Anemia Gizi
Anemia Gizi
Anemia Gizi
Agussalim Bukhari
Bagian Ilmu Gizi
Fak.Kedokteran Unhas
SEVERE PROTEIN ENERGY MALNUTRITION (PEM)
MARASMUS
KWASHIORKOR
Types of Malnutrition
•Marasmus
•Kwashiorkor
•Mixed
Tipe :
1. Mikrositik hipokremik ---- defisiensi Fe
2. Makrositis hiperkromik = megaloblastik
anemia--- defisiensi vitamin B12, Folic acid
Etiologies
1. diminished erythropoiesis due to
nutritional def or BM failure
2. Blood loss
3. Increased hemolysis, hereditary or
acquired
PENYEBAB DEFISIENSI
1. Asupan tidak adekuat
2. Absorpsi tidak adekuat
3. Utilisasi tidak adekuat---gangguan
enzim
4. Keperluan meningkat ( Bumil )
5. Eksresi Meningkat ( Penyakit Hati )
6. Mobilisasi dari penyimpanan (Ferritin)
terganggu---penyakit infeksi/
inflamasi
Etiologies
Category (MCV) Nutritional causes Other causes
Macrocytic (>100 u3) Folic acid def, Vit B12 Def Alcoholism. Liver
disease, hemolysis
etiologies
• Microcytic and macrocytic can coexist;
patient can have both iron and folic acid
def.
• In these case MCV may normal and
suggest a normocytic anemia but the
blood smear shows dimorphic RBCs
• Nutritional def anemia may occur in
normal intake if there are increased
requirements, inadequate ingestion,
malabsorption, impaired utilization,
elevated requirements, increased
excretion, or increased destruction
Diagnostic steps
Patient history
Physical examination
Lab: blood smear, blood count, Ht, MCV,
BM
Microcytic anemia
Common cause is iron def
Iron def: inadequate intake, absorption,
excessive loss/bleeding
Iron def is the most common nutritional
anemia and the most common nutritional
deficiency.
Pathophysiology
Iron in the body: functional and storage form
Iron incorporated into heme and myoglobin
Part of enzymes : COX, catalase, peroxidase
Storage form: ferritin and hemosiderin
Dietary iron: heme iron from animal/meat and
nonheme iron from vegetables and cooking
vessels
Largely absorbed in the duodenum
• Heme iron 20% bioavailable, nonheme iron 3%
available
• Net absorption of the two forms combined is 10%
• Each day, about 1 % RBC is destroyed releasing
about 30 mg of Iron into RES and circulation
• Of 30 mg released, about 29 mg salvaged and only
1 mg must be replaced
• 1 mg can be absorbed from 10 mg iron contained-
diet (RDA)
Premenopausal women need additional
0.5 mg/day to compensate menstrual
loss----1.5 mg ---15 mg RDA
The group with greatest risk: (1) 6 mo---4
y.o(2) early adolescence (3) menstrual
women (4) pregnant women
Lab
Lab finding Injury, Iron deficiency PEM
infection,
chronic
inflammation
KADAR
UMUR Ht MCHC
Hb
6 Bl – 6 Th 11 33 34
6 Th – 14 th 12 36 34
Laki dewasa 13 39 334
Wanita dewasa 12 36 34
Bumil 11 33 34
ANEMIA DEFISIENSI BESI
Anak :
1. Pada bayi karena cadangan Fe rendah
2. Pertumbuhan cepat
3. Variasi makanan yang terbatas
4. PMT terlambat
5. Infeksi – metabolisme meningkat
6. Absorbsi berkurang – infeksi TGI
7. Kehilangan darah kronis – ankylostomiasis
8 . Obesitas----inflamasi----gangguan mobilisasi Fe dari
ferritin dan gangguan absorpsi
Dewasa :
- Wanita haid --- kehilangan 30 mg --- butuh
1 mg Fe / hari
- Bumil --- 900 mg untuk cadangan foetus,
persalinan dan laktasi, butuh 2 mg Fe / hari
Pencegahan :
1. Fe prophylaxis
2. Perbaikan pola makan
3. Keluarga berencana
4. Fortifikasi makanan
5. Eradikasi infeksi dan infestasi parasit
Sumber Fe
Meat and alternative
Liver ( 300 mg) : 5.3 ug
Hamburger : 2.3
Soybean (2 cups) : 2.9
Fish 300 mg : 0.3
Chicken 300 mg : 0.9
Vegetables
Spinach 1 cup : 1.7 ug
Asparagus 1 cup : 1.2 ug
ANEMIA MEGALOBLASTIK ANAK
FOLIC ACID – Sintesis RNA dan DNA
Penyebab :
1. Asupan tidak adekuat
2. Gangguan absorbsi : stetoroe idiopatik, tropical
sprue, celiac disease, kelainan TGI lain
3. Antagonis folic acid : metotrexate, primetamin
Pengobatan :
1. Terapi penyebab dan asupan makanan
2. Pemberian folic acid 3 x 5 mg/hr atau 3 x 2,5
mg pada bayi
3. Tranfusi darah bila diperlukan
ANEMIA MEGALOBLASTIK DEWASA
= An Perniciosa Addison
Penyebab :