THIRD YEAR, SECOND SEMESTER

MEDICAL NUTRITION THERAPY 2: HEMATOLOGICAL SYSTEM

LECTURE BY: ASST. PROF. DIANE MENDOZA

components that will be transferred

OUTLINE OF TOPICS into the glomerulus to form the
I. REVIEW glomerular filtrate.
A. Blood Components
B. Hematological System F. NUTRIENTS
C. RBC - Erythrocytes ➔ The digested nutrients such as
D. White Blood Cells - Leukocytes
glucose, vitamins, minerals, and
E. Platelets - Thrombocytes
F. Hemoglobin proteins are absorbed into the blood
G. Hemostasis through the capillaries in the villi
H. Iron lining the small intestine.

II. DISEASES OF THE BLOOD G. ELECTROLYTES AND MINERALS

A. Anemia ➔ These are chemical substances that
B. Nutritional Anemias
are found naturally in the body.
C. Non-Nutritional Anemias
D. Clotting & Bleeding Disorders These are minerals present in our
body, tissues, blood, body fluids, and
BLOOD COMPONENTS urine.

A. RED BLOOD CELLS (RBC)

➔ Red blood cells are also called
erythrocytes and are the most
abundant cell type in the blood,
which are round with a flattish,
indented center, like doughnuts
without a hole. They carry fresh
oxygen all over the body.
➔ Food rich in Iron helps maintain
healthy red blood cells. Vitamins like
B-2, B-12 and B-3 found in foods
such as eggs, whole grains, and
bananas, and Folate found in
fortified cereals, dried beans, lentils,
orange juice and green leafy HEMATOLOGICAL SYSTEM
vegetables are also needed to build
A. Bone Marrow
healthy RBC.
➔ The spongy tissue inside some of the
bones, such as hip and thigh bones,
B. WHITE BLOOD CELLS (WBC)
contains stem cells that can develop
➔ WBC are also called leukocytes
into red blood cells.
which are responsible in fighting
➔ Hematopoiesis (stem cells) is the
infection and other diseases. All
formation of blood cellular
white blood cells are produced and
components. It is a process wherein
derived from multipotent cells in the
the body manufactures blood.
bone marrow known as
➔ Hematopoiesis occurs within organs
hematopoietic stem cells.
and tissues or the hematopoietic
➔ The different types of WBC are
system such as bone marrow, liver
neutrophil, eosinophil, basophil,
and spleen.
lymphocyte, and monocyte.
B. Spleen
C. PLATELETS
➔ The largest lymphoid organ in the
➔ A small colorless disk-shaped cell
body. Located in the upper-left part
fragment without a nucleus and is
of the abdomen, not far from the
involved in clotting. This is also called
stomach that produces lymphocytes
thrombocytes.
- an important element in the
immune system.
D. TRANSPORT PROTEINS
➔ One of the hematopoietic systems in
➔ Proteins that transport substances
which hematopoiesis occurs.
across biological membranes. They
are also called transporters which
C. Lymph System
are integral membrane proteins that
➔ Has a role in cell maturation and
help other substances to diffuse in
immune function.
and out of the cell.
➔ Protects the immune system/body
➔ Transferrin is an example of
from illness causing invaders,
transporter which is a protein that
maintains fluid levels and removes
binds iron and transports it
cellular waste.
throughout the body. The main iron
carrier in the blood.
D. Liver
➔ The liver is responsible for protein
E. NITROGENOUS WASTES
production
➔ Nitrogenous wastes including water
and nutrients are filterable blood
THIRD YEAR, SECOND SEMESTER
MEDICAL NUTRITION THERAPY 2: HEMATOLOGICAL SYSTEM
LECTURE BY: ASST. PROF. DIANE MENDOZA

➔ The major hematopoietic organ blood and lymph tissue.

