Anaemia
Excerpts from previous naturopathy assignments HLT60512.
| Anaemia | Anaemia is a reduction in the haemobglobin and erythrocytes in the blood. Inadequate numbers of erythrocytes may result from lack of red cell production or loss of blood in haemorrhage. Inherited defects can cause also cause Anaemia. | Hechtman 2012, gives the following examples:
Biochemical tests for irons status |
| Types of anaemia can occur from iron deficiency, renal disease, and chronic inflammation.
General causes / manifestations/ signs of anemia Haemorrhage Decreased erythropoiesis Increased erythrocyte destruction Decreased red blood cells Decreased Haemobglobin Decreased oxygen carrying capacity (hypoxaemia) Tissue hypoxia ischaemia: ‘weakness and fatigue, skin pallor, respiratory distress, e.g. increased respiratory rate, depth, and exertional dyspnea, and central nervous system problems causing dizziness, fainting, and lethargy’ (Craft, et al., 2011, p. 399) Craft et al states: Increase heart rate, capillary dilation, stroke volume and increase oxygen demands for work of heart, which might cause angina, and increase erythropoietin production which stimulates the bone marrow to make more red blood cells (Craft, et al., 2011, p. 399) Furthermore; Increased stroke volume also leads to: ‘hyper dynamic circulation, cardiac murmurs and high output cardiac failure. The renal compensatory mechanisms are: Increase renin – aldosterone response, increase salt and water retention, and increase extracellular fluid volume, again leading to hyper dynamic circulation and potential for cardiac murmurs and cardiac failure’(depending on severity), (Craft, et al., 2011, p. 399). |
include: Serum iron,
Haemoglobin, Haematocrit, Serum transferrin, Transferrin saturation, Serum ferritin, Total iron binding capacity Transferring receptor Erythrocyte protoporphyrin Zinc and haem ration test Hechtman states: ‘when assisting supplementation from testing, the formula 1mmol iron = 55.8mg iron is used’ (Hechtman, Clinical Naturopathic Medicine, 2012, pp. 398-400) Naturopathic observational deficiency signs Hechtman 2012 gives the following examples: Angular stomatitis, glossitis, Thin and brittle fingernails Spoon nails Pica Pagophagia (the compulsive consumption of iced drinks) |
| Cold intolerance
Palour (Hechtman, 2012, pp. 398-400) |
Iron deficiency anaemia
There may be iron deficient with hypertension due to short to medium term lack of iron. Pernicious anaemia may also be a factor if lack intrinsic factor is affecting B12 metabolism; and there are other reasons for anaemia which may be investigated, however the client’s presentation of fatigue and hypertension suggest a diagnosis of iron deficient anaemia. A busy lifestyle may indicate a lack of a balanced diet, the underlying problems contributing to fatigue can be further investigated as required as well therefore exacerbating complaints (Craft, et al., 2011, p. 400)
Anaemia signs
- Decrease in the erythrocyte concentration and decrease in total blood volume causes interstitial fluid to move into the blood stream to increase blood volume decreasing the viscosity of the blood and the offset to this is that cardiac output is increased (Craft, Gordon & Tiziani, 2011 p.400).
- Low oxygen delivery to the kidneys stimulates them to make the hormone erythropoietin (EPO) which in turn stimulates the bone marrow to produce erythrocytes thereby increasing levels in the blood (AIAS, 2017).
- Turbulent blood flow associated with lower viscosity of the blood may cause heart valve defects as ventricular hypertrophy occurs due to increased venous return and increased stroke volume.
- Congestive heart failure may occur after long term iron deficiency anaemia or in the more immediate term in those who have cardiovascular problems (Porth & Matfin, 2009 p. 284).
- Tachycardia and palpitations due to an increased heart rate or angina due to the increased loads placed upon the cardiac muscle (AIAS, 2017)
Symptoms
- Common early symptoms of anaemia are fatigue, weakness and pallor. Fatigue and weakness, are due to decreased amount of oxygen available for energy production in tissues. Coldness and pallor is associated with a redistribution of blood flow from the skin, nail beds, mucous membranes and conjunctiva of the eye, to organs and tissues more important for survival (like the cardiac muscle and brain), (Craft, et al., 2011, pp. 398-401)
- Dyspnoea, associated with the increased rate and depth of ventilation, may be experienced during physical exertion (Hoffbrand & Pettit).
