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Nutritional Aspects of Management of Hematological Disorders in Older Adults - Chapter 10
 

Nutritional Aspects of Management of Hematological Disorders in Older Adults - Chapter 10

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Hematopoiesis

Hematopoiesis
Anemia
Hematological deficiencies
Iron deficiency anemia
Vitamin B12 deficiency
Anemia of Chronic Disease

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    Nutritional Aspects of Management of Hematological Disorders in Older Adults - Chapter 10 Nutritional Aspects of Management of Hematological Disorders in Older Adults - Chapter 10 Presentation Transcript

    • Nutritional Aspects of Managementof Hematological Disorders in OlderAdultsChapter 10
    • Introduction• Hematopoiesis• Anemia• Hematological deficiencies– Iron deficiency anemia– Vitamin B12 deficiency– Anemia of Chronic Disease
    • Physiology• Blood Components
    • Physiology• Red Blood Cell Production– Produced in the bone marrow– Committed progenitor cells– Adequate amounts of proteins, vitamins, andminerals required• B and T-Cells– Lymphoid stem cells• Myeloid Stem Cells
    • Physiology• Myeloid Stem Cells– Erythroid• Yields red blood cells• Folic acid and Vitamin B12 are required– Megakaryocytic– Phagocytic
    • The Aging Hematopoetic System• Decline in reserve capacity• Numerous age related changes– Determines effects of aging on organ function andlifespan– Cell division and cell differentiation are balancedby apoptosis
    • The Aging Hematopoetic System
    • Anemias in Elderly Persons• Prevalence increases with age– Normocytic anemia– Microcytic anemia– Megaloblastic anemia– Sideroblastic anemia• Anemia of Chronic Disease• Iron Deficiency Anemia• Can occur with slow blood loss
    • Anemias in Elderly Persons• Signs and Symptoms of Anemia– Fatigue is often the presenting symptom• Physical decline and loss of independence• Untreated anemia– Increased mortality and comorbidities
    • Anemias in the Elderly Persons• The Comprehensive Assessment– History and Physical• Physical indicators of anemia• Indication of protein and/or energymalnutrition• Weight change• Review of medications• Diet history or food records
    • Anemias in Elderly Persons• The Diagnosis– Complete Blood Count (CBC)– Other lab tests and assessments– Serum ferritin– Examples of CBC panels• Total Iron Binding Capacity or Transferrin– Evaluates iron status– Can be used to monitor nutrition trends
    • Iron Deficiency Anemia• Most common form of anemia worldwide• Iron stores increase with age– Body not able to eliminate excessive iron• Iron malabsorption• Advanced heart failure can cause IDA• Deficiency of Vitamin A may contribute to IDA
    • Iron Deficiency Anemia• Inhibitors of Iron Absorption– Various foods• Enhancers of Iron Absorption– Various foods– Host-mediated enhancers
    • Iron Deficiency Anemia• Stages to disease progressionInsel P, Turner RE, Ross D. Nutrition. 3rd ed.Sudbury, MA: Jones & Bartlett; 2007, p. 506.Reproduced with permission.
    • Iron Deficiency Anemia• Presentation of Iron Deficiency Anemia– Mild may be asymptomatic– More severe symptoms occur– Abnormalities– Confusion and mental disturbances• Laboratory Iron Tests– Numerous lab tests– Serum transferrin receptor test
    • Iron Deficiency Anemia• Management of Iron Deficiency Anemia– Determine and eliminate cause– Iron replacement therapy• If anemia is due to nutrition problems• Use of medication to treat• Increase intake of high (heme) iron foods• Parenteral iron• Iron-sucrose complex for predialysis patients
    • Iron Deficiency Anemia• Drug Interactions Associated with TreatmentSuccess and Potential Complications– Medications that decrease acidity may decreasethe absorption of iron• Take 2-3 hours apart from ironsupplementation• Vitamin C may increase iron absorption
    • Iron Overload• Hemosideran– How excess iron is stored in body tissues• Hemosiderosis– Tissue damage caused by excess iron stores– Deposits of iron accumulate within the organ• Lungs affected• Primary Hematochromotosis
    • Iron Overload• Primary Hematochromotosis– Hereditary disorder– Increased iron absorption from the GI tract anddeposition in tissue– Diagnosis based on serum iron status• Management of Iron Overload– Serial phlebotomies– Nutrition education
    • Iron Overload• Other Disorders– Alcoholic liver disease– Nonalcoholic steatohepatitis– Chronic hepatitis C infection
    • Anemia of Chronic Disease• Most common anemia in the older population– As it progresses it becomes microcytic andhypochromic– Iron stores are normal or increased– Labs show mild anemia– ACD developed from rheumatoid arthritis– Chronic renal failure• EPO therapy– Nutrition counseling