during prenatal development. Leukocytopoiesis is the formation
and development of the various
E. Endothelium types of white blood cells.
➔ Thin membrane that lines the inside ➔ Granulocytopoiesis is a part of
of the heart and blood vessels. hematopoiesis that leads to the
➔ Responsible for controlling blood production of granulocytes
clotting, immune function and (eosinophils, basophils, and
platelet adhesion. neutrophils) or polymorphonuclear
leukocyte (PMN) which is a type of
RED BLOOD CELLS: ERYTHROCYTES WBC that has multi-lobed nuclei,
➔ Contains hemoglobin usually containing 3 lobes and has a
➔ Essential nutrients are PUFA which significant amount of cytoplasmic
helps in flexibility and shape of RBC (small) granules within the cell. They
membrane and Vit. E which prevents help the immune system fight off
oxidation and helps in the infection.
membrane's stability. ➔ Monocytopoiesis is the process
➔ RBC is made from undifferentiated which leads to the production of
cells called stem cells inside the monocytes (macrophages) which is
bone marrow or cells that have yet the largest (approx. 2%-10% of white
to develop into a particular type of blood cells) phagocytic WBC with a
cell. simple oval nucleus and clear,
➔ Reticulocytes are immature RBC and grayish cytoplasm. Monocytes
an increase in the number of young protect against viral, bacterial,
red blood cells is called fungal and protozoal infections.
reticulocytosis. ➔ Lymphocytopoiesis is the formation
➔ Hematopoiesis is the formation of all of lymphocytes which is a type of
blood cells from hematopoietic stem immune cell that is made in the
cells (immature cells that can bone marrow and is found in the
develop into all types of blood cells) blood and lymph tissue. The two
while erythropoiesis is the process main types of lymphocytes are B
that produces RBC. Lymphocytes (humoral immune
➔ Eryptosis is a suicidal system) which mature in the bone
preprogrammed RBC death. It marrow and T lymphocytes (cell
occurs before RBC has a chance to mediated immune system) which
be naturally removed from the mature in the thymus.
circulation after its 120 days lifespan. ◆ Helper T-Cells (CD3 1 CD4
◆ The process can be type cells)
membrane bleeding, cell ◆ Cytotoxic T-Cells (CD8 type
shrinkage, exposure to cells)
phosphatidylserine - a key ➔ Essential nutrients for WBC are Vit. A,
pathway for viruses to enter Iron, B-Vitamins and Protein.
cells via apoptotic mimicry.
PLATELETS: THROMBOCYTES
➔ Platelets, also called thrombocytes.
The smallest of our blood cells and
can only be seen under a
microscope.
➔ Shaped like small plates in their
non-active form.
➔ Platelets are the cells that circulate
within our blood and bind together
when they recognize damaged
blood vessels.
➔ Short-lived fragments
➔ Cytokines → Platelet Aggregation →
Overview of Hematopoiesis
Clot
➔ Measures of platelet activity:
◆ Clotting factors
◆ Bleeding time
◆ Clotting time

HEMOGLOBIN
➔ Four-subunit metalloprotein with iron
at the center of each subunit that is
Control of Erythropoiesis responsible for transporting oxygen
in the blood of vertebrates and
WHITE BLOOD CELLS: LEUKOCYTES carbon dioxide binding.
➔ A type of blood cell that is made in ➔ Hemoglobin subunits:
the bone marrow and found in the
THIRD YEAR, SECOND SEMESTER
MEDICAL NUTRITION THERAPY 2: HEMATOLOGICAL SYSTEM
LECTURE BY: ASST. PROF. DIANE MENDOZA

◆ Globin - Protein moiety; ➔ Vegetable fiber inhibit nonheme iron

superfamily of absorption
heme-containing globular ➔ Tea and coffee can reduce iron
proteins, involved in binding absorption through the formation of
and/or transporting oxygen. insoluble iron compounds with
◆ Heme - Porphyrin ring tannin.
structure that carries iron. ➔ Absorption may be inhibited by
Forms the non protein part of chelate iron (carbonates, oxalates,
hemoglobin and some other phosphates, and phytates)
biological molecules.
DISEASES OF THE BLOOD
A. Anemia
➔ Anemia is the deficiency of healthy
red blood cells in blood which is
essential in transporting oxygen to all
parts of the body.

Clinical Signs and Symptoms

Fatigue Difficulty
concentrating

Lethargy Sleepiness

Cheilosis Irritability

Glossitis General malaise

HEMOSTASIS
➔ A natural mechanism that leads to Pallor Gastrointestinal
regulation of bleeding, clotting and distress
blood flow. The stopping of a flow of
blood during injury. Pale Sclera Reproductive
➔ Hemo - meaning blood, and stasis dysfunction
meaning stopping.
➔ 3 mechanisms: Spoon-shaped Cardiovascular
◆ Vasoconstriction - Reduction fingernails sequelae
of blood flow
◆ Platelet plug information - Clubbing of joints in Paresthesias
von Willebrand factor the digits
(increased stickiness of
platelets) Cold extremities
Prothrombin → Thrombin
Fibrinogen → Fibrin Muscle aches
◆ Clotting of blood: Vit K and
Calcium (Factor IX, X, VII)
B. Nutritional Anemias
➔ Dietary factors: Vit K, Dietary fats,
➔ Macrocytic Anemia - Inability to
Antioxidants (Vit C, E, and Selenium),
absorb, transport, store or utilize iron.
Pro-oxidants (Iron and Copper) and
Referred to as macrocytosis when
Cell signals (Calcium Ions)
the mean corpuscular volume is
greater than 100fL in the setting of
IRON
anemia (hemoglobin less than 12
➔ Iron is a mineral that is important in
g/dL or hematocrit (Hct) less than
making red blood cells and is
36% in nonpregnant females,
involved in various bodily functions
hemoglobin less than 11 g/dL in
including the transport of oxygen in
pregnant females, or hemoglobin
the blood.
less than 13 g/dL or Hct less than 41%
➔ The rate of iron absorption is
in males).
dependent on the nutritional status.
◆ Divided into two forms:
➔ Heme iron
● Megaloblastic
◆ MFP - Meat, Fish and Poultry
● Non-megaloblastic
◆ Enhances the absorption of
➔ Microcytic Anemia - Impaired heme
nonheme iron present in the
synthesis. Defined as the presence of
same food items or other
small, often hypochromic, red blood
food items eaten at the
cells in peripheral blood smear and is
same time.
usually characterized by a low MCV
➔ Nonheme iron
(<83 micron 3).
◆ MFP and Eggs, Grains,
◆ Types of microcytic anemias:
Vegetables and Fruits.
● Iron Deficiency
➔ Vit C. enhances the absorption of
Anemia
iron.
● Functional Anemia
THIRD YEAR, SECOND SEMESTER
MEDICAL NUTRITION THERAPY 2: HEMATOLOGICAL SYSTEM
LECTURE BY: ASST. PROF. DIANE MENDOZA