- Nails concave, spoon shaped, clubbing in the nail beds (AIAS, 2017)
- Headaches, faintness, dizziness and dim vision are associated with hypoxia of the brain tissue (AIAS, 2017)
- Bone pain and sternal tenderness. Abdominal pain, nausea and vomiting associated with the decreased availability of oxygen to the organs and tissues of the gastrointestinal tract (AIAS, 2017)
Physiologic link between tiredness, lethargy and lack of energy.
This type of anaemia shows normal-looking erythrocytes in low numbers. Its primary reason of development is due to an inadequate dietary iron intake. Other presentations may be due to deficiencies in iron absorption, and/or excessive iron loss (through bleeding), (Craft, et al., 2011, p. 401).
Anaemia in Children
Children’s growth rate is affected by hormonal and central nervous system processes, thus dietary deficiencies in healthy children will generally result in nutritional deficiencies more quickly than would in healthy adults. Iron is of vital importance for healthy growth. If a vegetarian or vegan diet is well planned and nutritionally balanced it can match a diet containing meats and animal products, and their might be some real benefits if the diet is followed adequately over the years, such as lower body mass index and decreased risk of mortality potentially, due to lower serum cholesterol levels, and a greater intake of nutrient dense foods such as vegetables, legumes, beans, (some poultry here), fruits, carbohydrates, essential fatty acids, and vegetable based proteins. Supplementation may even be an option if at times there is a short fall in nutrient consumption (Di Genova & Guyda, 2007).
Major considerations in planning a healthy vegetarian diet
Protein intake
Animal foods have lower amounts of protein and are less digestible than animal proteins, amino acids are also lower and many vegetable proteins are deficient in 1 or more amino acids which are essential. It is essential to eat a variety of plant proteins and consider a vegetable based protein supplement where needs are not being met. It is important to note that in infancy and toddler years a diet such as a macrobiotic diet does not usually contain enough protein (Di Genova & Guyda, 2007).
Vitamin D
Supplementation may be required to decrease the risk of osteoporosis or rickets, as many dairy products contain this nutrient. Exposure to sunlight only isn’t a reliable ongoing source in most cases and can come with the risk of skin cancers if overdone (Di Genova & Guyda, 2007).
Vitamin B12
Low serum vitamin B12 levels have been observed in some studies, as plant foods are not a high quality source of vitamin B12, this is increased in vegan or macrobiotic diets without supplementation. Megaloblastic anaemia is a serious problem resulting from a deficiency in this vitamin, other neurological disorder can develop such as issue with myelination and nerve signal impulses because the cells aren’t conducting their impulses sufficiently (Singh, 2017). Other symptoms are megoblastic and pernicious anaemia, peripheral neuropathy, poor brain development, and anaemia (Wlassoff, 2014).
Iron
Iron deficiency in pre-schoolers may mean that there is slowed mental and psychomotor development thus this should be monitored and children’s supplementation given where there is lack (Di Genova & Guyda, 2007)
Calcium
Low calcium results in reduced bone mineral content, rickets, or osteoporosis and this increases fracture risks. Foods rich in calcium or children’s supplementation may be given (Di Genova & Guyda, 2007).
Signs and symptoms of anaemia that develops as a result of the pathophysiology of the condition.
The signs and symptoms of iron deficiency anaemia are typically due to decreased erythrocytes and haemoglobin which in the early stages (haemoglobin of 70 or 80 g/l) causes tissue hypoxaemia and weakness and fatigue with skin pallor, and increased respiratory rate with dyspnoea on exertion, and central nervous system along with central nervous system issues such as dizziness or fainting. More severe signs and symptoms include tachycardia and systolic murmurs (50g/l Iron levels) (Craft, et al., 2011, pp. 399 Fig 17-3, pp.401).
The above signs and symptoms are caused by tissue hypoxia in the former case, and further compensatory mechanisms such as increased heart rate, capillary dilation increased erythropoietin in bone marrow, increased renin aldosterone response, salt and water retention, extracellular fluid volume, increased stroke volume, and hyper dynamic circulation with murmur or heart failure at the most extreme cases (Craft, et al., 2011, pp. 399 Fig. 17-3).
Heather Indiana Rose
Copyright 2019