NUTRITIONAL

ANEMIA
Nurpudji Astuti. MD, MPH, Sp.GK

Nutrition Department
School of Medicine
Hasanuddin University

Anemia gizi
Anemia yang disebabkan oleh

defisiensi nutrien yang merupakan

faktor eritropoesis dalam
pembentukan sel darah merah
Fe, vit.B.12, vit.B6, Vit.C, Cu dan

Co, asam folat dan protein

Definisi Anemia
Keadaan dimana kadar hemoglobin

darah lebih rendah dari normal

Penyebab

Asupan tidak adekuat ( Primer)

Absorbsi tidak adekuat ( TGI disease )
Utilisasi tidak adekuat (keganasan, infeksi)
Kebutuhan yang meningkat (kehamilan)
Eksresi yang meningkat ( peny.hati)

TIPE ANEMIA GIZI

BERDASARKAN PEMERIKSAAN
HEMATOLOGIK
Anemia mikrositik hipokromik

disebabkan oleh defisiensi zat besi

Anemia makrositik hiperkromik atau

megaloblastik anemia
disebabkan oleh defisiensi vitamin
B.12 dan asam folat

NILAI HEMOGLOBIN DAN

HEMATOCRIT/PCV DAN MCHC
KELOMPOK UMUR

Hb
g/100ml

Ht atau PVC
(%)

MCHC

Anak 6 bln -6 th

11

33

34

Anak 6 th 14

12

36

34

Laki2 dewasa

13

39

34

Wanita dewasa

12

36

34

Bumil

11

33

34

GEJALA KLINIK ANEMIA GIZI

GEJALA KLINIK ANEMIA AKAN

MEMBERIKAN GAMBARAN SERUPA

APAPUN PENYEBABNYA

DEFISIENSI ZAT BESI PADA ANAK

DITEMUKAN PADA NEGARA MAJU DAN

BERKEMBANG
PADA ANAK

Cadangan besi yang terbatas

Pertumbuhan yang cepat
Variasi makanan yang terbatas
Makanan tambahan yang terlambat
Metabolisme yang meningkat
Absorbsi yang berkurang

ETIOLOGI
ANEMIA PADA ANAK
Bayi < 6 bulan
Cadangan

besi tidak adekuat

Makanan tambahan terlambat

Umur 1 - 2 tahun
Infeksi

sal. cerna dan nafas

Diet tidak adekuat

5 tahun
Infeksi

parasit ( ankylostomiasis, trichuris,

amubiasis )

ANEMIA PADA WANITA DEWASA

Keperluan yang meningkat pada masa

menstruasi
Kehamilan
Laktasi

Pada saat menstruasi

Rata-rata kehilangan darah 30 ml/hari
Dibutuhkan 0,1 mg Fe
Absorbsi dalam makanan 20%, untuk itu

dibutuhkan asupan zat besi sebanyak 10

mg dalam makanan
Absorbsi makanan akan ditingkatkan
oleh protein hewani
Akan dihambat oleh kandungan pytat
dari tumbuh2an

KEHAMILAN DAN LAKTASI

Kehilangan besi pada kehamilan normal
Fe

foetus
Persalinan
Laktasi

Total

400 mg
325 mg
175 mg
900 mg

Untuk periode selama 460 hari

membutuhkan tambahan 2mg Fe/hari

Patogenesis terjadinya
defisiensi zat besi pada wanita
Perubahan metabolisme zat besi selama

kehamilan
Faktor lain
Perubahan

komposisi darah
Perubahan pada sumsum tulang
Pertumbuhan dan perkembangan foetus
Intake yang kurang
Absorbsi meningkat 20-40% ( ibu anemi)
Pool bumil yang rendah (jarak hamil dekat)

Total zat besi dalam tubuh

4-5gr (dewasa) & 400mg (Bayi)
RBC yang beredar

60%

Ferritin & hemosiderin

30%

Myoglobin

5-10%

Enzym2 haem

<1%

Fe plasma

0.1%

KEHILANGAN BESI DARI TUBUH

Bayi

0.3-0.4mg/hr

Anak umur 4 12 th

0.4-1.0/hr

Laki2 dewasa

1.0-1.5/hr

Wanita dewasa

1.0-2.5/hr

bumil

2.7mg/hr

IRON
Human body contains 3 to 5 g iron
Approximately 2 g as Hemoglobin and 8 mg as

enzymes
Well conserved by the body ; approximately 90% is
recovered and reused extensively.
Highly reactive element that can interact with oxygen
to form intermediates able to damage cell membrane
or degrade DNA.
Iron must be tightly bound to proteins to prevent
destructive effects.

IRON COMPOUND IN THE BODY

METABOLIC PROTEIN

Heme Proteins
Hemoglobin
Oxygen transport from lungs to tissues
Myoglobin
Transport & store Oxygen in muscle
Enzymes - Heme
cytochromes
Electron transport
Cytochrom
P-450
Oxidative degradation of drugs
Catalase
Convert hydrogen peroxide to oxygen and
water
Enzymes-Nonheme
Iron sulfur & metalloproteins

Oxidative metabolism

Enzymes-iron dependent
Tryptophan pirrolase Oxidation of tryptophan

IRON COMPOUND IN THE BODY, cont..

