Nutritional Anaemia

1. PREPARED BY
MILAN DHAKAL
Nutritional Anaemia
6/21/2020Nutritional Anaemia

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.
6/21/2020
2
Nutritional Anaemia

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.
6/21/2020
3
Nutritional Anaemia

4. Nutritional requirement for the formation of RBC
 Iron for Hb synthesis
 Vitamin B12 and folate for normal DNA synthesis
 Other vitamines – B6(pyridoxine), thiamin,
riboflavin and vitamins C & E
 Trace metals such as cobalt
6/21/2020
4
Nutritional Anaemia

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
6/21/2020
5
Nutritional Anaemia

6. 6/21/2020Nutritional Anaemia 6

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 B12
 RBCs irregular in shape and size, usally larger than normal
 Aka orthochromic macrocytic anaemia.
iii. Dimorphic :-
 If both iron and folate or vitamin B12 are deficient it give rise
to hypochromic macrocytic or dimorphic anaemia.
6/21/2020
7
Nutritional Anaemia

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 requirementsof iron
e. Inadequate absorption of iron
6/21/2020
8
Nutritional Anaemia

9. Cut-off points for haemoglobin values for diagnosis of
anaemia:-
Group Hb g/dl
Adult men >13
Adult women >12
Pregnant women >11
Lactating women >12
Children till 5 yrs >11
Children 5-11 yrs >11.5
Children 12- 13 yrs >12
Other children >12
6/21/2020
9
Nutritional Anaemia

10. Clinical findings
A. Immunocompetence
 Decreased no. Of T-cells and production of antibodies.
B. Diminished work performance
C. Cognitive development
o Fe 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 koilonychia may appear
• Mouth changes include atrophy of lingual papillae, glossitis,
angular stomatitis and dysphagia.
6/21/2020
10
Nutritional Anaemia

11. 6/21/2020Nutritional Anaemia 11
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.
6/21/2020
12
Nutritional Anaemia

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.
6/21/2020
13
Nutritional Anaemia

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
6/21/2020
14
Nutritional Anaemia

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 btwn 45-65 yrs
• Affects females more than males
6/21/2020
15
Nutritional Anaemia

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
6/21/2020
16
Nutritional Anaemia

17.  If Hb < 4g/dl blood transfusion should be given.
 Hydroxocobalamin should be given in a dosage
of 1000 mcg intramuscularly twice during 1st
week then 250 mcg until blood count is normal
 Then 1000mcg every six week
Treatment
6/21/2020
17
Nutritional Anaemia

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
6/21/2020
18
Nutritional Anaemia

19. Folate deficiency
 Common in 20-30 yrs
Aetiology
 Poor dietary intake
 Low absorption
 Increased requirements
 Infestation and infection
 Drugs
6/21/2020
19
Nutritional Anaemia

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.
6/21/2020
20
Nutritional Anaemia

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,greenleafy vegetables,cluster
beans,ladiesfinger,gingelly diet seeds,liver
and eggs should be included in the diet.
6/21/2020
21
Nutritional Anaemia

22. Prevention
1. Diet
 Balanced diet rich in protein, vitamin and minerals
should be consumed.
2. Supplementation
 Expectant and nurshing mother 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.
6/21/2020
22
Nutritional Anaemia

23. Contd…..
3. Education
 Promotion of consumption of pulses, green leafy vegetables
and meat products – rich in bioavailable iron,particularly
by pregnant and lactating mother.
 Addition of iron richfoods to 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.
6/21/2020
23
Nutritional Anaemia

24. Thank you !!!
6/21/2020
24
Nutritional Anaemia