ANEMIA:

- VITAMIN DEFICIENCY ANEMIA -

By Rommel Ricio – Sept 6, 2018

OVERVIEW

Vitamin deficiency anemia is a lack of healthy red blood cells

caused when you have lower than normal amounts of certain
vitamins. Vitamins linked to vitamin deficiency anemia include
folate, vitamin B-12 and vitamin C.

Vitamin deficiency anemia can occur if you don't eat enough

folate, vitamin B-12 or vitamin C. Or vitamin deficiency anemia
can occur if your body has trouble absorbing or processing
these vitamins.
 SYMPTOMS

Fatigue Dizziness Weight loss Personaity changes

Numbness or tingling in Unsteady movements

Shortness of breath Pale or yellowish skin
your hands and feet
Mental confusion or
Irregular heartbeats Muscle weakness forgetfulness
 CAUSES
Vitamin deficiency anemia occurs when your body doesn't have
enough of the vitamins needed to produce adequate numbers
of healthy red blood cells. Red blood cells carry oxygen from
your lungs throughout your body. If your diet is lacking in
certain vitamins, vitamin deficiency anemia can develop. Or
vitamin deficiency anemia may develop because your body
can't properly absorb the nutrients from the foods you eat.
Causes of vitamin deficiency anemias, also known as
megablastic anemia include :
FOLATE DEFICIENCY ANEMIA
1 Folate, also known as vitamin B-9, is a nutrient
found mainly in fruits and leafy green
vegetables. A diet consistently lacking in these
foods can lead to a deficiency.
2 VITAMIN B-12 DEFICIENCY ANEMIA
Vitamin B-12 deficiency can result from a diet
lacking in vitamin B-12, which is found mainly in
meat, eggs and milk. Vitamin B-12 deficiency
anemia can also occur if your small intestine
can't absorb vitamin B-12.
3 VITAMIN C DEFICIENCY ANEMIA
Vitamin C deficiency can develop if you don't
get enough vitamin C from the foods you eat.
Vitamin C deficiency is also possible if
something impairs your ability to absorb
vitamin C from food. For instance, smoking
impairs your body's ability to absorb vitamin C.
 RISK FACTORS

YOUR DIET YOU’RE PREGNANT YOU HAVE YOU ABUSE YOU TAKE CERTAIN
CONTAINS LITTLE INTESTINAL ALCOHOL PRESCRIPTION
TO NO NATURAL PROBLEMS OR MEDICATIONS
VITAMIN FOOD OTHER MEDICAL
SOURCES CONDITIONS
 PREVENTION
Choose a Don’t smoke
healthy diet Smoking interferes with the absorption of
nutrients, such as vitamin C, so it can raise
You can prevent some forms your risk of a vitamin deficiency. If you
of vitamin deficiency smoke, quit. If you don't smoke, don't
anemias by choosing a start. If you've tried to quit on your own
and haven't been successful, talk with
healthy diet that includes a your doctor about strategies to help you
variety of foods. quit.

Drink alcohol in
Consider a
moderation, if at
multivitamin
all
If you're concerned about getting enough vitamins from the
food you eat, ask your doctor whether a multivitamin may Alcohol can contribute to vitamin deficiency anemia. If you
be right for you. Most people get enough vitamins from the choose to drink alcohol, do so in moderation.
foods they eat. But if your diet is restricted, you may wish to
take a multivitamin.
 MEDICAL
TREATMENT
• Replacement of vitamin B12 or folate

• The treatment of anemia due to vitamin B12 deficiency or folate deficiency consists of
$347
replacing the deficient vitamin.

•$722
Commonly, vitamin B12 is administered by injection, particularly when the deficiency is
$567the vitamin from the digestive tract. At first,
severe or caused by an inability to absorb
injections are given daily or weekly for several weeks until the blood levels of vitamin
B12 return to normal. Then injections are given once a month. Vitamin B12 can also be
taken daily as a nose spray, a tablet placed under the tongue, or a tablet that is
$931
swallowed. People who have anemia due to vitamin B12 deficiency usually must take
$1,258
vitamin B12 supplements for life.

• Folate can be taken as one tablet daily.

