Anaemia –a silent enemy Brief information about anaemia How to prevent/manage anaemia Anaemia in India

contents Red Blood Cells (RBCs) in our blood, Haemoglobin (Hb) What is anaemia and why does it develop? Different types/causes of anaemias Normal Hb levels and Classification of anaemia in India Symptoms of anaemia Adverse effects/complications of anaemia Diagnosis and principles of treatment About nutritional deficiency anaemia in India and possible prevention, some tips

Red Blood Cells (RBCs) in our blood, Haemoglobin (Hb) Blood, constantly circulating in our body, is our lifeline that provides nutrients and oxygen to all the cells and carries waste products from them Red Blood Cells or RBCs are the prominent cells in our blood and they are produced in our bone marrow (core of the bone) They contain a protein called haemoglobin (Hb), that acts as a carrier of oxygen from air we inhale in lungs, to all parts of our body, where it is used to generate energy. Adequate and continuous oxygen supply is vital for every living cell

What is anaemia and how does it develop? “ a condition in which a number of red cells or their oxygen carrying capacity is insufficient to meet physiological needs” World Health Organization (WHO) defines anaemia as, In other words, anaemia develops when our blood lacks adequate number of RBCs (too few or abnormal) or haemoglobin ( too low or abnormal) Our body is not able to make enough red blood cells Loses too many red blood cells Destroys the red blood cells faster than they can be replaced Thus anaemia occurs when, When anaemia develops, the cells in our body do not get enough oxygen, hence are not able to work/function properly

Types of anaemias There are more than 400 types of anaemias! They can be broadly divided in three categories: Anaemia caused by blood loss Anaemia caused by decreased or faulty RBC production Anaemia caused by excessive/unnatural destruction of red blood cells There are more than 400 types of anaemias!

Anaemia caused by blood loss Can occur slowly, over a long period of time and may go undetected initially Common causes: Bleeding from our digestive track as can happen with ulcer, piles, cancer Use of some drugs that can cause irritation and ulceration in the digestive track – for e.g.; common anti-inflammatory drugs such as ibuprofen, diclofenac, indomethacin, aspirin Excess bleeding during menstruation

Anaemia caused by decreased or faulty rbc production Iron deficiency anaemia: Commonest form of anaemia. Can occur due to, Diet poor in iron Pregnancy, breastfeeding where demand for iron is more Menstruation with heavy bleeding, again excess blood loss increases the demand Frequent blood donations, same reason as above Anaemia due to Vit B12 and/or folic acid deficiency Diet poor in Vit B12 – common in pure vegetarians Overcooking and eating too less vegetables can cause folate deficiency Pregnancy – due to increased demand (adequate supplements needed, as folic acid deficiency can also cause birth defects in the baby)

Anaemia caused by decreased or faulty rbc production Inherited condition linked to gene defect Instead of usual oval/round shape, RBCs are crescent shaped and break down rapidly, causing anaemia Sickle cell anaemia: Aplastic anaemia: Very little or almost no RBCs are produced in bone marrow Can be inherited or caused by certain medications such as anticancer drugs, radiations, some infections Thalassemia: Genetically inherited condition, can be mild or severe and life threatening RBCs do not grow and mature properly, hence are easily destroyed Problems in bone marrow can lead to decreased or defective RBC production:

Anaemia due to excess destruction of RBCs and associated with some other diseases Anaemia due to excess destruction of RBCs – Haemolytic anaemia: RBCs are excessively fragile, hence break down easily and prematurely Excess destruction seen in sickle cell anaemia and haemophilia Some infections, some drugs, exposure to toxic chemicals, severe burns Snake and spider venom Anaemia associated with other diseases: Advanced kidney disease Hypothyroidism (low activity of thyroid gland) Cancer, long standing infections, diabetes, rheumatoid arthritis

