ANEMIA

Kylie Leeper, Melissa Saka,

Cathlin Ongkowidjojo, Alice
Huynh

Pathophysiology
Production of RBC:
Kidney
Erythropoietin hormone (EPO)
Bone Marrow
Hematopoietic stem cell
Formation of immature RBC (erythroblast)
Maturation of RBC 120 day life
Reticulocyte: young immature RBC

Anemia
Having too few RBC
Two categories:
Underproduction of RBCs
Decreased bone marrow activity
Reticulocyte count <3%
Destruction of RBCs
Increase bone marrow activity
Reticulocyte count >3%

Underproduction of RBCs
Macrocytic Anemia
Caused by shortage of DNA precursors
MCV >100 m3
Microcytic Anemia
Caused by decreased hemoglobin
MCV < 80 m3
Normocytic Anemia
Everything else
MCV 80-100 m3

Non-nutritional Anemia
Caused by:
Abnormal bleeding from injury, non-injury
bleeding (menstrual, hemorrhoids, stomach
ulcers, cancers)
Genetics
Disease or disease treatment

Nutritional Anemia
Anemia: A condition in which there is low number
of red blood cells circulating in the body
Nutritional anemia stems from a diet deficient in:
Iron
Folate
Vitamin B12

Nutritional Anemia
Types of nutritional anemia:
1. Iron Deficiency Anemia
2. Pernicious Anemia (B12 deficiency Anemia)
3. Folate Deficiency Anemia
- Megaloblastic

Iron Deficiency Anemia

Most common form of nutritional anemia
Due to insufficient iron
Red blood cells are microcytic (small) and
hypochromic (pale) due to low hemoglobin
content

Who is at Risk?
Premature and low-birth-weight babies
Infants and young children
Pregnant women
Vegetarians

Complications
Heart complications
Rapid/irregular heartbeat
Pregnancy complications
Iron deficiency linked to low-birth-weight and
premature birth
Growth complications
Delayed growth and development

Causes
Lack of iron
Blood loss
Lack of dietary iron
Necessary for growth and development during
times of growth and development (pregnancy
and childhood)

Causes
Inability to absorb iron
Intestinal surgery: gastric bypass
Disease of intestine: Crohns disease or celiac
disease

Symptoms
Extreme fatigue
Shortness of breath
Dizziness
Headache
Coldness of hands and
feet
Pale skin
Brittle nails
Cracks on the sides of
the mouth

In infants and young

children:
Poor appetite
Slowed growth and
development
Behavioral problems

Treatment
Ferrous Sulfate or Iron supplementation
If possible, take on empty stomach (may cause
nausea)
Dont take with antacids, they may interfere with
absorption
Vitamin C helps absorption
Antibiotics and other medications
Used to treat peptic ulcers
Surgery
To remove bleeding polyp, tumor, or fibroid

Prevention
Eat a well-balanced diet that includes iron-rich
foods!
Iron Supplement
In moderation!
Women of childbearing age may be tested for iron
deficiency anemia

Sources of Iron
Iron-rich Foods
Red meat
Pork
Poultry
Seafood
Beans
Green, Leafy Vegetables (Spinach)
Dried Fruit (Raisins, Apricots)
Iron-fortified bread, cereal, pasta
Peas

Pernicious Anemia
Vitamin B12 deficiency
Type of macrocytic anemia
May become megaloblastic anemia
Characterized by atrophic gastritis, parietal cell
loss, and lack of intrinsic factor only.

Who is at risk?
Northern European and African descent
Older people
Family history
Stomach/small intestine surgery
Autoimmune disease involved endocrine glands
Strict vegetarianism

Causes
Loss of ability to absorb
Most common underlying cause
Atrophic gastritis
Lack of intrinsic factor
May be considered end stage immune gastritis
type A gastritis
Genetic factor may be involved

Symptoms
Symptoms are insidious
Signs and symptoms due to anemia itself
Fatigue
Depression
Low-grade fevers
Jaundice
Glossitis
Look of exhaustion
PA may also affect the nervous system
Memory changes
Difficulty walking
Unsteady gait
Muscle weakness
Clumsiness

Complications
Children
Delayed physical growth
For adolescents
Delay in puberty
Brain and nervous system
Neurological issues
Likely to develop gastric cancer
People without the ability to absorb vitamin B12
Life-long disorder

