NUTRITION THERAPY FOR DISEASES IN THE BLOOD AND BLOOD FORMING ORGANS

DISEASE/DISORDER BLOOD AND BLOOD-FORMING ORGANS

NUTRITIONAL ACUITY Level 1 - 2 (Minimal Role)

RANKING

ROLE OF NUTRIENTS IN ● Iron - responsible for the production of hemoglobin, a protein that allows
HEMATOPOIESIS red blood cells to carry oxygen to every part of your body.
(process of creating a wide variety of
blood and bone marrow cells, namely
erythrocytes, platelets, granulocytes,
lymphocytes, and monocytes)
 ● Folate - necessary for maturation of red blood cells
● Vitamin B12 - also necessary for RBC maturation called extrinsic factor
which requires an intrinsic factor in gastric secretion for its absorption
and eventual utilization

● Protein - constituent of hemoglobin

● Vitamin C - promotes absorption and utilization of iron and converts
folate to folinic acid, the biologically active form

Note: Folinic acid (5‐formyl tetrahydrofolate) is one active form in the group of vitamins known as folates. In
contrast to folic acid (which is a synthetic form of folate) folinic acid is one of the forms of folate found naturally
in foods
● Copper - promotes the utilization of iron and converts folate to folinic
acid, the biologically active form
● Vitamin E - preserve the integrity of the RBC by protecting the cell
membrane lipids from oxidation
● Zinc - essential for the production of new red blood cells in anemia; in
combination with iron supplementation was found to increase
hemoglobin levels to a higher extent than iron alone
TYPES OF CHANGES IN RBC ● Reduction in the size or number of RBCs, the quantity of Hb or both
resulting in decreased capacity of the blood to carry oxygen
● s/sx: pallor, breathlessness on excretion, easy fatigue, dizziness, insomnia and
lack of appetite
● Classified into cell size: Large (macrocytic), Small (microcytic), or Normal
(normocytic)

Nutrient Deficiency Type of Anemia Changes in the RBC

Iron Deficiency Iron-Deficiency Anemia Microcytic, hypochromic

B9 (Folate) Deficiency Megaloblastic Anemia

Macrocytic, hyperchromic
B12 (Cobalamin) Deficiency Pernicious Anemia

● Another classification is based on the color index of the blood: high

(hyperchromic); low (hypochromic) or normal (normochromic)
 ● Anemia may be due to excessive loss of blood cell destruction as a result of
chemical poisons such as lead or specific infections such as malaria; or to
congenital abnormalities of the RBCs, as in sickle cell anemia (abnormal form of
hemoglobin that causes the red cells to become rigid, and sickle shaped)

​
● May also be due a defect in blood formation (nutritional origin) or due to aplasia
of the bone marrow, toxic inhibition, or diseases that affect the bone marrow,
spleen, liver or lymph nodes

CHANGE IN BLOOD VALUES

IN BLOOD DISORDERS
Blood Component Decreased in Increased in

Ferritin Iron deficiency Iron overload

Hematocrit Iron deficiency anemia Polycythemia

Sickle cell anemia

Hemoglobin Iron deficiency anemia Polycythemia

Iron Iron deficiency Iron overload; Hemolytic anemia

Mean Cell Iron deficiency Macrocytic anemia

Corpuscular Volume Polycythemia Folate deficiency

Red Blood Cells Iron deficiency anemia Polycythemia

Transferrin Saturation Absolute or relative iron Hemolytic, Megaloblastic and

deficiency Sideroblastic anemia

White Blood Cells Leukopenia Leukemia

NON-NUTRITIONAL ANEMIA May be due to a defect in blood formation or due to aplasia (did not develop normally) of
the bone marrow.
● Anemia of chronic disease - due to abnormalities in the recycling of iron from
hemoglobin of old blood cells that frequently accompany infections,
inflammatory disorders or connective tissue disease (i.e., arthritis)
● Sports anemia - transient anemia seen in strenuous exercise or heavy physical
training
● Sickle cell anemia/disease (SCD) - inherited anemia in which defective
hemoglobin causes erythrocyte to be sickle-shaped. The cause of SCD is the
substitution of glutamic acid with valine at the 6th position of the b-globin chain
of hemoglobin.

Two primary manifestations:

1. hemolytic anemia (RBCs are destroyed faster than they are made)
2. vaso-occlusion (occlusion of blood vessels)
● Nut. Rx: High calorie, high protein to meet the higher than normal nutrient
needs of the patient and to prevent malnutrition
○ Sideroblastic anemia - a microcytic, hypochromic anemia similar to
IDA, except that the serum iron is normal or elevated. (anemia from lack
of RBC, but too much iron as the body does not use it in RBCs)
○ Anemia of the ESRD - caused primarily by decreased production of the
hormone erythropoietin, which is normally produced by the kidneys

Aplastic Anemia - a condition that occurs when your body stops producing enough new
blood cells
● Aplastic anemia occurs when your bone marrow doesn't make enough red and
white blood cells, and platelets.
● This condition can make you feel tired, raise your risk of infections, and make
you bruise or bleed more easily.
● To treat the low blood counts, early treatment involves easing symptoms.
Causes of Aplastic Anemia
● History of certain infectious diseases (such as hepatitis, HIV, Epstein-Barr virus,
CMV, or paravirus B19)
● History of taking certain medicines, such as antibiotics and anticonvulsants
● Exposure to certain toxins, such as heavy metals
● Exposure to radiation
● History of an autoimmune disease, such as lupus
● Inherited condition
S/Sx:
● Headache
● Dizziness
● Upset stomach (nausea)
● Shortness of breath
● Bruising
● Lack of energy or tiring easily (fatigue)
● Abnormal paleness or lack of color in the skin
● Blood in stool
● Nosebleeds
● Bleeding gums
● Fevers
● Sore sinuses
● Enlarged liver or spleen
● White patches in the mouth (oral thrush