    • Megaloblastic Anemia-Vitamin B12and Folic Acid Deficiency• Megaloblastic anemia– Usually develops from vitamin B12 and folic aciddeficiency– Multiple causes– Potentially serious and can be deadly– Excessive folate may interfere with function ofB12– Deficiencies occur as a result of inadequatevitamin B12 or folic acid
    • Megaloblastic Anemia-Vitamin B12and Folic Acid Deficiency• Clinical presentations of two types of anemia– Vitamin B12 deficiency• Inadequate level of B12– Pernicious Anemia• Rare blood disorder• Inability of body to properly use B12– Signs are subtle– Eventually leads to ineffective hematopoiesis– Hyperhomocysteinemia
    • Megaloblastic Anemia-Vitamin B12and Folic Acid Deficiency• Pernicious Anemia– Inability to properly use B12– Develops slowly over 20-30 years– Result is ineffective erythropoiesis– Three types of PA• Congenital• Juvenile• Adult-onset
    • Megaloblastic Anemia-Vitamin B12and Folic Acid Deficiency• Pernicious Anemia– Cause: chronic atrophic gastritis and poor VitaminB12 absorption– Often associated with other autoimmunedisorders– Occurs primarily in adults older than 60– Treated with Vitamin B12
    • Megaloblastic Anemia-Vitamin B12and Folic Acid Deficiency• Pathology of Pernicious Anemia– Ineffective erythropoiesis in bone marrow– Macrocytes in blood circulation– Cell is normochromic– Premature cell death– Increase in LDH– Increase in indirect bilirubin
    • Megaloblastic Anemia-Vitamin B12and Folic Acid Deficiency• Diagnosis of Vitamin B12 deficiency andPernicious Anemia– Megaloblasts• Larger than normal RBCs and have small nuclei• Diminished levels of B12 accompanied– Increased homocysteine– Increased MMA
    • Megaloblastic Anemia-Vitamin B12and Folic Acid Deficiency• Management of Vitamin B12 Deficiency andPernicious Anemia– Lifelong administration of Vitamin B12• Injections• Nasal• Folic Acid Deficiency– Results from inadequate intake– Body stores from 4-6 months of folic acid
    • Megaloblastic Anemia-Vitamin B12and Folic Acid DeficiencyInsel P, Turner RE, Ross D. Nutrition. 3rd ed.Sudbury, MA: Jones & Bartlett; 2007, p. 442.Reproduced with permission.
    • Megaloblastic Anemia-Vitamin B12and Folic Acid Deficiency• Folic Acid Deficiency– Clinical Presentation• Results in neurological problems– Diagnosis• Confirmed by macrocytic RBCs andhypersegmented neutrophils– Management• medication
    • Myelodysplastic Syndromes:Sidroblasts and other Anemias• Group of stem cell disorders causing anemia• Most common hematologic cancers in olderadults• Sideroblastic Anemia– Presenting signs of myelodysplastic syndromes• Dominated by peripheral neuropathy anddermatitis– Diagnosis• Development is slow, asymptomatic• Anemia attributed to aging
    • Myelodysplastic Syndromes:Sidroblasts and other Anemias• Management– Prognosis is variable– Severe cases• Induce partial or complete remission• Minimize number of transfusions• Blood transfusions• Nutrition support as needed
    • Myelodysplastic Syndromes:Sidroblasts and other Anemias• Refractory Anemia– Disorder of the RBC lineage of cells• Thalassemia Minor– Most common in African, American Indian, andAsian populations– Causes microcytosis with or without anemia– No treatment is required– May benefit from a diet high in quality protein– Avoid multivitamin/minerals– Maintain adequate fluid intake
    • Vitamin and Mineral Considerations inHematologic Problems• Hyperhomocysteinemia– Abnormally large levels of homocysteine in theblood– Inherited as a defect in methionine metabolism orAcquired by Vitamin B6, B12, or folate deficiency• Vitamin C– Anemia will occur if vitamin C and iron intake arelow
    • Vitamin and Mineral Considerations inHematologic Problems• Vitamin B1 and B2– Thiamine can create a shortage of other B vitamins iftaken in excess– Riboflavin helps in the production of RBCs• Vitamin K– Necessary for the regulation of coagulation– Management is parenteral Vitamin K• Calcium– Absorption decreases with age– Calcium citrate effectively absorbed
    • Vitamin and Mineral Considerations inHematologic Problems• Copper– The “twin” to iron– Aids in the formation of Hb– Promotes absorption of iron from GI tract– A deficiency can prevent the release of iron fromstorage– Supplement copper to correct deficiency
    • Vitamin and Mineral Considerations inHematologic Problems• Zinc– Assists in linking oxygen to Hb– Vital to immune response– An important role in taste– Large amounts of phytate and fiber can depresszinc absorption
    • Protein Calorie Malnutrition• Common syndrome in older adults• Clinical manifestation relates to the durationof malnutrition• Stress-related malnutrition (kwashiorkor)• Compensated malnutrition (marasmus)• Nutrition objectives– Correct weight loss, provide adequate nutrients,correct dehydration, avoid refeeding
    • Conclusion• Assessment and treatment of anemia iscomplicated• Each type of anemia has its own impact onmetabolic process