Treatment
Replacement of Vitamin B12 stores
Injections of B12
High-dose B12 supplements

Sources of Vitamin B12

Sardines
Salmon
Tuna
Cod
Lamb
Scallops
Shrimp
Beef
Yogurt
Cows milk

Folate Deficiency Anemia

Type of macrocytic anemia
May become megaloblastic
Due to poor absorption or inadequate amounts of
folic acid

Causes
Lack of folic acid in the diet
Body is unable to absorb folate
Other illness

Who is at Risk?
Those who dont eat a healthy diet
Alcoholics
Pregnant women
Certain medications taken for seizures,
rheumatoid arthritis, or cancer
If your body cant properly absorb folate
Those with celiac disease

Symptoms
Pale skin
Decreased appetite
Tingling in feet and hands
Irritability
Lack of energy
Growth problems
Diarrhea
Smooth tender tongue

Treatment
Vitamin/Mineral supplements of folic acid for 2 to
4 months
Change in diet
Treatment of underlying disease

Complications
Pregnancy complications
Neural tube birth defects
Megaloblastic anemia
Low white blood cells and platelets

Sources of Folate
Green leafy vegetables
Fresh fruit
Cereals
Meats
Liver
Yeast

Diagnosis
Inadequate vitamin intake (specifically folate and
B12)
Imbalance of nutrients
Altered nutrition-related lab values

Diagnostic Tests
Complete Blood Count (CBC)
- Tests hemoglobin and hematocrit levels, WBC,
RBC and platelets
Mean Corpuscular Volume (MCV)
- Measures size of RBC
Hemoglobin Electrophoresis
- Tests different types of hemoglobin in blood
Reticulocyte count
- Measures # of young RBC in blood

Diagnosis Tests
Serum iron, serum ferritin, total iron-binding
capacity (Specific to iron deficiency anemia)
- Tests iron levels in body
Schilling test Sspecific to pernicious anemia)
4-stage test used to determine bodys ability to
absorb Vitamin B12
Serum Folate Test/RBC folate level (Specific to
folate deficiency anemia)
Tests folate levels

Diagnosis Test
Plasma/Urine Homocysteine (Specific to
pernicious and folate deficiency anemia)
Elevated levels of homocysteine
Methylmalonic acid (MMA) test (Specific to
pernicious anemia)
Bone marrow tests (RARE)
Examine the development of RBC

Diagnostic Tests

Additional test may be considered for conditions

such as:
Kidney failure
Lead poisoning (in children)
Vitamin deficiencies (B12 and folic acid)

Medical or Surgical Treatments

Blood Transfusions

PES Statements
Limited access to food R/T subsistence farming
and use of high-phytate, arid-tolerant crops AEB
limited consumption of animal sources of protein
and bioavailable iron.
Food and nutrition knowledge deficit R/T family
not using the government-supplied iron
supplements AEB history indicating that an oral
explanation for supplement use was not provided
and head of household has limited reading ability

PES Statements
Altered nutrition-related laboratory values RT
inadequate vitamin B12 intake secondary to longstanding vegan vegetarianism without
incorporation of fortified foodstuffs AEB
holotranscobalamin II lab values below normal
with no observable absorptive abnormalities and
normal MMA results.

Multiple Choice Questions:

What is the most common type of anemia?
A. Iron deficiency anemia
B. Folate deficiency anemia
C. Pernicious anemia
D. Megaloblastic anemia

Answers
What is the most common type of anemia?
A. Iron deficiency anemia
B. Folate deficiency anemia
C. Pernicious anemia
D. Megaloblastic anemia

Multiple Choice Questions:

Which deficiencies can lead to megaloblastic
anemia?
A. Vitamin C and Iron
B. B12 and Vitamin C
C. B12 and Folate
D. Iron and Vitamin E

Answers
Which deficiencies can lead to megaloblastic
anemia?
A. Vitamin C and Iron
B. B12 and Vitamin C
C. B12 and Folate
D. Iron and Vitamin E

Multiple Choice Questions:

What illnesses lead to anemia?
A. Celiac
B. Crohns
C. Fractures
D. A and B

Answers
What can lead to a nutritional anemia?
A. Celiac
B. Crohns
C. Fractures
D. A and B

Works Cited
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