Laboratory Values:
● Anemia (low Hgb, Hct) - fatigue, lassitude (physical and mental weakness),
dyspnea
● Thrombocytopenia (low platelets) - bruises, petechiae, serious bleeding
● Neutropenia (low neutrophils, type of WBC) - infections

Nutrition Therapy:
People with low white blood cell counts are at risk for infections should follow food safety
guidelines, which include:
● fully cook all meat, fish, and egg dishes
● avoid fruits and vegetables that you cannot peel
● avoid raw foods
● avoid unpasteurized cheese, milk, and other dairy products
● avoid unpasteurized juices

Thalassemia - an inherited (i.e., passed from parents to children through genes) blood
disorder caused when the body doesn't make enough of a protein called hemoglobin, an
important part of red blood cells
● a treatable disorder that can be well-managed with blood transfusions and
chelation therapy.
NUTRITIONAL ANEMIA Due to a deficiency of nutrients necessary in the formation of blood
Nutritional Description and Nutrition Recommendation
Anemia

Copper ● Copper is essential for the formation of Hb and mobilization of iron from
Deficiency its storage sites to the plasma
Anemia ● Iron cannot be released if copper is deficient
● May occur in infants fed with cow’s milk or Cu-deficient formula
● Seen in children or adults who have a malabsorption syndrome, or who
are receiving long-term total parenteral nutrition that does not contain
copper
Nut Rx: includes foods rich in Cu: liver, shellfish, whole grain cereals, nuts and
legumes; requires adequate intake of calories, protein, vitamins and other minerals

Folic Acid ● Increased requirements due to growth and pregnancy

Deficiency ● May be due to faulty absorption, as in intestinal resection and congenital
folate malabsorption
Nut Rx: to replenish folate stores, recommended to take 1 mg of folate everyday for
2-3 wks

Protein ● Macrocytic type of anemia associated with protein malnutrition

Deficiency ● Protein is essential for the proper production of Hgb and RBC
Anemia ● Includes signs of multiple nutritional deficiencies, especially of folic acid,
B12 and iron
Nut Rx: adequate intake of protein for heme and non-heme sources of iron.

B12 Deficiency ● Malabsorption

Anemia ○ A megaloblastic, macrocytic type of anemia due to lack of
intrinsic factor (necessary for B12 absorption) in gastric juice
and in gastrectomy and ileal resection. Basic cause of
pernicious anemia
○ Impaired absorption of folic acid in certain diseases (i.e., sprue,
celiac disease)
● Inadequate intake of folate or vitamin B12
○ B12 is found only in animal products, which is commonly
lacking in strict vegetarians/vegans
● Drugs
○ Many drugs used in chemotherapy are folic acid antagonists.
Nitrous oxide impairs utilization of B12
○ s/sx are similar to that of folic acid deficiency, except that it is
also inadequate in myelination of the nerves which causes poor
memory, hallucination and muscle coordination
Nut Rx: Consumption of B12 sources (i.e., liver, fish, meat, poultry, milk and eggs);
B12 injection

Vitamin C ● Macrocytic type of anemia seen in severe cases of vitamin C deficiency

Deficiency (scurvy)
Anemia ● Vitamin C is necessary for the absorption of iron and the conversion of
folic acid to its biological active form (folinic acid)
Nut Rx: intake of Vit C F&V; fortified drinks; Add 5-25 IU/d

Iron Deficiency ● Deficiency in the size or number of erythrocytes, or the amount of Hgb
Anemia (limits the O2 exchange in blood
Nut Rx: iron therapy (oral supplementation of ferrous sulfate or PN of iron-dextran)
OTHER BLOOD DISORDERS ● Leukemia - type of blood cancer due to proliferation (rapid increase) of
leukocytes and decreased production of RBC
○ Etiology unknown; although ionizing radiation, effects of certain
chemicals, heredity, and hormonal abnormalities may be causative
factors. Usually occurs with sudden onset
○ Visible signs are fatigue, pallor, and extreme weakness
○ Pts have frequent hemorrhaging and mouth ulcers
○ Some Pts have been successfully treated with chemotherapy and with
bone marrow transplantation
Nut Rx: Serve attractive meals in small frequent feedings providing 30-35 kcal and 1.5 g
protein per kgBW

● Polycythemia - increase in red cell mass believed to be a result of a timorous

condition of the bone marrow, increasing the rate of cell production
○ Increased blood viscosity impedes blood flow, may block circulation,
increase arterial pressure, increase load on heart leading to heart failure

● Leukopenia - decrease in production of WBC due to bone marrow damage by

poisons, toxic reaction to drugs and radiation.
○ Results to reduced resistance to infections

Management of polycythemia and leukopenia: drug therapy, blood transfusion, bone

marrow transplant
Dietary Rx: for those at risk for infections should follow food safety guidelines (low
microbial diet)