Anaemia is a condition in which the number of red blood cells (RBC)
or the amount of haemoglobin in the blood is below ‘normal’ for
age and sex of the individual. It is thus defined as a decrease in
the red cell mass and is usually discovered and quantified by
measurement of the RBC count, haemoglobin (Hb) concentration, and
haematocrit (Hct). Anaemia is suggested in males with Hb levels
less than 13 g/dl and in females with Hb levels less than 12 g/dl
(less than 11.5 g/dl in pregnant women).
What is the cause?
The 3 broad categories of anaemia are due to: a) decreased
production of red blood cells, b) loss of blood (haemorrhage) or
c) break-down of red blood cells (haemolysis) and a number of
causes and diseases can be listed under each of these. Anaemia is
a symptom of disease that requires investigation to determine the
underlying cause. Mere treatment of anaemia will result in
recurrence unless the condition causing it is treated. It is twice
as common in women as in men, especially during the childbearing
years, due to menstrual blood loss and multiple pregnancies.
Anaemia is also very common in children due to their rapid growth,
poor nutrition, food fads and presence of chronic illness.
Nutritional anemia due to dietary lack of iron is the most common
cause of anaemia women and children in our country, as iron is
required to make haemoglobin. This deficiency is often exacerbated
by concurrent excessive loss of iron from the body.
Decreased production of red blood cells may be due to the lack of
vitamin B12 or folic acid in the diet, diseases affecting the bone
marrow like some viral infections or drugs, inherited blood
diseases like thalassaemia or sickle cell anemia, chronic disease
of kidney or joints, chronic infections, some hormonal disorders
and cancers like leukemia. Blood loss may be due to gynaecological
diseases in women, chronic worms in children, diseases of the
gastro-intestinal tract like ulcers or polyps etc. Drugs or
infection like malaria most commonly causes red cell breakdown.
What are the symptoms?
The symptoms of anaemia depend on its severity, its
rate of occurrence and presence of co-existing diseases. If it
occurs gradually (chronic anaemia) as in nutritional deficiency or
chronic disease, the body is able to adapt itself and the person
may be able to function even with a low haemoglobin level. On the
other hand, if anaemia occurs in a short period of time (acute
anaemia) due to bleeding or red cell breakdown, the symptoms
appear rapidly. There is usually a feeling of tiredness, lack of
stamina, light-headedness and shortness of breath. The skin may
appear pale along with pale palms, gums, eyes, and nails. There
may be associated rapid heartbeat and chest pain. When anaemia
results from break down of the red blood cells, there may also be
jaundice, which causes a yellowing of the skin and eyes.
How is it diagnosed?
The symptoms of anaemia are not distinct or specific while
findings like paleness of skin and eyes are quite subjective. A
simple blood test can confirm it. The work-up includes not just
the estimation of haemoglobin but a complete blood count (which
includes the red cell indices), estimation of reticulocyte count
and a peripheral smear examination. This helps to quantify anaemia,
suggest a cause and direct further investigations.
What is the treatment?
The treatment of anaemia depends on the underlying cause.
In case of iron deficiency, treatment is with iron tablets. The
cheapest and most effective form is ferrous iron. The side effects
experienced on taking iron tablet are proportional to the amount
of iron available for absorption. The iron preparation you take
should contain between 30-100 mg elemental iron. Avoid
enteric-coated or prolonged-release preparations. The dose you
take should be sufficient to provide between 150-200 mg elemental
iron per day and the tablet may be taken 2 to 3 times a day about
1 hour before meals. A glass of fruit juice aids in iron
absorption.
Though ferrous sulphate is recommended to treat iron deficiency,
often patients complain of gastrointestinal discomfort, bloating
and other distress. Ferrous gluconate, which is roughly equivalent
in cost, produces fewer problems, and is preferable as the initial
treatment of iron deficiency. Polysaccharide-iron complex is a
more recent option and most patients tolerate this form of iron
better than the iron salts, even though the 150 mg of elemental
iron per tablet is substantially greater than that provided by
iron salts (50 to 70 mg per tablet).
The treatment should be continued for 3 months after the
haemoglobin has returned to normal so that the body iron stores
are replenished. Response to treatment is confirmed by doing a
reticulocyte count after 10-12 days of treatment and the rate of
rise of haemoglobin (with adequate dose of iron about 1 g/dl per
week).
How to take care?
Follow the doctor's advice for treating anaemia and any underlying
cause:
* Take the medication for as long as advised.
* Iron-deficiency anaemia is often caused by consuming diets low
in iron. Most iron is obtained from foods in our diet, but only 1
mg of iron is absorbed for every 10 to 20 mg of iron ingested. A
person unable to have a balanced iron-rich diet may suffer from
some degree of iron-deficiency anaemia.
* Absorption of iron from food is influenced by many factors. One
important factor is the form of the dietary iron. The iron found
in animal sources is called haeme (ferrous, Fe 2+) while that
obtained from plant sources is non-haeme (ferric Fe 3+) iron.
* Haeme iron (meat and meat products) is highly available for
absorption and usually 20-30% of it is absorbed from the diet. The
level of haeme iron absorption is relatively unaffected by other
dietary factors.
* In contrast, non-haeme iron of vegetable sources (cereals, green
vegetables, pulses, dried fruits etc.) is relatively poorly
absorbed (usually less than 10% of dietary intake and often under
5%). Its absorption is markedly influenced by an individuals iron
status and dietary factors that can either inhibit or enhance it.
Vegetarians thus need more iron in their diets than
non-vegetarians and should choose several iron-rich plant foods
daily. Grains, beans and lentils, vegetables (green-leafy ones,
tomato, potato, green & red chillies etc), fruits, nuts and seeds
are rich sources of non-haeme iron. The absorption of non-haeme
iron can be improved when a source of haeme iron meat/fish/poultry
is consumed in the same meal or iron absorption enhancing foods
like fruits/fruit juices are consumed. But coffee/tea and calcium
if consumed along with a meal impair iron absorption.
* Females, particularly those with heavy menstrual periods, must
have a higher intake of iron to prevent anaemia.
* Iron deficiency in infants can cause problems in development
affecting growth, memory and behavior. After weaning a child, used
iron fortified products, iron supplements and add items rich in
iron to the diet. Early introduction of cow’s milk and its
consumption of more than 700 ml per day after the age of 1-year
increase the risk of iron deficiency as this milk is low in iron
content and may replace foods with higher iron content.
Sickle cells block the flow of
blood in small blood vessels known as Capillaries
Anemia
In Female
Sickle-Cell Anaemia
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