➔ Hemolytic Anemia - A disorder in ➔ Pernicious Anemia - Associated with

which the RBC are destroyed faster Vit B12 deficiency, specific to
than they can be made. Usually gastrointestinal dysfunction.
caused by deficiencies or excesses ◆ Etiology
in Vit E. ● Aging
● Disease state
● Poor intake of Vit B12
Type of Related Nutrient Def/Toxicity
Anemia ● Helicobacter Pylori
Deficiency Toxicity ● Decrease in gastric
acid secretion
Macrocytic Cyanocobalamin ◆ Medical Nutrition Therapy
Folate ● Vit B12 or Folate
Thiamine
Pyridoxine
Supplementation
● High protein diet
Microcytic Protein Cooper (1.5g/kg of body
Iron Zinc weight) for liver
Ascorbate Lead function and blood
Vitamin A Cadmium regenation.
Pyridoxine Other ● Increase consumption
Cooper heavy
of the following:
Manganese metals
○ Green leafy
Hemolytic Vitamin E deficiency or toxicity vegetables (Iron
and Folic acid)
○ Liver (Vit B12, Iron
➔ Iron Deficiency Anemia - A common and Folic Acid)
type of anemia in which blood lacks ○ Meats, eggs, milk
adequate healthy red blood cells. and milk
● Low normal circulating RBC products (Vit B12)
(Cubic millimeter of blood)
● Low hemoglobin
● Low packed RBC (Deciliter of
blood)
◆ Etiology
● Blood loss
● Inadeq intake and/or
absorption
● Infancy/childhood
● Pregnancy
● Mineral excesses (Ca,
Zn, Cu and Mn)
● Contaminants (Lead)

➔ Hemochromatosis - Also known as

iron overload since it is a disorder in
which extra iron builds up in the
body to harmful levels. The
regulatory mechanisms for iron are
inoperative which leads to the
build-up of iron and pro-oxidant iron
damage of cells.
● Hepcidin is a peptide hormone
made in the liver, a systemic
iron-regulating hormone that
controls plasma iron
concentration and tissue
distribution of iron by inhibiting
intestinal absorption, iron
recycling and iron mobilization.
◆ Etiology:
➔ Megaloblastic Anemias - A ● Genetics
condition in which the bone marrow ● Alternate conditions
produces unusually large, structurally such as liver disease
abnormal, immature red blood cells ◆ Pathophysiology:
(megaloblasts) ● Chronic toxicity:
◆ RBC has decreased capacity ○ Functional DM
for oxygen transfer. ○ Hepatomegaly
◆ Deficiencies of Folate and ○ Cicatrix formation
Cyanocobalamin (B12) ○ Cirrhosis
THIRD YEAR, SECOND SEMESTER
MEDICAL NUTRITION THERAPY 2: HEMATOLOGICAL SYSTEM
LECTURE BY: ASST. PROF. DIANE MENDOZA

