Sandy Le

DIE 3213
Treatment of Nutritional Anemias
10/26/17

Complete this sheet bring to class and put in folder on Thursday (Worth 20 points)

Define and Describe Treatment of Nutritional Anemias (3pts)

1. Microcytic Anemias: Iron Deficiency and Functional Anemia

Definition- caused by impaired heme synthesis, as a result of an inability to absorb, transport, store, or
utilize iron. Impaired synthetic abilities from deficiencies of protein, iron, or ascorbate, vitamin A, pyridoxine,
copper, or manganese. Anemia means the abnormal blood constituents resulting from various etiologies.
Anemia is a symptom and is often a result of decrement in blood constituents, although some form of elevated
blood components that are non-functional may be referred to as an anemia. Microcytic means to an
abnormally small cell size.
Treatment- increasing nutrient iron needs by increasing the nutrient density of foods over the long term.
An intake of iron supplementation is another way a patient who has Microcytic Anemia can increase their iron.
Nutrition education regarding micronutrient density and sufficiency is also important.

2. Megaloblastic Anemias
Definition- characterized by red blood cells (RBCs) that have a decreased capacity for oxygen transfer
and are large, irregular, and immature. These cells are found both in marrow and in circulation. This type of
anemia is often observed with deficiencies of both folate and vitamin B12. Megaloblastic means an abnormal,
immature, large red blood cell that is oval in shape.
Treatment- oral crystalline cyanocobalamin and supplemental folate should be administered. Parenteral
administration of vitamin B12 alone or in conjunction with other B vitamins is recommended. Patients may be
monitored by measuring the numbers of immature red blood cells, which are an indication of the patients
response to vitamin therapy.

3. Hemochromatosis
Definition- iron overload is a condition in which a number of regulatory mechanisms for iron are
inoperative. Elevated levels of iron that can cause tissue damage, especially in the liver.
Treatment- routine phlebotomy is a primary treatment for hemochromatosis. Removal of 500 mm of
blood, containing 250 mg of iron, is performed once a week until laboratory measures are normalized; then the
phlebotomy is individualized based on consistent testing. An iron chelator such as deferoxamine may also be
administered, but due to poor absorption, it must be infused or injected. Deferiprone, deferasirox. Deferitrin,
and combination thereof can be orally administered. Alternate methods include proton pump inhibitors to
suppress absorptions of dietary non-heme iron and black tea tannin isolates to reduce iron absorption from the
gut.

Define and Explain Nutrition Therapy of Hemoglobinopathies: Non-Nutritional Anemias (7pts)

1. Sickle Cell Anemia- a heredity disease of genetically altered red blood cells that have a sickle cell
shape, carry abnormally formed hemoglobin, and have abnormal transport capabilities for oxygen. The
disease is thought to confer protection against malaria.
Nutrition Therapy- increase macronutrients. Optimize mineral intake. Improve antioxidant
status. Ensure fluid adequacy and nutrient density.

2. Thalassemia- a group of related blood disorders involving abnormal globin subunits in the hemoglobin
molecule; these are hereditary and are most common in persons of Mediterranean or southeastern Asian
descent.
 Nutrition Therapy- ascorbate administration, antioxidant administration, ensure nutritional
adequacy.

3. Polycythemia- an increase in circulation RBCs, polycythemia can be spurious or real. Spurious

polycythemia refers to an apparent increase in RBCs per deciliter of blood that is related to decrease
plasma volumes; real polycythemia is a result of dysregulated feedback and increased production of red
blood cells by marrow, usually detected by abnormal epoetin levels.
Nutrition Therapy- increase dietary iron. Ensure nutrient density.

4. Hemolytic Anemia- an anemia brought on by rapid, premature destruction of red blood cells in
circulation, which may be precipitated by vitamin E deficiency.
Nutrition Therapy- iron, folate, and protein supplementation.

5. Anemia of Prematurity- anemia seen in premature infants is usually related to low levels of
erythropoietin due to underdeveloped kidneys and failure of feedback mechanisms for erythropoiesis.
Nutrition Therapy- vitamin E supplementation. Ensure appropriate infant feeding practices.

