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Response # 1 To Jennifer Shah

 

Shah Initial Discussion Post

Folate Deficiency Anemia

Folate, also known as folic acid, is a B-vitamin required for RNA and DNA synthesis within erythrocytes (Huether & McCance, 2012).  For humans, folic acid comes from diet.  While folate is not stable in food preparation, folic acid is stable and has been added to breads and cereals since the 1990s to decrease the incidence of neural tube defects (Crider, Bailey, & Berry, 2011).  Folate is absorbed in the small intestine and then circulates through to be stored in the liver (Huether & McCance, 2012).   A deficiency in folate, therefore, comes from diet or conditions affect the small intestine.  Individuals at risk of folate deficiency include alcoholics, malnourished individuals, cancer patients, and those with celiac disease (Johns Hopkins Medicine, n.d.). 

Folate deficiency anemia is considered a macrocytic anemia characterized by larger stems cells in the marrow that mature into large erythrocytes with a normal hemoglobin content (Huether & McCance, 2012).  The defective DNA synthesis causes the growth and development of the red blood cells to happen at unequal rates (Huether & McCance, 2012).  The erythrocytes die prematurely due to the ineffective DNA synthesis, resulting in anemia (Huether & McCance, 2012). 

Iron Deficiency Anemia

            Iron deficiency anemia (IDA) is a microcytic-hypochromic anemia with small erythrocytes and a reduced amount of hemoglobin (Huether & McCance, 2012).  Similar to other types of anemia, it stems from a deficiency, this anemia is with iron.  IDA results from lack of iron in diet, blood loss such as peptic ulcers or heavy menstrual bleeding, pregnancy, or inability to absorb iron (Mayo Clinic, 2015).  Iron on hemoglobin is in constant use in the body carrying oxygen to cells and can be recycled, but when blood loss occurs, iron depletion occurs (Huether & McCance, 2012). 

            Both of these types of anemia can be diagnosed with blood tests and can be corrected with supplements.  However, in IDA, if bleeding is the cause of the deficiency, the source must be eliminated (Huether & McCance, 2012). 

Factors

            Both types of anemia can result from a dietary deficiency.  Individuals at risk for both anemias include those who are malnourished such as alcoholics, patients with eating disorders, and individuals who lack access to sufficient food supplies.  Alcoholics and those on fad diets are considered to cause their anemia through behavior.  A change in diet can help improve their condition.

            Women can be at risk of both anemias due to pregnancy.  Pregnant women require more folic acid and iron than non-pregnant women and may not be supplementing enough with prenatal vitamins.  During pregnancy, iron stores are transferred from the mother to the fetus (Allen, 2000).  If a woman begins pregnancy with already depleted iron stores, the anemia becomes worse during pregnancy (Allen, 2000).

            According to Huether and McCance (2012), IDA affects children under two years of age due to an increased need during growth.  IDA affects males more in earlier life and females later in life (Huether & McCance, 2012).  One type of IDA, iron-refractory iron deficiency anemia has a genetic link.  It is caused by a mutation to the TMPRSS6 gene and inherited in an autosomal recessive pattern (Genetics Home Reference, 2014).

References

Allen, L. (2000). Anemia and iron deficiency: effects on pregnancy outcome. The American Journal of Clinical Nutrition, 71(5), 1280-1284.

Crider, K., Bailey, L., & Berry, R. (2011). Folic Acid Food Fortification—Its History, Effect, Concerns, and Future Directions. Nutrients, 3(3), 370-384. doi:10.3390/nu3030370

Genetics Home Reference. (2014). Iron-refractory iron deficiency anemia. Retrieved from http://ghr.nlm.nih.gov/condition/iron-refractory-iron-deficiency-anemia

Huether, S., & McCance, K. (2012). Understanding pathophysiology (Laureate Custom ed.). St. Louis, MO: Mosby.

Johns Hopkins Medicine. (n.d.). Anemia of Folate Deficiency. Retrieved from http://www.hopkinsmedicine.org/healthlibrary/conditions/hematology_and_blood_disorders/anemia_of_folate_deficiency_85,P00089/

Mayo Clinic. (2015). Iron Deficiency Anemia. Retrieved from http://www.mayoclinic.org/diseases-conditions/iron-deficiency-anemia/basics/causes/con-20019327

 

 

Response # 2 to Chelsea Vanrooy

Chelsea Van Rooy

           

Pathophysiology of Iron Deficiency Anemia

Heuther and McCance (2012) describe the development of iron deficiency anemia (IDA) in three stages. The first of those stages occurs when the body’s excess iron is depleted leaving little to supply future hemoglobin and red cell production. (Heuther & McCance, 2012). In the second stage, red blood cell production begins in the bone marrow with an insufficient supply of iron (Heuther & McCance, 2012). In the third and final stage, these iron depleted red blood cells are released into circulation (Heuther & McCance, 2012). At this point, clinical manifestations begin to emerge. Signs and symptoms of IDA can include fatigue, weakness, shortness of breath, and pale earlobes, palms and conjunctiva” (Heuther & McCance, 2012, p. 504). Dry skin, brittle nail, dysphagia, dry mouth, gastritis, headache, and neuromuscular changes may also develop (Heuther & McCance, 2012). Common causes of IDA are pregnancy and blood loss (Heuther & McCance, 2012).

