Diagnosis and

Management of
Anemia in Children
Karthik K P
Anemia
definition

<2.5 SD lesser than

the Median Hb for
age and sex
Why D/D?
Communicate the prognosis
Making claims
Safer medications and Pathyapathyam
Identify life-threatening underlying conditions
 Pathology Reference

Affliction of Kapha, Vāta, Rakta, Tvak and Māmsa by (Ca. Ci. 16/9-10) [21]
Pitta vitiated by external factors

Vitiation of Rasa dhātu (Ca. Su. 28/10)

Rakta (Su. U. 40/3)

Loss of Rakta (Su. Su. 14/30) [22]

and affliction of Rakta by Kapha (A. Sam. Su. 19/22) [23]

Pathologies exhibiting Pāṇḍu

Anemias: Various pathologies
Nutrition
Hematopoiesis
Hemolysis
Hemoglobinopathies
Hemorrhage
Infections
Inflammations
Clinical D/D
Major markers
CBC: Hb, RBC Count

Red cell indices: Hematocrit (RBC/whole blood), MCV (Size of an RBC), MCHC (Amt of
Hb/volume of blood)

RBC Morphology: Peripheral smear, Hb electrophoresis

Iron Supply Studies: S. Iron, S. Ferritin, Total Iron Binding Capacity

Reticulocyte counts: A marker of erythropoiesis, hemorrhage, and hemolysis.

Bone Marrow Assay: Bone Marrow Aspiration and biopsy

Introductory markers
Low MCV
High MCV
Normal MCV
Confirmatory Tests
Abnormal Morphologies
Basophilic stippling: Thalassemia, Lead poisoning, Hemolysis
Target Cells: Hb-pathies S, C, A.
Schistocytes: Coagulatory/Vascular pathologies
Spherocytes: Hereditary spherocytosis
Ayurvedic Kr̥mi

Etiologies
Raktapitta Grahaṇi

Svatantra Pāṇḍu

Santarpaṇaja
Beejaduṣti Viṣa

Paratantra
Dīrghavyādhi
Apatarpaṇaja
Nutritional Anemia
Aravindasava
Punarnavasava/Punarnavadi kashaya
Navayasa Lauha
Dhatri Lauha
Nutritional rehabilitation
Iron Absorption Promoters
Mainly Amla Dravyas
Ascorbate
Lactic acid
Animal tissues
Iron Absorption Inhibitors
Phytates (Seeds, nuts, whole grains)
Polyphenols (Tea, spices)
Calcium
Oxalic Acid
Kr̥mi
Pica, Bruxism, Whitish spots over face, pruritis ani,
Avoid Bakery, pastry, biscuits
Avoid milk at night
Kr̥mimudgara Rasam
Kr̥mikuṭhāra Rasam
Sarṣapa taila and Saindhava
Viḍaṅgādi lauha
Āmavāta ⟷ Kr̥mi
Grahaṇi (Pernicious, Megaloblastic)
Takraṁ
Navāyasa lauha
Maṇḍūra vaṭakaṁ
Punarnavā Maṇḍūram
Pravāl̥a bhasmaṁ
Kalyāṇaka ghr̥ta
Thalassemia
Drākṣādi lehyaṁ
Loha śodhana: Triphalādi avaleha, Gomutra
haritaki, Gandhakadi Yoga
Dāḍimādi ghr̥ta
Kalyāṇaka ghr̥ta
Hemorrhagic
Vasaguḍūcyādi
Drākṣādi
 Dosage of Bhasmas as per Ayurvedic Formulary of India
Bhasma Dosage as per AFI

Abhraka Bhasma 125 mg – 375 mg

Godantī Bhasma 500 mg

Kāsīsa Bhasma 250 mg

Loha Bhasma 120 mg – 250 mg

Maṇḍūra Bhasma 250 mg – 500 mg

Pravāl̥a Bhasma 250 mg

Rajata Bhasma 125 mg

Svarṇamākṣika Bhasma 120 mg – 250 mg

Tāmra Bhasma 31.25 mg – 62.5 mg

Yaśada Bhasma 125 mg

Specific scenarios:
Anemias associated with infections: Punarnavādi, Godanti bhasma
Malnutrition: Drākṣādi kaṣāyaṁ, Aravindāsava, Drākṣādi lehyam
Hemolytic: Drākṣādi lehyam, Vāśāguḍūcyādi kaṣāyam, Dāḍimādi ghr̥ta
Irritability, CNS symptoms: Rajata bhasma, Tapyadi lauham
Post-Chemo Anemia: Gaṇḍīra rasāyana
Rakta Vasti
When to monitor
Symptoms
Immediate measure: Retic counts: 4 days of therapy
Monitoring after intervention: 2 months
Hb-pathies: Hb-after each transfusion, CBC after every month, ferritin, LFT, KFT,
Phosphorus
Thank You