Anemia

Anemia is a deficiency in the size or number of red blood cells (RBCs) or the amount of haemoglobin they contain. This deficiency limits the exchange of oxygen and carbon dioxide between the blood and the tissue cells. Anemia classification is based on cell size—macrocytic (large), normocytic (normal), and microcytic (small)—and on hemoglobin content—hypochromic (pale color from deficiency of hemoglobin) and normochromic (normal color). Macrocytic anemia presents with larger-than-normal RBCs, plus increased mean corpuscular volume (MCV) and mean corpuscular hemoglobin concentration (MCHC). Microcytic anemia is characterized by smaller-than-normal erythrocytes and less circulating hemoglobin, as in iron deficiency anemia and thalassemia. Most anemias are caused by a lack of nutrients required for normal erythrocyte synthesis, principally iron, vitamin B12, and folic acid. These anemias that result from an inadequate intake of iron, protein, certain vitamins, copper, and other heavy metals are called nutritional anemias. Other anemias result from conditions such as hemorrhage, genetic abnormalities, chronic disease states, or drug toxicity, and have varying degrees of nutritional consequence.

If you suspect you or someone else is experiencing Anemia, it is crucial to seek immediate medical attention by calling emergency services or consult with a Nutritionist.

Causes

1. Inadequate dietary intake secondary to a poor diet without supplementation.
2. Inadequate absorption resulting from diarrhea, achlorhydria, intestinal disease such as celiac disease, atrophic gastritis, partial or total gastrectomy, or drug interference.
3. Inadequate utilization secondary to chronic gastrointestinal disturbances 
4. Increased iron requirement for growth of blood volume, which occurs during infancy, adolescence, pregnancy, and lactation and which is not being matched with intake. 
5. Increased excretion because of excessive menstrual blood (in females); hemorrhage from injury; or chronic blood loss from a bleeding ulcer, bleeding hemorrhoids, esophageal varices, regional enteritis, celiac disease, Crohn’s disease, ulcerative colitis, parasitic or malignant disease.
6. “Increased destruction” of iron from iron stores into the plasma and defective iron use caused by a chronic inflammation or other chronic disorder.

Risk Factors

Iron status can range from overload to deficiency and anemia. Routine measurement of iron status is necessary because approximately 6% of Americans have a negative iron balance, approximately 10% have a gene for positive balance, and approximately 1% have iron overload. stages of iron status range from iron overload to iron deficiency anemia and are summarized as follows: a. Stage I and Stage II negative iron balance (i.e., iron depletion). In these stages iron stores are low and there is no dysfunction. In Stage I negative iron balance, reduced iron absorption produces moderately depleted iron stores. Stage II negative iron balance is characterized by severely depleted iron stores. b. Stage III and IV negative iron balance (i.e., iron deficiency). Iron deficiency is characterized by inadequate body iron, possibly causing dysfunction and disease. In Stage III negative iron balance, dysfunction is not accompanied by anemia; anemia develops in Stage IV negative iron balance. c. Stage I and II positive iron balance. Stage I positive balance usually lasts for several years with no dysfunction. Supplements of iron and/or vitamin C promote progression to dysfunction or disease, whereas iron removal prevents progression to disease. Iron overload disease develops in persons with stage II positive balance after years of iron overload have caused progressive damage to tissues and organs.

Symptoms

Iron deficiency anemia is characterized by the production of (microcytic) erythrocytes and a diminished level of circulating hemoglobin. This microcytic anemia is the last stage of iron deficiency, and it represents the end point of a long period of iron deprivation. There are many causes of iron deficiency anemia. With few exceptions, iron deficiency anemia in adult men is the result of blood loss. Large losses of menstrual blood can cause iron deficiency in women, many of whom are unaware that their menses are unusually heavy. Because anemia is the last manifestation of chronic, long-term iron deficiency, the symptoms reflect a malfunction of a variety of body systems. Inadequate muscle function is reflected in decreased work performance and exercise tolerance. Neurologic involvement is manifested by behavioral changes such as fatigue, anorexia, and pica, especially pagophagia (ice eating). Abnormal cognitive development in children suggests iron deficiency before it has developed into overt anemia. Growth abnormalities, epithelial disorders, and a reduction in gastric acidity are also common. A possible sign of early iron deficiency is reduced immunocompetence, particularly defects in cell-mediated immunity and the phagocytic activity of neutrophils, which may lead to frequent infections. Restless legs syndrome (RLS) with leg pain or discomfort may result from a lack of iron in the brain; this alters dopamine production and movement. Besides iron deficiency, kidney failure, Parkinson’s disease, diabetes, rheumatoid arthritis, and pregnancy can aggravate RLS. As iron deficiency anemia becomes more severe, defects arise in the structure and function of the epithelial tissues, especially of the tongue, nails, mouth, and stomach. The skin may appear 634 PART V Medical Nutrition Therapy pale, and the inside of the lower eyelid may be light pink instead of red. Mouth changes include atrophy of the lingual papillae, burning, redness, and in severe cases a completely smooth, waxy, and glistening appearance of the tongue (glossitis). Angular stomatitis also may occur, as may a form of dysphagia. Gastritis occurs frequently and may result in achlorhydria. Fingernails can become thin and flat, and eventually koilonychia (spoon-shaped nails) may be noted, some behavioral symptoms respond to iron therapy before the anemia is cured, suggesting they may be the result of tissue depletion of iron-containing enzymes rather than from a decreased level of hemoglobin. • Inadequate muscle function • Growth abnormalities • Epithelial disorders • Reduced immunocompetence • Fatigue Late • Gastritis