 $347

$722
$567

$931
$1,258
 SICKLE CELL ANEMIA

• Sickle cell anemia is an inherited form of

$347 anemia — a condition in which there aren't
enough healthy red blood cells to carry
adequate oxygen throughout your body.
$722
$567 • Normally, your red blood cells are flexible and
round, moving easily through your blood
vessels. In sickle cell anemia, the red blood
$931 cells become rigid and sticky and are shaped
like sickles or crescent moons. These
$1,258
irregularly shaped cells can get stuck in small
blood vessels, which can slow or block blood
flow and oxygen to parts of the body.
 SYMPTOMS

Anemia
Episodes of pain
Painful swelling of hands and feet
Frequent infections
Delayed growth
Vision problems
CAUSES

• Sickle cell anemia is caused by a mutation in the gene that tells your body to make the
red, iron-rich compound that gives blood its red color (hemoglobin). Hemoglobin allows
red blood cells to carry oxygen from your lungs to all parts of your body. In sickle cell
anemia, the abnormal hemoglobin causes red05 blood cells to become rigid, sticky and
misshapen.
04
• The sickle cell gene is passed from generation to generation in a pattern of inheritance
called autosomal recessive inheritance. This means that both the mother and the father
03 a child to be affected.
must pass on the defective form of the gene for

02the child, that child will have the sickle

• If only one parent passes the sickle cell gene to
cell trait. With one normal hemoglobin gene and one defective form of the gene, people
with the sickle cell trait make both normal hemoglobin
01
and sickle cell hemoglobin. Their
blood might contain some sickle cells, but they generally don't have symptoms. But they
are carriers of the disease, which means they can pass the gene to their children.
RISK FACTORS

For a baby to be born with sickle cell anemia,

05 both parents must carry a
sickle cell gene. In the United States, it most commonly affects black
people. 04

03

02

01
COMPLICATIONS
• Sickle cell anemia can lead to a host of complications, including:

• Stroke. A stroke can occur if sickle cells block blood flow to an area of your brain. Signs of stroke include seizures, weakness or numbness of your arms and legs,
sudden speech difficulties, and loss of consciousness. If your baby or child has any of these signs and symptoms, seek medical treatment immediately. A stroke can
be fatal.
• Acute chest syndrome. This life-threatening complication causes chest pain, fever and difficulty breathing. Acute chest syndrome can be caused by a lung infection
or by sickle cells blocking blood vessels in your lungs. It might require emergency medical treatment with antibiotics and other treatments.
• Pulmonary hypertension. People with sickle cell anemia can develop high blood pressure in their lungs (pulmonary hypertension). This complication usually affects
adults rather than children. Shortness of breath and fatigue are common symptoms of this condition, which can be fatal.
• Organ damage. Sickle cells that block blood flow through blood vessels immediately deprive the affected organ of blood and oxygen. In sickle cell anemia, blood is
also chronically low on oxygen. Chronic deprivation of oxygen-rich blood can damage nerves and organs in your body, including your kidneys, liver and spleen.
Organ damage can be fatal.
• Blindness. Sickle cells can block tiny blood vessels that supply your eyes. Over time, this can damage the portion of the eye that processes visual images (retina)
and lead to blindness.
• Leg ulcers. Sickle cell anemia can cause open sores, called ulcers, on your legs.
• Gallstones. The breakdown of red blood cells produces a substance called bilirubin. A high level of bilirubin in your body can lead to gallstones.
• Priapism. Men with sickle cell anemia can have painful, long-lasting erections, a condition called priapism. As occurs in other parts of the body, sickle cells can block
the blood vessels in the penis. This can damage the penis and lead to impotence.
TREATMENT
Bone marrow transplant, also known as stem cell transplant, offers the only
potential cure for sickle cell anemia. It's usually reserved for people younger
than age 16 because the risks increase for people older than 16. Finding a
donor is difficult, and the procedure has serious risks associated with it,
including death.
05

As a result, treatment for sickle cell anemia is usually aimed at avoiding

crises, relieving symptoms and preventing 04 complications. Babies and children
age 2 and younger with sickle cell anemia should make frequent visits to a
doctor. Children older than 2 and adults 03
with sickle cell anemia should see a
doctor at least once a year, according to the Centers for Disease Control and
Prevention.
02

Treatments might include medications to01reduce pain and prevent

complications, and blood transfusions, as well as a bone marrow transplant.
MEDICATIONS
Medications used to treat sickle cell anemia include:

 Antibiotics. Children with sickle cell anemia may begin taking the antibiotic penicillin when they're about 2 months old and
continue taking it until they're at least 5 years old. Doing so helps prevent infections, such as pneumonia, which can be life-
threatening to an infant or child with sickle cell anemia.

 As an adult, if you've had your spleen removed or had pneumonia, 05

you might need to take penicillin throughout your life.