6. Aplastic Anemia- also known as Fanconis anemia. It is the result of marrow failure and is inherited.
Fanconi cells of the marrow have abnormal oxygen metabolism cycles.
Nutrition Therapy- ensure nutrient density. Maintenance of normal fluid and electrolytic status,
particularly sodium, with corticosteroid and immunosuppressive treatment. Maintenance of adequate
macro- and micronutrient status. Monitor calcium and vitamin D.

7. Hypochromic Microcytic Transient Anemia (Sports Anemia)- hypochromic means abnormally pale
in color upon inspection under a microscope. Microcytic means to an abnormally small cell size.
Transient means temporary. Anemia means the abnormal blood constituents resulting from various
etiologies. Anemia is a symptom and is often a result of decrement in blood constituents, although some
form of elevated blood components that are non-functional may be referred to as an anemia.

Define and Explain Nutrition Therapy of Clotting and Bleeding Disorders (2pts)
1. Hemophilia- an inherited disorder of blood clotting with pronounced bleeding upon tissue injury.
Nutrition Therapy- maintain nutritional adequacy. Ensure antioxidant adequacy.

2. Hemorrhagic Disease of the Newborn- characterized by clotting the deficiencies due to insufficient
amounts of vitamin K available to the neonate.
Nutrition Therapy- maintain optimal feeding practices for young infants.

Fill in the following Table:

Dietary Reference Intakes (DRI) for Select Micronutrients Involved in Hematopoiesis (4pts)

Life Stage Folate B12 g/d Iron mg/d (RDA) Vitamin K

g/d (RDA) g/d (AI)
(RDA)
0-6 months M= 65mcg M= 0.4mcg M= 0.27mg M= 2.0mcg
F= 65mcg F= 0.4mcg F= 0.27mg F= 2.0mcg
7-12 months M= 60mcg M= 0.5mcg M= 11mg M= 2.5mcg
F= 80mcg F= 0.5mcg F= 11mg F= 2.5mcg
 1-3 years M= M= 0.9mcg M= 7mg M= 30mcg
150mcg F= 0.9mcg F= 7mg F= 30mcg
F= 150mcg
4-8 years M= M= 1.2mcg M= 10mg M= 55mcg
200mcg F= 1.2mcg F= 10mg F= 55mcg
F= 200mcg
9-13 years M= M= 1.8mcg M= 8mg M= 60mcg
300mcg F= 1.8mcg F= 8mg F= 60mcg
F=300mcg
14-18 years M= M= 2.4mcg Males 11mg M= 75mcg
400mcg F= 2.4mcg Females 15mg F= 75mcg
F= 400mcg
19-70 years M= M= 2.4mcg Males 8mg Males 120mcg
400mcg F= 2.4mcg Pre-menopausal Females
F= 400mcg Females 10mg 90mcg
Post-menopausal
Females 9mg
Pregnancy >18 600mcg 2.6mcg 27mg 90mcg
years
Lactation > 18 500mcg 2.8mcg 9mg 90mcg
years

For the following scenario write 1 PES statement with a goal and at least 2 interventions: Make
sure it is a smart goal and interventions relate to goal (4pt)

Dana is a 30-year-old mother of a 2-year-old and is now planning to become pregnant with her
second child. Struggling to lose the last 10 pounds from her first pregnancy, her diet of choice over
this past year has been a version of the low-carbohydrate diet. Dana's food intake lacks variety and
balance. She is low on fruits, vegetables, and grains. She complains of diarrhea, loss of appetite,
weakness, and irritability. Her blood work reveals a normal hemoglobin level but a low serum folate
level. She has scheduled an appointment to see you.

PES: Weakness related to a lack of variety and balance of food intake as evidence by low serum folate
level.

Goal: The patient will have a two-week meal plan to get her serum folate level back into normal
range.

Interventions
1. The patient will be educated and counseled about daily recommended intakes during
pregnancy.
2. The patient will record her food intake in her food journal for the next two-weeks.