Chapter 11 Anemia and Its Effect on the Older Adult

hemoglobin content will be replaced via transfusion or erythropoiesis (14). While it is common for therapeutic supplementation of iron to be ordered for three months, the iron levels need to be reevaluated to determine whether supplementation goals are being met (13) and whether ongoing supplementation will be beneficial. Deficient erythropoiesis anemias include micro- cytic anemias, normochromic-normocytic anemias, and macrocytic anemias. All are characterized by low hemoglobin and hematocrit values (5,11). The distinc- tion can be made by examining the MCV (2), which will reveal the average size of the client’s RBCs. In microcytic anemias, the heme or globin synthesis is deficient or defective, resulting in a lower-than-normal MCV. In normocytic anemia, bone marrow failure pre- vents the erythroid mass from expanding as needed, but the volume is normal, so the MCV is normal. Megaloblastic erythropoiesis results when DNA or RNA synthesis is impaired; MCV then exceeds normal values (14).

Excessive hemolysis anemias are caused by the destruction of RBCs. These are much less common and rarely associated with blood loss or bone marrow failure. These anemias are caused by defects that are either extrinsic (eg, autoimmune hemolysis) or intrinsic (eg, sickle cell disease) to the RBCs (11,14).

NUTRITIONAL ANEMIAS There are four types of nutritional anemias (15):

● ● ● ● iron-deficiency anemia

anemia of chronic disease/inflammation megaloblastic anemia pernicious anemia

Early onset of all is evidenced by lack of energy, malaise, and decreased interest in activities of daily living and lifelong interests. This can lead to a down- ward spiral resulting in greater difficulty with consum- ing adequate nutrition and an increase in severity of the physical manifestations of anemia. It is vital that the RDN be able to identify the likely etiology for the anemia and recommend appropriate interventions in a timely manner. Each of the nutritional anemias pres- ents with a different pattern of laboratory results from a variety of blood tests. Because the nutritional anemias present similar symptoms and may appear to be the same, it is important to look at more than one labora- tory value before recommending a plan for medical nutrition therapy. Anemias are categorized using RBC indexes about the size, weight, and hemoglobin con- centration (5,11). Each of the four types is discussed below.

Iron-Deficiency Anemia

Iron-deficiency anemia may be the result of a chronic blood loss, an acute blood loss, a deficient diet, medi- cations, malabsorption of iron, or increased need for iron. It may occur concurrently with anemia of chronic disease (13). See Box 11.1 for further information.

BOX 11.1 Clinical Signs and Symptoms of Iron-Deficiency Anemiaa

●

Inflammation of the tongue, lips, or mucous membranes of the mouth

● Spooned nails

● Blood loss (tarry stools) ● Pica

●

Koilonychia (spoon-shaped changes in nail beds)

● Dysphagia (from esophageal webs) ● Mouth and tongue soreness (from atrophy) a

Clinical signs and symptoms of iron-deficiency anemia are sometimes described as a microcytic hypochromic anemia in advanced state.

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Laboratory tests used to diagnose iron-deficiency anemia include low hemoglobin concentration, low hematocrit value, low MCV, low serum iron level, ele- vated total iron-binding capacity (TIBC), and low ferri- tin level. The MCV is the key test to examine, once low hemoglobin and low hematocrit values are identified (11). Table 11.4 (see page 162) illustrates the pattern of laboratory values typically seen in iron-deficiency anemia.

Mild iron-deficiency anemia that is not related to blood loss can be treated by increasing the iron intake in the diet. Eating fortified breads and cereals, pairing high–vitamin C foods and meat protein concurrently with nonheme sources, and decreasing foods high in plant phytates (unleavened bread, unrefined cereals, and soybeans) and beverages with tannins (teas and coffee) is recommended. Because of phosvitin, the iron in egg yolks is poorly absorbed. Phosvitin is one of the egg yolk phosphoproteins; it accounts for 60% of total egg yolk phosphoproteins and holds about 90% of the egg yolk phosphorous. Egg yolk phosvitin shows a very strong affinity to bivalent metals such as calcium, mag- nesium, and iron since it carries a high number of phos- phate molecules (16).

Once underlying causes of iron-deficiency anemia related to other factors are identified and addressed, iron can be administered. Oral iron therapy in dosages sufficient to provide between 150 and 200 mg