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ANEMIA
Dr. Naveed Akthar
NUTRITIONAL ANEMIA
ANEMIA IS
NEVER
NORMAL
NUTRITIONAL ANEMIA
Anemia is the most common Nutritional
Disorder.
Nutritional anemiarefers to a type
ofanemiathat can be directly attributed
to nutritional causes.
Iron deficiency Anemia is the most
common and widespread form of Anemia
accounting for about 95% of anemia cases.
Who is Aneamic ?
why
Causes of Anemia
Decreased
Increased
Red
Red
Nutritional anaemia
reduced
Iron deficiency
Other deficiencies
Copper deficiency anemia
protein-energy malnutrition Anemia
Sideroblastic (pyridoxine-responsive) anemia
Vitamin Eresponsive (hemolytic) anemia
Increased demand
Pregnancy
Decreased absorption
Poor intake
tachypnea
Pallor, Jaundice
Murmur
Koilonychia or Spoon nails
Splenomegaly, lymphadenopathy
Petechiae, ecchymoses
Atrophy of tongue papillae
Daily Iron
Requirements(mg/day)
Age (years)
Male
Female
0 - 0.5 -----------6
6
0.5 - 10 -----------10
10
11 18 -----------12
15
19 -- 50 ---------- 10
15
50+---------- 10
10
Pregnant
30
Lactating 15
Sources of Iron
Haem iron
Fish, meat and chicken
Non-haem iron
vegetables cereals,
beans
and grains
When iron storage is full in body, it
automatically reduces the further iron
absorption
Liver reduces apotransferrin formation
Transferrin decrease release of iron so
that, transferrin is completely saturated
with iron and further absorption is
prevented.
Iron
haem iron : not affected by ingestion of
other food items.
non-haem iron Inhibitors :
Food
with
polyphenol
compounds;
oats
Iron
Absorption
Loss of iron
In
In
females,About 50 ml of blood is
lost during menstruation and it
contains about 25 mg of iron.
Lab results
Decreased
serum iron
Increased TIBC
Decreased serum ferritin levels
-Reflect iron stores.
Decreased transferrin saturation
Micro, Hypo, Aniso, target cells and
pencil cells
Microscopy/Morphology
Microcytosis
Hypochromia
Anisocytosis
Target cells
Pencil cells
Reactive thrombocytosis
Microscopy/Morphology
Treatment
Iron
supplementation therapy
Oral
and
i/v
Part -2
MEGALOBLASTIC ANEMIA
Dr. Naveed Akhtar
MEGALOBLASTIC
ANEMIA
Requirements for Red Blood Cell
Production
Erythropoeitin
Proteins, required for globin synthesis
Iron
Vitamin B12 and folic acid
Vitamin B6
Vitamin C
Thyroid hormones, estrogens and
androgens
MEGALOBLASTIC
ANEMIA
Megaloblastic Anemia is a
condition in which the
bone marrow produces
unusually large,
structurally
abnormal, immature red
blood cells (megaloblasts).
Myeloid
Results of Megaloblastic
Anemia
Megaloblastosis can be associated with
severe anemia
pancytopenia
gastrointestinal dysfunction
glossitis
personality changes
psychosis, and
neurological disorders.
Types of Megaloblastic
Anemia
Vitamin
Folic
B12 deficiency
Acid deficiency
VitaminB12
or Cobalamin is
coenzyme in the body
Pernicious anemia
Autoimmune
Pernicious anemia
Vitiligo
1-Oral
Schilling Test
0 - 10
3.6g /kg
> 10
3g /kg
Pregnants 500 g
Lactation
+100 g
Diet contains 100 - 500 g folate/day.
Symptoms
Numbness
and
tingling in the hands
and feet.
Diarrhea or
constipation
Muscle weakness.
Irritability.
Memory loss.
Dementia.
Depression.
Psychosis.
grey hair
Weakness, tiredness, or
light-headedness
Rapid heartbeat and
breathing
Pale skin
Sore tongue
Easy bruising or bleeding,
including bleeding gums
Stomach upset and
weight loss
Lab tests
Blood Film
Hypersegmented nuclei ("senile neutrophil").
Anisocytosis (increased variation in RBC size)
and
poikilocytosis (abnormally shaped RBCs).
Macrocytes (larger than normal RBCs) are
present.
Ovalocytes macrocytes (oval-shaped RBCs) are
present.
Howell-Jolly bodies (chromosomal remnant) also
present.
Blood chemisty
increased LDH level. is LDH-2 more
specific.
Holotranscobalamin (HoloTC), the
active fraction of plasma cobalamin
Increased homocysteine and
methylmalonic acid in Vit. B12 deficiency
Increased homocysteine in folate
deficiency
Bone marrow shows megaloblastic
hyperplasia.
Bone Marrow
Bone marrow shows
megaloblastic hyperplasia.
Erythroid hyperplasia
nuclear-cytoplasmic
asynchrony.
Giant Myelo and
Metamyelcytes
bands and hypersegmented
polymorphonuclear neutrophils
Bone Marrow
Special tests
Give
Thank You