Nutritional Anaemia 1 PREPARED BY MILAN DHAKAL Nutritional

Nutritional Anaemia 1 PREPARED BY MILAN DHAKAL Nutritional Anaemia 9/10/2020

Defination of Anaemia 2 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. Nutritional Anaemia 9/10/2020

Causes of Anaemia 3 q. By the absence of any dietary essential that is involved in haemoglobin formation or by poor absorption of these dietary essentials. q. By lack of dietary iron or high quality protein. q. By lack of vitamin B 6, vitamin C , Vitamin E. q. By lack of copper. Nutritional Anaemia 9/10/2020

Nutritional requirement for the formation of RBC 4 Iron for Hb synthesis Vitamin B 12 and folate for normal DNA synthesis Other vitamines – B 6(pyridoxine), thiamin, riboflavin and vitamins C & E Trace metals such as cobalt Nutritional Anaemia 9/10/2020

Prevalance 5 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 Nutritional Anaemia 9/10/2020

Nutritional Anaemia 6 9/10/2020

Types of Anaemia 7 i. ü ü Hypochromic and microcytic: Insufficiency of iron for haemoglobin formation RBCs are pale and small. Megaloblastic : ü deficiency of folate and vitamin B 12 ü RBCs irregular in shape and size, usally larger than normal ü Aka orthochromic macrocytic anaemia. iii. Dimorphic : ü If both iron and folate or vitamin B 12 are deficient it give rise to hypochromic macrocytic or dimorphic anaemia. ii. Nutritional Anaemia 9/10/2020

Iron Deficiency Anaemia 8 v Most common form of anaemia v 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 Nutritional Anaemia 9/10/2020

Cut-off points for haemoglobin values for diagnosis of anaemia: 9 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 Nutritional Anaemia 9/10/2020

Clinical findings 10 A. Immunocompetence Ø 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. Nutritional Anaemia 9/10/2020

Koilonchiya Nutritional Anaemia 11 9/10/2020

Treatment 12 Oral administration of inorganic iron in the ferrous form – ferrous sulphate 50 -200 mg 3 times daily for adults and 6 mg/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. Nutritional Anaemia 9/10/2020

Megaloblastic Anaemia 13 DNA synthesis is intense in haemopoietic tissue. Vit B 12 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. Nutritional Anaemia 9/10/2020

Vitamin B 12 deficiency/pernicious anaemia 14 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 Nutritional Anaemia 9/10/2020

Causes of pernicious anaemia 15 Inadequate ingestion ü Vegans are susceptible for B 12 deficiency ü Chronic alcoholism, poverty, religious taboos and dietary fads can also cause B 12 deficiency. 2. Inadequate absorption and utilization of B 12 3. Inadequate utilization due to presence of B 12 antagonists 4. Increased requirements Prevalance • Rare before age of 30 • Occurs mainly btwn 45 -65 yrs • Affects females more than males 1. Nutritional Anaemia 9/10/2020

Clinical features 16 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 B 12 < 160 ng/l while plasma folate is normal Nutritional Anaemia 9/10/2020

Treatment 17 If Hb < 4 g/dl blood transfusion should be given. Hydroxocobalamin should be given in a dosage of 1000 mcg intramuscularly twice during 1 st week then 250 mcg until blood count is normal Then 1000 mcg every six week Nutritional Anaemia 9/10/2020

Dietary consideration 18 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 Nutritional Anaemia 9/10/2020

Folate deficiency 19 Common in 20 -30 yrs Aetiology ü Poor dietary intake ü Low absorption ü Increased requirements ü Infestation and infection ü Drugs Nutritional Anaemia 9/10/2020

Diagnosis 20 • Hb level may be <4 g/dl. • Glossitis is often present. • Paraesthesia is a common complaint. • Plasma folate <3 ng/ml. • Free Hcl in gastric juice. • Increased serum homocysteine level. • Formimino glutamic acid excretion test in urine is a test of folic acid deficiency. Nutritional Anaemia 9/10/2020

How to treat? ? 21 • Folic acid in dose of 5 -10 mg daily is effective • Patient with haemoglobin<5 g/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. Nutritional Anaemia 9/10/2020

Prevention 22 1. Diet § Balanced diet rich in protein, vitamin and minerals should be consumed. 2. Supplementation § Expectant and nurshing mother are given 6 omg of elemental iron and 0. 5 mg of folic acid. § Children in the age group 1 -5 yrs are given 20 mg of elemental iron and 0. 1 mg of folic acid. Nutritional Anaemia 9/10/2020

Contd…. . 23 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. Nutritional Anaemia 9/10/2020

24 Thank you !!! Nutritional Anaemia 9/10/2020