Anemia Defisiensi

Besi dan Stunting

Moretta Damayanti
 Key Points

Definisi, faktor risiko dan gejala zat besi untuk tata laksana ADB
anemia defisiensi besi (ADB)

Efek anemia pada tumbuh kembang Strategi nutrisi untuk tata laksana ADB
anak.
 Anaemia
Ana=Absent/decreased Emia: blood

Kondisi dimana jumlah sel darah merah (RBCs) tidak cukup

untuk memenuhi kebutuhan fisiologik tubuh.
Hemoglobin cut off level (WHO)
Efek samping anemia
Penyebab

Produksi menurun Destruksi meningkat/

pendarahan

Drugs : TMP-sulfamethoxazole, amphotericin Hemolysis : TTP, G6PD, AIH

B, ganciclovir, dapsone
Deficiencies : Erythropoietin, iron, folate,
vitamin B-12
Infection: HIV, Parvovirus B-19, Histoplasma
capsulatum
Marrow failure/replacement: Aplastic
anemia, pure red cell aplasia,
malignancy
Anemia of chronic disease
Defect of hemoglobin :
hemoglobinopathy, thalassemia
Defect of the red cell membrane
(spherocytosis)
Hypersplenisme
Acute or chronic blood loss
7

CLINICAL APPROACH TO ANAEMIA

https://labpedia.net/anemia-classification-diagnosis-and-routine-workup/
Introdu
 Anemia
defisiensi
besi (ADB)
Prevalensi
Prevalensi Stunting dengan ADB???
 • Masih menjadi masalah kesehatan di dunia
• WHO: 25% penduduk dunia anemia, separuhnya adalah ADB
• Sulit terdeteksi secara dini
• Besi sangat diperlukan dalam proses metabolisme, mielinisasi
otak, sistem imun
• Defisiensi besi akan berpengaruh terhadap proses tumbuh
kembang anak
• Derajat anemia yang terjadi ~ tingkat keparahan dampak negatif
jangka panjang dan bersifat ireversibel

Penting
pencegahan
sebelum terjadi
anemia
 Kriteria ADB

Kadar Kadar hemoglobin Ditambah satu atau

Gambaran darah tepi
hemoglobin meningkat setelah lebih kriteria: Red-
lebih kecil dari menunjukkan terapi besi cell Distribution
batas nilai mikrositik dan atau elemental selama
normal untuk Width (RDW) lebih
hipokrom dua bulan
dari 14%, indeks
usianya.
Mentzer lebih dari 13
 Gejala dan Klinis ADB Pica à rasa kurang
nyaman di mulut
(berkurangnya enzim
sitokrom oksidase yang
mengandung besi)
Iritabel, lesu, lemas, nafsu
makan berkurang, perhatian Pucat, lidah licin,
mudah teralih, tidak bergairah stomatitis, keilitis,
bermain, cepat lelah bila koilonikia aklorhidria
sedang bermain. dengan atrofi mukosa
saluran cerna
parestesia, aktifitas otot
Sulit konsentrasi dalam rangka terganggu
belajar, pusing atau sakit fungsi leukosit abnormal,
kepala, dada berdebar- fungsi sel T dan fungsi
debarà defisiensi besi membunuh neutrofil
tingkat jaringan (peninggian berkurang (sering
ekskresi norepinefrin) demam)
 ADB dan stunting

ADB merupakan salah satu

faktor penyebab terjadinya
stunting, dan sebaliknya.

Kumar SB et al, Nutrients 2022, 14, 2976.

Tata laksana
Kebutuhan zat besi
 Normal diet
• A normal diet : 6mg/1000 calories, with a daily intake of 15-20 mg of iron absorbed in
the duodenum and the first part of the jejunum (1-2 mg/day).
• Iron is found in 2 forms: haem (10%) and non-haem (90% ionic).
• Haem iron is found in foods of animal origin (red meat, chicken, fish) in the form of
haemoglobin or myoglobin; between 15% and 20% of haem iron is absorbed.
• Non-haem, or inorganic, iron is found in foods of plant origin, cereals, and some foods
or animal origin such as milk and eggs; less than 5% of non-haem iron is absorbed.
• Haem is most easily absorbed form of iron: through a pro- cess called endocytosis, iron
is taken up directly by intestinal cells, where haem oxygenase (hox) breaks its ring to
release ferrous iron (Fe2+).
 Enhancers vs Inhibitors

“Neptune is the “Saturn is a gas giant

fourth-largest planet and has rings. It’s
by diameter in the composed mostly of
Solar System” hydrogen and helium”

Jenna Doe, 25 John James, 36

 Efek antinutrient factors

Mercury Venus Saturn

Mercury is the It has a beautiful Saturn is s planet
closest planet to name and is the composed of
the Sun second planet hydrogen

Samtiya et al. Food Production, Processing and Nutrition (2020) 2:6

Efek antinutrient factors

98%
Mercury is the closest planet to the Sun
 Bagaimana
MPASI Indonesia
Umi Fahmida, Otte Santika, Risatianti Kolopaking, and Elaine Ferguson
 Bagaimana
MPASI Indonesia

• MPASI homemade lebih dominan

dibandingkan MPASI siap saji.
• Cenderung tidak tepat waktu dan
kuantitas tidak sesuai dengan anjuran
pemerintah.
• Tinggi protein (ASI) namun semua
mikronutrien termasuk zat besi kurang.
• Rendah lemak.
 Nutrition strategy

Combine Avoid antinutrient

Avoid too Vitamin C
heme-iron rich factors
much milk. Vitamin C helps the
foods with saponins, tannins, phytic
Prevent the absorption of iron. acid, gossypol, lectins,
non-heme rich absorption of iron. Include a source of protease inhibitors,
foods Children eat less solid Vitamin C with amylase inhibitors,
foods at meal time every meal antivitamin factors, metal
binding ingredients,
goitrogens, etc
Simpulan
ADB merupakan masalah yang masih
sering dijumpai di Indonesia dan
dapat berhubungan dengan stunting.
Perlu tindakan pencegahan berupa
nutrisi yang tepat dan suplementasi
besi terutama jika telah terjadi
deplesi atau defisiensi.
Perlu tindakan pencegahan berupa
nutrisi yang tepat dan suplementasi
besi terutama jika telah terjadi
deplesi atau defisiensi.
Diperlukan perbaikan dalam
pemberian MPASI bagi bayi-bayi di
Indonesia..
 Thanks!

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Gejala, klinis dan kriteria ADB

Mercury Mars
It’s the closest Despite being red,
planet to the Sun Mars is a cold place

Venus Saturn
It’s the second Saturn is a gas giant
planet from the Sun and has rings
 Innovations
Principal Innovations

30% 100%
The Sun is a star at the center of
the Solar System
 Our Awards

Mercury Venus Mars

Mercury is the closest Venus has a beautiful Despite being red, Mars
planet to the Sun name, but it’s hot is a cold place

Jupiter Saturn Neptune

It’s the biggest planet in Saturn is a gas giant and It’s the farthest planet
the Solar System has rings from the Sun
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