Normal hb levels and Anaemia classification Anaemia classification based on Hb values: Haemoglobin normal values: Men: > 13 gm/dl (range 13.5 – 17.5 gm/dl) Women: > 12 gm/dl (range 12.0-15.5 gm/dl) ICMR, India WHO Mild 10 -11 gm/dl 9 – 11 gm/dl Moderate 7 -10 gm/dl 7 – 9 gm/dl Severe 4 -7 gm/dl < 7 gm/dl

Iron Deficiency Anaemia in children: Symptoms of anaemia Pale skin, conjunctiva of eye, nails, tongue Weakness, tiredness even though one has slept well Dizziness, difficulty in concentration Headache, leg cramps Palpitations (feeling the rapid heart beats), chest pain, shortness of breath Common Symptoms: Hearing of buzzing, ringing noise inside the head (tinnitus) Sore tongue, food tasting strange, difficulty in swallowing Painful, open sores in the corner of mouth Spoon shaped nails, hair loss Uncommon Symptoms: May additionally show urge to eat inappropriate things such as dirt, soil, chalk etc Iron Deficiency Anaemia in children: Jaundice may occur if there is rapid destruction of RBCs – for e.g., in haemolytic anaemia

Complications of anaemia Untreated anaemia can, Make the immune system weak (body’s ability to fight infections and other illnesses), making one more prone to infections and other illnesses Heart related complications: Due to less oxygen in blood, heart needs to work harder to supply enough oxygen to organs and may come under pressure Can lead to symptoms such as chest pain, palpitations, shortness of breath, irregular heart beats and rhythm Severe anaemia may lead to heart failure Lead to many complications before and after delivery Lead to stunted physical and mental development in children

Diagnosis and principles of treatment Complete blood Count (CBC) generally gives fairly good idea about anaemia It gives Hb levels, count of RBCs, white blood cells and platelets Provides information on factors like average size, volume, variations and Hb concentration within RBCs For anaemias other than due to nutritional deficiency, special tests such as bone marrow biopsy (testing core of the bone) may be required Diagnosis: Find out and treat the cause (most important) Iron and/or Vitamin deficiency anaemia is commonest form and is treated with iron, vitamin tablets, injections, blood transfusions depending on how severe it is Sometimes other therapies are needed to treat root cause/other illness, for e.g.,: Where anaemia is due to severe kidney disease, injection of hormone erythropoietin is needed to stimulate production of RBCs If autoimmune disorder is attacking patient’s own RBCs, then a corticosteroid such as prednisolone may help Treatment Principles:

Nutritional deficiency anaemia in India Prevalence of anaemia in all age groups is higher in India compared to other developing countries Iron and vitamin deficiency anaemia (nutritional anaemia) is the commonest cause It is estimated that 50% of Indians may have nutritional deficiency anaemia, in some areas it may be as high as 80 to 90%, especially in pre-school children, pregnant and lactating mothers and adolescent girls Some reports estimate that India may have highest number of anaemia cases in the world!

Preventing anaemia: some tips Diet Eat or drink more Eat or drink less (avoid large amounts) Dark green, leafy vegetables Tea, coffee Pulses, nuts, dry fruits Food containing high levels of phytic acid such as wholegrain cereals Meat, fish, liver Milk and dairy products can interfere with absorption of iron, so stagger the timing For vit B12 and folates – eggs, milk, dairy products, spinach, banana Daily iron requirements: Adult men: 8.7 mg/day Women between 19 to 50 years: 14.8 mg/day Higher in growing children, during adolescence, pregnancy and lactation Can easily be met with good wholesome diet in most (supplements needed during pregnancy)

References: Jadhav BN. A critical review of iron deficiency anaemia in female population of developing India. International Journal of Fauna and Biological Studies 2016; 3(5):116-119 Mayo Clinic, patient care and health information, tests and procedures WHO website Web MD A to Z guides. Understanding Anaemia, the basics www.NHS.UK/conditions/iron-deficiency-anaemia Kidney health, Australia On line picture library