TRANSPORT AND STORAGE PROTEINS

Transferrin
Ferritin
Storage

transport of iron and

other minerals
Storage
Hemosiderin

Two Types IRON in Food:

Heme-Iron:

In animals product (hemoglobin & myoglobin)

Well absorbed About 90% of iron consumed
Nonheme-iron :

Mainly in plants
Main source of iron in the diet (~10%)
Absorption variable affected by other factors

Iron cont
95% is associated with proteins e.g hemoglobin & myoglobin
Functions:
Respiratory transport of O2 & CO2
(Oxygen binding component of hemoglobin and myoglobin)
Co-factor for enzymes
Involved in the immune function and cognitive
performance
Absorption
Transported
Sources

:
Well regulated
:
Transferrin
Meat, seafood, some vegetables

Iron Absorption
Healthy Individuals: 5-10% absorbed
Iron deficiency : Up to 40% absorbed
Factors that affect absorption:

enhancing factors:
acid in the stomach
heme iron
high body demand
low body stores
meat protein factor
vitamin C

Iron Absorption, cont.

Inhibiting factors

dietary fiber (phytate)

tannin in tea
Calcium helps to remove phosphate,

oxalate and phytate that would combine

with iron and inhibit its absorption

Iron routes in body

Most iron is recycled.

Some lost with body tissues and must be replaced by eating ironcontaining food
Intestinal cells:
store excess in ferritin; if body no need iron-----some losses in shed
intestinal cells; package iron in transferrin (transport protein)
Blood:
transferrin carries Fe in blood; some losses via urine, sweat, skin;
some Fe delivered to myoglobin of muscle cells; bone marrow puts
Fe into haemoglobin of red blood cells; stores excess in ferritin and
haemosiderin
Liver/lien;
Dismantle red blood cells and package Fe into transferrin, stores
excess as ferritin / haemosiderin

Iron Deficiency and Toxicity

Deficiency:

decreased blood hemoglobin (anemia)

Low plasma iron

increased transferrin and reduction in tissue iron

lethargy

Toxicity

Not common, usually due to a genetic disorder

Source of Iron
Adequate diet contains no more than

6mg/1000kcal of iron
RDA 12mg/day
Dried beans and vegetables are the best plant
sources
Best sources dietary iron

Liver, heart, kidney, lean meat

oysters, shellfish
Fish
Poultry

COPPER
COMPONENT OF MANY ENZYMES
OXIDIZING IRON BEFORE IT IS

TRANSPORTED ( ceruloplasmin, copper

containing protein, required for normal

mobilization of iron from its storage site to
the plasma)
PLAYS ROLE IN MITOCHONDRIAL ENERGY

PRODUCTION, PROTECTION FROM

OXIDANTS, AND SYNTHESIS PF MELANINE
AND CATHECOLAMINE

Source of Copper
Most diet provide 2mg/day
RDA 1.5 - 3mg/day
Food high in copper
Oysters, shellfish
Liver, Kidneys
Chocolate
Nuts
Dried legumes, Dried foods
Cereals
Poultry

Cobalt
A component of vitamin B12 (cobalamin)
This vitamin is essential for maturation of red blood

cells and normal functioning of all cells

Requirement expressed in terms of Vit B12 : 1.4-2
ug daily
Toxicity : intake of 10 to 20 ug/kg Body weight : high
intake cobalt in animal diet produce polycytemia,
bone marrow hyperplasia, reticulocytosis, and
increased blood volume
Deficiency: related to Vit B12 deficiency --macrocytic anemia

Source of Cobalt
RDA 1.4 - 2.0 ug/day
Liver, kidney,
Oysters, clams
Poultry
Milk

FOLIC ACID
RDA

Male
Female

200ug
180ug

Functions

Essential for bio-synthesis of nucleic acids.

Essential for normal maturation of RBC
Functions as co-enzyme: tetrahydro-folic
acid

Source of Folic acid

Green leafy vegetable,
Organ meats (liver),
lean beef,
Wheat, dry beans,
lentils, cowpeas
Asparagus, broccoli,
collards, yeast
Synthesized by intestinal tract

B12 Vitamin
Involved in the metabolism of single

carbon fragment
Essential for biosynthesis of nucleic acid
and nucleoproteins
Role in metabolism of nervous tissue
Involved with folate metabolism
Related to growth

B12 Vitamin cont.

RDA 2ug
Liver, kidney
Eggs, fish
Milk and dairy product
Vegans require supplement

Contoh soal
Seorang wanita yg menderita anemia dengan

kadar Hb 9 gr%.
Berapa kebutuhan Fe yang harus diberikan
untuk menaikkan Hb menjadi 12, jika setiap
kenaikan 0.5 gr Hb/100 ml dibutuhkan 85 mg
elemental diet?
Dari 9 gr jadi 12 = 6 x 85 mg elemental Fe, plus
50% untuk pool Fe
Total kebutuhan Fe= 510gr el. Fe + 205gr el.Fe
= 715 el.Fe
Terapi dilanjutkan selama 6 bulan