 Pain-relieving medications. To relieve pain during a sickle cell crisis, your doctor might prescribe pain medications.
04
 Hydroxyurea (Droxia, Hydrea). When taken daily, hydroxyurea reduces the frequency of painful crises and might reduce the need
for blood transfusions and hospitalizations. Hydroxyurea seems to work by stimulating production of fetal hemoglobin — a type of
hemoglobin found in newborns that helps prevent the formation of sickle cells.
03
 Hydroxyurea increases your risk of infections, and there is some concern that long-term use of this drug might cause problems
later in life for people who take it for many years. More study is needed.
02
 Your doctor can help you determine if this drug might be beneficial for you or your child. Don't take the drug if you're pregnant.
01
 Assessing stroke risk
 vaccinations to prevent infections
 blood transfusions
 bone marrow transplant
Treating a sickle cell complications 05
 experimental treatments (gene theraphy, nitric oxide, drugs to boost
04
fetal hemoglobin production)
03

02

01
NUTRITION MANAGEMENT

05

04

03

02

01
• Special care and attention should be given to the diet for those with sickle
cell anemia:
• Dietary intake is usually low since there is pain in the abdomen
• Children need to make sure they have adequate amounts of calories to
maintain growth and development
• Also have metabolic increase rate since the constant inflammation and
oxidative stress 05

• Diets must have enough calories and provide foods high in folate, zinc,
copper, and even vitamins A,C,D, and E04
• Multivitamin that containing 50 to 150% RDA of folate, zinc, and copper is
recommended 03
• 2 to 3 quarts of water each day is very important
02
• Also patients may need higher than RDA of protein
• Low in absorbable iron, so iron rich foods should be excluded
01
• Alcohol and ascorbic acid should be avoided since they increase iron
absorption
ANEMIA OF PROTEIN ENRGY -MALNUTRITION
Protein is essential for the proper production of hemoglobin and red
blood cells 05
Protein-Energy Malnutrition (PEM)
04
Is a reduction in cell mass and thus a reduction in oxygen requirements
Fewer red blood cells are then required03 to oxygenate the tissue

Blood volume stays the same so there is a reduced number of red

02
blood cells with a low hemoglobin level (hypochromic, normocytic
anemia) 01
Can mimic an iron deficiency and is actually a physiologic (non harmful) rather than
harmful anemia
In acute PEM loss of active tissue mass may be greater than reduction in red blood
cells then leading to polycythemia
The body responds to this red blood cell production which is not a reflection of
protein and amino acid deficiency but an oversupply
05
of red blood cells

04
Iron released from normal red blood cell destruction is not reused but stored
Iron deficiency anemia can reappear with rehabilitation
03
A diet lacking in protein usually is deficient in iron, folic acid, and less frequently
02
vitamin B12
Dietitian plays a key role in assessing the diet
01 for typical amounts of these nutrients
VITAMIN E RESPONSIVE ANEMIAS
Children and the elderly are more vulnerable age groups
Men may be at higher risk for deficiency than women
Premature Infants need vitamin E since the production 05 of Vitamin E doesn’t happen for a baby until
right before scheduled birth
Since iron is a biologic oxidant a diet high in either iron
04 or PUFA’s increases the risk of vitamin E
deficiency
PUFA’s are incorporated into the red blood cell membranes and are more susceptible to oxidative
damage 03
This anemia is becoming more and more uncommon since there is a ratio of Vitamin E to PUFA
given in infant formula
02
Recommendation is .7 IU per 100 kcal and at least 1 IU of Vit. E per gram of linoleic acid
Supplemental vitamin E appears to be most highly bioavailable when finely dispersed in a fortified
food source or as a powder 01
High doses of Vitamin E results in intraventricular hemorrhage, sepsis, necrotizing enterocolitis, liver
and renal failure, and death
 REFERENCES

 Mayo Clinic. (2018). Sickle cell anemia - Symptoms and causes. [online] Available at:
https://www.mayoclinic.org/diseases-conditions/sickle-cell-anemia/symptoms-causes/syc-20355876 [Accessed 4
Sep. 2018].
 MSD Manual Consumer Version. (2018). Sickle Cell Disease - Blood Disorders - MSD Manual Consumer Version.
[online] Available at: https://www.msdmanuals.com/home/blood-disorders/anemia/sickle-cell-disease [Accessed
6 Sep. 2018].
 Slideplayer.com. (2018). Spenser Parker, Katie Gardner, Juliette Soelberg, McKell Compton - ppt download.
[online] Available at: https://slideplayer.com/slide/5792594/ [Accessed 6 Sep. 2018].