Diagnosis

A definitive diagnosis of iron deficiency anemia requires more than one method of iron evaluation; serum ferritin, iron and transferrin are the most useful. The evaluation also should include an assessment of cell morphology. By itself, hemoglobin concentration is unsuitable as a diagnostic tool in cases of suspected iron deficiency anemia for three reasons: (1) it is affected only late in the disease, (2) it cannot distinguish iron deficiency from other anemias, and (3) hemoglobin values in normal individuals vary widely.

Treatments

Treatment of iron deficiency anemia should focus primarily on the underlying cause, although this is often difficult to determine. The goal is repletion of iron stores. Oral Supplementation. The chief treatment for iron deficiency anemia involves oral administration of inorganic iron in the ferrous form. Although the body uses ferric and ferrous iron, the reduced ferrous is easier on the gut and better absorbed. At a dose of 30 mg, absorption of ferrous iron is three times greater than if the same amount were given in the ferric form. Iron is best absorbed when the stomach is empty; however, under these conditions it tends to cause gastric irritation. Gastrointestinal side effects can include nausea, epigastric discomfort and distention, heartburn, diarrhea, or constipation. If these side effects occur, the patient is told to take the iron with meals instead of on an empty stomach; however, this sharply reduces the absorbability of the iron. Gastric irritation is a direct result of the high quantity of free ferrous iron in the stomach. Chelated forms of iron (combined with amino acids) are more bioavailable than nonchelated iron. Chelated iron is less affected by phytate, oxalate, phosphate, and calcium (all iron absorption inhibitors). Chelated iron causes less gastrointestinal disturbances than elemental iron because it is needed in lower doses when it is absorbed into mucosal cells (Ashmead, 2001). Health professionals usually prescribe oral iron three times daily for 3 months to treat iron deficiency. Depending on the severity of the anemia and the patient’s tolerance, the daily dose of elemental iron recommended is 50-100 mg three times daily for adults and 4-6 mg/kg of body weight divided into three doses per day for children. Vitamin C greatly increases iron absorption and gastric irritation somewhat through its capacity to maintain iron in the reduced state.

Preventive Measures

Prevention is key when it comes to managing and combating anemia. By taking proactive steps, individuals can significantly reduce their risk of developing this condition and its associated complications. One of the most effective ways to prevent anemia is through proper nutrition. Consuming a well-balanced diet that includes iron-rich foods such as lean meats, poultry, fish, leafy green vegetables, and fortified cereals can help maintain healthy iron levels in the body. Vitamin C-rich foods like citrus fruits and tomatoes also aid in iron absorption. In addition to a nutritious diet, it is crucial to adopt healthy lifestyle habits. Regular exercise promotes good circulation and oxygenation of the blood, which can help prevent anemia. Avoiding excessive alcohol consumption and quitting smoking are also important factors in preventing anemia as these habits can interfere with nutrient absorption and affect red blood cell production. For certain individuals at higher risk for anemia due to underlying medical conditions or specific life stages such as pregnancy or menstruation, healthcare professionals may recommend additional preventive measures. This could include taking iron supplements or undergoing regular blood tests to monitor iron levels. By prioritizing prevention through proper nutrition, lifestyle choices, and medical guidance when necessary, individuals can take control of their health and reduce the likelihood of developing anemia. Remember that prevention is always better than cure when it comes to maintaining optimal well-being.

Do's & Don’t's

If you suspect you or someone else is experiencing Anemia, it is crucial to seek immediate medical attention by calling emergency services or consult with a Nutritionist.