hematology.pptx

Anemia:
Deficiency in the size, or the number of erythrocytes, or the amount of hemoglobin which restrict oxygen and carbon dioxide exchange between the blood and tissues
Most anemia are caused by a lack of nutrients needed to synthesize normal erythrocytes, principally:
Iron
Vitamin B12
Folate
Nutritional anemia may be caused by inadequate intake of:
Iron
Protein
Certain vitamins: B12, folate, pyridoxine, vitamin C
Copper and other heavy metals

1. Nutritional Anemia Aminuddin Department of Nutrition Faculty of Medicine University of Hasanuddin

2. Nutritional anemia

3. What is nutritional anemia? Anemia: Deficiency in the size, or the number of erythrocytes, or the amount of hemoglobin which restrict oxygen and carbon dioxide exchange between the blood and tissues Most anemia are caused by a lack of nutrients needed to synthesize normal erythrocytes, principally: Iron Vitamin B12 Folate Nutritional anemia may be caused by inadequate intake of: Iron Protein Certain vitamins: B12, folate, pyridoxine, vitamin C Copper and other heavy metals

4. Iron deficiency anemia Most common form of nutritional anemia Microcytic hypochromic anemia Causes: poor/inadequate iron intake e.g. vegetarian diet, poor iron content of diet Inadequate iron absorption: diarrhea, partial or total gastrectomy Inadequate use due to chronic intestinal problems Increased requirement due to growth of blood volume e.g. infancy, adolescent, pregnancy, lactation Increased excretion e.g. menstrual blood, chronic bleeding Defective release of iron stores into the plasma and defective iron use due to chronic inflammation other chronic disorders

5. Clinical findings Hb concentration below normal  late sign

6. Nutritional anemia laboratory data work-up Complete blood count: MCV: Microcytic: <80 fl Normocytic: 80-99 fl Macrocytic: >100 fl MCH MCHC Hematocrit , Hb concentration, erythrocyte count WBC differential count Sensitivity and specificity low for differentiating nutritional and nutritional anemia

7. Stopler T: Medical Nutrition Therapy for Anemia in Mahan LK, Escott-Stump S Krause s Food and Nutrition Therapy

8. Serum iron Amount of circulating iron bound to transferrin Poor index of iron status Large day to day changes Diurnal variation: highest at 6-10 AM, lowest midafternoon Transferrin and TIBC Transferrin and TIBC increases in iron def. anemia Transferrin saturation < 16% in iron def. anemia Nutritional anemia laboratory data work-up Normal values can persist until late stages Can not detect pre-anemic iron def. and iron store depletion

9. Ferritin iron storage protein in RE: liver, spleen, bone marrow Some leak into the blood people with normal iron store: 1 ng/ml serum ferritin represents 8 mg of stored iron Serum ferritin is an excellent indicator for iron body store Acute-phase reactant protein: inflammation, infection, cancer, lymphoma can increase the concentration Serum transferrin receptor test Not affected by inflammation Increases in cellular iron depletion Serum levels excellent indicator for iron def. anemia in inflammatory background Nutritional anemia laboratory data work-up

10. Stopler T: Medical Nutrition Therapy for Anemia in Mahan LK, Escott-Stump S Krause s Food and Nutrition Therapy

11. Medical and Nutrition interventions Iron supplement to restore body iron store Adult: 50-200 mg elemental iron/day Children: 6 mg/ kgbw elemental iron/day Iron supplementation continued for 4-5 month even after Hb level restoration Consumption a good source of iron in the diet Liver, kidney, beef, dried fruits, dried peas and beans, nuts, green leafy vegetables, Iron absorption should be at least 1.8 mg/day for most adult male and female Iron bioavailability is most important determinant in absorption AKG untuk zat Besi Ferro sulfate: elemental iron 65 mg

12. Iron bioavailability The lower the iron store, more absorption of dietary iron Iron def anemia individuals absorbs 20-30% of dietary iron Individuals with no iron def anemia absorb only 5-10% dietary iron Form of dietary iron Heme iron: more efficient (15% absorbed) e.g. meat, fish, poultry Non heme iron: 3-8% absorption Increased with added vit . C Increased with consumption with heme iron source Inhibition of iron absorption: Carbonates, oxalate, phosphate, and phytate (unleavened bread, unrefined cereals, soybeans) Vegetable fiber inhibits non heme iron Meals with tea, coffee, can reduce 50% of iron absorption

13. Strategies to maximize iron absorption and to prevent iron deficiency anemia Better food choices to increase total iron intake Include source of vitamin C in every meals Include meat, fish, poultry at every meals if possible Avoid drinking large amount of tea, coffee, with meals

14. Megaloblastic anemia Caused by deficiency of Folic acid and or vitamin B12 Macrocytic hypochromic anemia  late stages If both folate and vitamin B12 occur at the same timefolate supplementation can mask vit B12 deficiency irreversible neuropsychiatric damage

15. Pernicious anemia Deficiency of vitamin B12 Most commonly secondary to intrinsic factor deficiency It affects not only blood but also gastrointestinal tract, peripheral and central nervous systems

16. Clinical findings Overt symptoms Inadequate myelination of nerves Parastehesia in hand and feet Poor sense of vibration and position Poor muscle coordination Poor memory Hallucination If prolonged, these neuropsychiatric symptoms will be irreversible

17. D iagnosis Serum vitamin B12 Unsaturated B12 binding capacity IFAB Schilling test dU suppression test Homocystein and methonin level

18. Medical and Nutrition T herapy Intramuscular or subcutaneous injection of 100 ug of vitamin B12 once per week Very large doses of oral vitamin B12 (1000ug) is also effective High protein diet (1.5 g/ kgbw ) Consume more liver, beef, eggs, and milk and its products

19. Folic acid deficiency anemia It is associated with tropical sprue Can affect pregnant women It can occur in infants born to mother with folic acid deficiency Folic acid deficiency at early pregnancy can result in neural tube defect

20. Clinical findings Fatigue Dyspnoe Sore tongue Diarrhea Irritability Forgetfullness Anorexia Glossitis Weight loss

21. D iagnosis Serum folate :< 3 ng /ml RBC folate : < 140-160ng/ml

22. Medical N utrition T herapy 1 mg folate taken daily for 2-3 weeks Maintenance: oral intake 50-100ug daily Eat at least one fresh fruit, vegetables, or fruit juice daily e.g. a cup of orange juice: 135 ug folic acid

23. Other forms of nutritional anemia Copper deficiency anemia Anemia of PEM Sideroblastic Anemia