Learning Outcomes
By the end of this section, you should be able to:
- 10.3.1 Identify drug–food interactions for their impact on treatments used for hematologic disorders.
- 10.3.2 Identify treatments and medications that can cause nutritional deficiencies in clients with hematologic disorders.
Drug–Food Interactions with Treatments for Hematologic Disorders
Some treatments for hematologic disorders will not work as intended if taken with certain foods. Limiting groups of foods during an already vulnerable state of nutritional need can lead to additional micronutrient deficiencies. For example, individuals requiring iron replacement are instructed to avoid cereals, dietary fiber, tea, coffee, eggs, and milk while taking iron supplements because these foods are known to decrease iron absorption (Moustarah, 2022).
Unlike individuals with other hematologic illnesses previously discussed, individuals with SCD and thalassemia are at risk for iron overload rather than iron deficiency. The primary cause of iron overload is red blood cell transfusion therapy. However, iron overload can occur in people with and without transfusion-dependent thalassemia because of intestinal absorption of iron secondary to ineffective erythropoiesis (Srichairatanakool et al., 2020). These individuals are therefore counseled to avoid iron-rich foods. The rate of iron accumulation varies and correlates with the number of red blood cell transfusions received. Each unit of packed red blood cells contains 200–250 mg of elemental iron, equating to 0.3–0.6 mg/kg/day of elemental iron, and most transfusion-dependent older children and adults will receive 2–4 units of blood monthly. The symptoms and associated health risks from iron overload depend on where the iron accumulates. The liver, heart, and endocrine glands are the most common initial sites (Srichairatanakool et al., 2020). Frequent complications of iron overload in people living with hemoglobinopathies include:
- Increased risk for thrombosis
- Pulmonary hypertension
- Hypothyroidism
- Hypogonadism
- Osteoporosis
Nurses should ensure client rights regarding medication administration, which includes understanding any contraindications and drug–food interactions. Equally important is a nutritional evaluation prior to the start of treatment for hematologic disorders and the development of a plan to avoid further nutritional deficiencies that can impact the desired response of treatment.
Unfolding Case Study
Part B
Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.
Catalina’s health care provider confirms that her physical exam is normal other than signs of pallor. A complete blood count (CBC) and ferritin level are ordered to evaluate for ID and anemia. Catalina is also referred to a gynecologist for further evaluation of her heavy menstrual bleeding.
Catalina’s laboratory test results reveal a hemoglobin level of 7 g/dL (expected range: 12–15 g/dL) and a ferritin level of 9 ng/mL (expected range: 12–150 ng/mL), confirming IDA. She is started on oral iron replacement and counseled on foods to avoid while taking oral iron for better absorption. She is also encouraged to add iron-rich foods to her diet daily and to return in 6 weeks.
At her 6-week follow-up visit, Catalina reports that she is feeling less tired, and her shortness of breath has resolved. Her hemoglobin level at this visit is 10 g/dL. She has also been evaluated by a gynecologist and started on oral birth control pills to decrease her heavy menstrual bleeding. Catalina is instructed to continue oral iron therapy for at least 2 more months and then return for follow-up.
Treatments and Medications That Can Cause Nutritional Deficiencies
Treatments for hematologic malignancies can lead to nutritional deficiencies due to decreased food intake that is secondary to adverse treatment effects such as nausea, vomiting, diarrhea, mouth sores, and loss of appetite. Traditional chemotherapy and novel targeted therapy can affect taste and saliva production, further affecting the individual’s interest in food.
Several of the most frequent hematologic malignancies, such as myelodysplasia and multiple myeloma (a blood cancer affecting plasma cells found in bone marrow), occur in older adults. The average age at diagnosis for hematologic malignancies in adults is 70 years, and 40% already have reduced food intake. The prevalence of malnutrition in these individuals is approximately 30% and is more common in male clients (Stauder et al., 2020). Associated symptoms include a high systemic inflammatory score, alterations in mood and cognition, and moderate to severe fatigue. Decreased food intake, weight loss, low body mass index, and laboratory evidence of malnourishment have been associated with decreased survival rates in older adults with hematologic malignancies (Stauder et al., 2020). A complete nutritional assessment, timely intervention with micronutrient and macronutrient replacement, and dietary referral are essential.