Nutritional anaemia

Nutritional Anaemia

1. PREPARED BY
MILAN DHAKAL
Nutritional Anaemia
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2. Defination of Anaemia
The condition that results from the inability of the
erythropoietic tissue to maintain normal haemoglobin
concentration on account of inadequate supply of one
or more nutrients leading to reduction in the total
circulating haemoglobin.
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3. Causes of Anaemia
By the absence of any dietary essential that is
involved in haemoglobin formation or by poor
absorption of these dietary essentials.
By lack of dietary iron or high quality protein.
By lack of vitamin B6, vitamin C , Vitamin E.
By lack of copper.
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4. Nutritional requirement for the formation of RBC
Iron for Hbsynthesis
Vitamin B12 and folatefor normal DNA synthesis
Other vitamines–B6(pyridoxine), thiamin,
riboflavin and vitamins C & E
Trace metals such as cobalt
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5. Prevalance
According to WHO
Worldwide prevalance = abt 30%
Higher rates in developing countries
40% in young children
50% of pregnant women and 35% of non-pregnant
women affected
18%adult males
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7. Types of Anaemia
i.Hypochromic and microcytic:-
Insufficiency of iron for haemoglobin formation
RBCs are pale and small.
ii.Megaloblastic :-
deficiency of folate and vitamin B
12
RBCs irregular in shape and size, usally larger than normal
Aka orthochromic macrocytic anaemia.
iii.Dimorphic :-
If both iron and folate or vitamin B
12are deficient it give rise
to hypochromic macrocytic or dimorphic anaemia.
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8. Iron Deficiency Anaemia
Most common form of anaemia
Mainly women of reproductive age , infants
and children are affected
Aetiology
a.Inadequate iron intake
b.Inadequate utilization of iron
c.Blood losses
d.Increased requirementsofiron
e.Inadequate absorption of iron
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9. Cut-off points for haemoglobin values for diagnosis of
anaemia:-
Group Hbg/dl
Adult men >13
Adult women >12
Pregnant women >11
Lactating women >12
Children till 5 yrs >11
Children 5-11yrs >11.5
Children 12-13 yrs >12
Other children >12
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10. Clinical findings
A.Immunocompetence
Decreased no. Of T-cells and production of antibodies.
B. Diminished work performance
C. Cognitive development
oFe deficient young adolescent have been shown to score relatively
lower in test.
D.Behavioural implications
E.Structure and function of epithelial tissues
•Mostly tongue, nails, mouth, and stomach are affected
•Pale skin
•Nails can become thin and flat and koilonychiamay appear
•Mouth changes include atrophy of lingual papillae, glossitis,
angular stomatitisand dysphagia.
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Koilonchiya

12. Treatment
̶Oral administration of inorganic iron in the ferrous
form –ferrous sulphate 50-200 mg 3 times daily for
adults and 6mg/kg for children.
̶Iron is best absorbed when stomach is empty but it
tends to cause gastric irritation.
̶Gastrointestinal side effects can be minimized by
increasing dose slowly until the requirement is
reached and by giving iron in divided doses at least 3
times/day.
̶Use of chelated form of iron can improve absorption.
̶Ascorbic acid helps in Fe absorption.
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13. Megaloblastic Anaemia
DNA synthesis is intense in haemopoietic tissue.
Vit B12 and folate are essential for DNA synthesis
are.
Deficiency of one or both causes disordered cell
proliferation.
Morphological changes appear in marrow cells.
Cells appear abnormally large.
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14. Vitamin B12 deficiency/pernicious anaemia
Inability to produce IF results prenicious anaemia
RBC count is often <2.5 million and large proportion of
cells are macrocytic
Occurs mainly in middle aged and elderly person and may
be genetic
Arises as autoimmune disease as antibodies against gastric
mucosa can probably be responsible for destroying
mechanism of producing IF
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15. Causes of pernicious anaemia
1.Inadequate ingestion
Vegans are susceptible for B12 deficiency
Chronic alcoholism, poverty, religious taboos and
dietary fads can also cause B12 deficiency.
2.Inadequate absorption and utilization of B12
3.Inadequate utilization due to presence of B12
antagonists
4.Increased requirements
Prevalance
•Rare before age of 30
•Occurs mainly btwn45-65 yrs
•Affects females more than males
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16. Clinical features
Patients have lemon yellow or pale skin
Anorexia, glossitis, achlorhydria, abdominal discomfort,
frequent diarrhoea, weight loss, general weakness
Hb may be < 8%
Numbness of limbs, coldness of extremities and difficulty in
walking
Gastric secretions are devoid of pepsin, acid and IF
Diagnosis
Age of patient
Plasma B12 < 160 ng/l while plasma folate is normal
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17. If Hb < 4g/dl blood transfusion should be given.
Hydroxocobalamin should be given in a dosage
of 1000 mcg intramuscularly twice during 1
st
week then 250 mcg until blood count is normal
Then 1000mcg every six week
Treatment
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18. Dietary consideration
High protein diet of 100-150 g protein with high
calorie
Moderate fat
Fried foods avoided
Soft or clear diet preferable until glositis completely
disappears
Avoid spicy food
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19. Folate deficiency
Common in 20-30 yrs
Aetiology
Poor dietary intake
Low absorption
Increased requirements
Infestation and infection
Drugs
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20. Diagnosis
•Hb level may be <4g/dl.
•Glossitis is often present.
•Paraesthesia is a common complaint.
•Plasma folate <3ng/ml.
•Free Hcl in gastric juice.
•Increased serum homocysteine level.
•Formimino glutamic acid excretion test in urine
is a test of folic acid deficiency.
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21. How to treat??
•Folic acid in dose of 5-10mg daily is
effective
•Patient with haemoglobin<5g/dl need
blood transfusion.
Dietary consideration
•Foods rich in folic acid like
pulses,greenleafyvegetables,cluster
beans,ladiesfinger,gingellydiet seeds,liver
and eggs should be included in the diet.
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22. Prevention
1.Diet
Balanced diet rich in protein, vitamin and minerals
should be consumed.
2. Supplementation
Expectant and nurshingmother are given 6omg of
elemental iron and 0.5mg of folic acid.
Children in the age group 1-5 yrs are given 20mg of
elemental iron and 0.1mg of folic acid.
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23. Contd…..
3. Education
Promotion of consumption of pulses, green leafy vegetables
and meat products –rich in bioavailableiron,particularly
by pregnant and lactating mother.
Addition of iron richfoodsto the weaning foods of infants.
Promotion of home gardening to increase the availability of
common iron rich food such as green leafy vegetables.
4. Fortification
Fortification of a commonly consumed food item with iron
has been considered as one of the practical approaches for
the prevention and control of iron deficiency anaemia.
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24. Thank you !!!
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