◆ Medical Nutrition Therapy: ➔ Sickle cell anemia is an inherited red

● Minimize the risk of blood cell disorder in which there
excess iron intake aren’t enough healthy RBCs to carry
● Educate patients about oxygen throughout the body. It is a
iron sources, role of result of defective hemoglobin
acidic and vitamin C synthesis which produces
rich foods on iron sickle-shaped RBCs (crescent
absorption. shaped) and does not carry oxygen
● No iron-containing well.
supplements and ● Substitution shaped cell
heavily fortified foods glutamic acid in hemoglobin
(cereal products). causes it to turn into a gel.
◆ Medical Nutrition Therapy:
➔ Sideroblastic anemia is a type of ● Increased
anemia that results from abnormal macronutrients, oral
utilization of iron during erythropoiesis. glutamine
◆ Pathophysiology: supplementation,
● Abnormal heme folate and B12.
synthesis ➔ Polycythemia refers to an increase in
● Iron overload due to the number of red blood cells in the
adjustment for poor body. The extra cells cause the
oxygenation blood to be thicker, increasing blood
● Microcytic and viscosity.
hypochromic RBCs ● Primary cause: High EPO
● High iron levels, build up (erythropoietin) levels.
of sideroblasts which ● Secondary cause: Physiological
are iron containing response to hypoxia (state in
immature RBCs. which oxygen is not available in
◆ Medical Nutrition Therapy: sufficient amounts at the tissue
● Pyridoxine level to maintain adequate
supplementation (25 to homeostasis).
100 times higher than ➔ Aplastic anemia is a condition that
RDA). occurs when your body stops
producing enough new blood cells.
➔ Hemolytic Anemia is a disorder in It is a failure of the bone marrow to
which red blood cells are destroyed produce cells.
faster than they can be made. The ● Reduces clotting ability,
premature destruction of erythrocytes. immunity and ability to carry
◆ Pathophysiology: oxygen.
● Defects in red blood ● Normochromic (normal color),
cells membranes lead normocytic (normal size) anemia.
to oxidative damage
and eventually to cell D. Clotting & Bleeding Disorders
lysis or cellular disruption ➔ Hemophilia is an inherited bleeding
in which the outer disorder in which the blood does not
boundary of cell clot properly.
membrane is broken ◆ Epidemiology:
down or destroyed in ● Hemophilia A occurs
order to release in 1 per 5,000 live
inter-cellular materials male births.
(DNA, RNA, Protein or ● Hemophilia B occurs
organelles from cell). in 1 in 30,000 male live
● Vit. E deficiency births.
● Shortened survival of ◆ Etiology:
mature RBCs (Less than ● Hereditary inability to
120 days). make needed
clotting factors.
C. Non-Nutritional Anemias ◆ Pathophysiology:
➔ Thalassemia is a reduction of globin ● Hemorrhage and
availability that results in decreased bleeding occurs in
hemoglobin synthesis, RBC death the joints.
and inability to carry oxygen. ◆ Clinical manifestations:
● Microcytic (small size), ● Bleeding
hypochromic (pale color) and ● Joint and soft tissue
short lived RBCs increases plasma damage
volume, splenomegaly ● Pain and loss of
(enlargement of the spleen), and function
bone marrow expansion. ◆ Treatment:
● Synthetic clotting
factor administration.
THIRD YEAR, SECOND SEMESTER
MEDICAL NUTRITION THERAPY 2: HEMATOLOGICAL SYSTEM
LECTURE BY: ASST. PROF. DIANE MENDOZA

● Gene transfer therapy platelet plug formation,

is under investigation. and fibrin formation.
◆ Nutritional Therapy: ◆ Clinical manifestations:
● Maintain nutritional ● Differs depending on
adequacy. where the clot is formed
● Ensure antioxidant or where it lodges.
adequacy. ◆ Treatment:
➔ Hemorrhagic disease of the newborn ● Anticoagulants
is a bleeding problem that occurs in (Coumarin derivatives,
a baby during the first few days of Coumadin warfarin,
life. Babies are normally born with Heparin etc.)
low levels of vitamin K. ◆ Nutritional Therapy
◆ Epidemiology: ● Maintain constant
● Vit. K administration at vitamin K rich food
birth results in an intake over time.
extremely low
prevalence rate.
◆ Etiology:
● Vit. K deficiency is
seen in infants with a
sterile GI tract.
◆ Pathophysiology:
● Vit. K is required for
clotting factor
activation.
◆ Clinical Manifestations:
● Bleeding from the
umbilicus after birth.
● Bleeding from the GI
tract, skin or orifices
post delivery.
◆ Treatment:
● 0.5 to 1.0mg
phylloquinone given
by intramuscular
injection.
◆ Nutrition Therapy:
● Maintain optimal
feeding practices for
young infants.
➔ Thrombosis occurs when a blood
clot forms either in a vein or an
artery.
◆ Epidemiology:
● Prevalence differs
according to the
exact etiology of the
clotting.
◆ Etiology:
● Atherosclerosis
● Chronic inflammation
● Increased blood
viscosity
● Increased platelet
activity
● Risk factors such as:
○ High fat, high
cholesterol diet.
○ Smoking
○ Sedentary lifestyle
○ Obesity
○ Hypertension
○ Oxidative stress
○ Hyperhomocysteinemia
○ Increased coagulation
factors.
◆ Pathophysiology:
● Coagulation processes
including; vessel spasms,