Pathophysiology of Pernicious Anemia

            Pernicious anemia (PA) is caused by a vitamin B12 deficiency (Heuther & McCance, 2012). In PA, and individual lacks intrinsic factor (IF) which is an enzyme required for the absorption of the vitamin (Heuther & McCance, 2012). Signs and symptoms of PA can include “fatigue, dry skin, brittle nails, flushing, fever, glossitis, hair loss, weight loss, and jaundice” (Hooper, Hudson, Porter, & McCaddon, 2014, p.378). Neurological symptoms such as confusion and memory loss may develop later in the disease process (Hooper et al., 2014). Gastrointestinal problems are common and can include diarrhea, indigestion, and loss of appetite (Hooper et al., 2014). Common causes of PA include gastric disease, autoimmune disease, and pancreatic insufficiency (Hooper et al., 2014).

Comparison

             IDA is a microcytic-hypochromic anemia meaning that it results in the ineffective production of hemoglobin molecules (McPhee & Hammer, 2012). These anemias are characterized by small erythrocytes with an insignificant amount of hemoglobin (Huether & McCance, 2012). IDA is directly related to some type of blood loss, lack of dietary iron, or pregnancy. Often, in women, this can develop with menorrhagia. Other factors that can cause concern for IDA incidence include gastrointestinal medications that can cause bleeding, surgical procedures, insufficient dietary intake, and certain eating disorders (Heuther & McCance, 2012). Other bleeding disorders such as hemoptysis and hemoglobinuria may also contribute (McPhee & Hammer, 2012).

PA is a macrocytic-normochromic anemia characterized by enlarged stem cells and normal hemoglobin content. PA is said to not be caused by blood loss, but rather by a lack of vitamin B12 (Heuther & McCance, 2012). Gastritis, gastric surgery, and other gastric disorders may cause an acid and pepsin deficiency that inhibits the release of B12 (Hooper et al., 2014). Autoimmune disorders can contribute to IF deficiency (Hooper et al., 2014). Pancreatic insufficiency and other intestinal factors may also contribute to a lack of B12 (Hooper et al., 2014). IDA and PA have similar clinical manifestations.

Factors Impacting Anemia

            IDA is said to more prevalent in women of childbearing age due to menorrhagia (McPhee & Hammer, 2012). Children are also more at risk due to their increased iron needs (Huether & McCance, 2012). Individuals living in poverty may be more at risk due to poor dietary intake and lack of access to care and care coverage (Peate & Jones, 2014). IDA is prevalent in developed and non-developed countries (Heuther & McCance, 2012). IDA may also have a familial component (Peate & Jones, 2014). Diet and family history should be assessed during the initial history.

            PA is more common in females over 30 years of age (Heuther & McCance, 2012). Northern Europeans, blacks, and Hispanics are more likely to have PA (Hooper et al., 2014). Dietary intake of B12 also plays a role. Vegans and children of vegans have a high incidence rate of PA (Hooper et al., 2014). Hooper et al. (2014) showed that 265 out of 889 participants in their study had either a parent or grandparents with PA, which is a significant indicator that genetics are involved in the development of PA.

Conclusion

            Anemia, in general, is the most common blood disorder. IDA and PA differ in their pathophysiology but have many of the same clinical manifestations. Factors such as age, gender, ethnicity, and lifestyle can influence the rate of these diseases. It is important, as advanced practice nurses, to understand the different types of anemia from their risk factors to their pathophysiology.  

 

References

Hooper, M., Hudson, P., Porter, F., & McCaddon, A. (2014). Patient  journeys: Diagnosis and treatment of pernicious anaemia. British Journal of Nursing, 23(7). Retrieved from http://info.britishjournalofnursing.com/

Huether, S. E., & McCance, K. L. (2012). Understanding pathophysiology (Laureate custom ed.). St. Louis, MO: Mosby.

McPhee, S. J., & Hammer, G. D. (2012). Pathophysiology of disease: An introduction to clinical medicine (Laureate Education, Inc., custom ed.). New York, NY: McGraw-Hill Medical.

Peate, I. & Jones, N. (2014). Pathophysiology series 1: Iron deficiency anemia. British Journal of Healthcare Assistants, 8(4), 164-169. Retrieved from http://www.magonlinelibrary.com/toc/bjha/current

 

 

 

 

 

 

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