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Anaemia
Anaemia
CONTENTS
• WHAT IS ANAEMIA?
• WHO IS PRONE TO ANAEMIA?
• PREVALENCE OF ANAEMIA
• AETIOLOGY OF ANAEMIA
• SYMPTOMS OF ANAEMIA
• CLASSIFICATION OF ANAEMIA
• COMPLICATIONS OF ANAEMIA
• DIAGNOSIS AND TREATMENT OF ANAEMIA
• DIETARY CONSIDERATION
• PREVENTION AND CONTROL OF ANAEMIA
WHAT IS ANAEMIA?
• Anaemia is very common blood disorder in which there is a decrease in the size of
RBC or number of RBC or the amount of haemoglobin in RBC than the normal.
• Severe or long lasting anaemia can cause damage to heart, brain and other organs
in the body. Very severe anaemia may even cause death.
• To produce the red blood cells and haemoglobin the human body needs iron,
vitamin B12, folate along with vitamin C which is required for the absorption of
iron.
• Anemia can also occur when the body does not receive enough of the above
nutrients, though this is not the sole cause for this condition to occur.
Normal haemoglobin levels (g/dl)
Category Value Category Value
MALES CHILDREN
At birth 13.5-24.0
Age 12-18 years 13.0-16.0
< 1month 10.0-20.0
Age >18 years 13.6-17.7
1-2 months 10.0-18.0
FEMALES
2-6 months 9.5-14.0
Age 12-18 years 12.0-16.0
6 months -2 years 10.5-13.5
Age >18 years 12.1-15.1 2-6 years 11.5-13.5
Pregnant woman 11.0-14.0 6-12 years 11.5-15.5
GRADES OF ANAEMIA
GRADE SEVERITY HAEMOGLOBIN
LEVELS (gm/dl)
>12 for women
Grade 0 Normal >14 for men
10 - lower limit to
Grade 1 Mild
normal
Morphological Aetiological
classification(On the classification (On the
basis of morphology basis of cause of
of RBC) anaemia)
Haemorrhagic anaemia
• Normocytic Normochromic Haemolytic anaemia
• Microcytic hypochromic Nutrition deficiency anaemia
• Macrocytic hypochromic Aplastic anaemia
• Anaemia of chronic diseases
Morphological classification
• Based on size and colour of RBC there are three types of anaemia.
• Size of RBC is determined by Mean Corpuscular Volume (MCV).
• Colour of RBC is determined by Mean Corpuscular Haemoglobin Concentration (MCHC).
• The three types of anaemia based on morphology of RBC are:
a)Normocytic Normochromic Anaemia
b)Microcytic Hypochromic Anaemia
c) Macrocytic Hypochromic Anaemia
iii) During periods of accelerated demand like in infancy (rapidly expanding blood volume),
adolescence (rapid growth and onset of menses in girls) and pregnancy and lactation can result
in anaemia.
iv) Insufficient iron absorption due to poor availability of iron in phytate and fibre rich Indian diet
causes anaemia. Iron absorption also decreases due to the lack of vitamin C in body as vitamin C
plays a role in enhancing iron absorption in intestine. Vitamin C reduces ferric ion to ferrous
state, which is commonly absorbed. This is due to the reducing property of vitamin C. Vitamin C
helps in formation of ferritin (storage form of iron) and mobilization of iron from ferritin.
Three stages of iron deficiency
a) First stage is characterized by decreased storage of iron without any other detectable
abnormalities.
b) An intermediate stage of latent iron deficiency, that is, iron stores are exhausted, but
anaemia as not occurred as yet. Its recognition depends upon measurement of serum ferritin
levels. The percentage saturation of transferrin falls from a normal value of 30 per cent to less
than 50 per cent. This stage is the most widely prevalent stage in India.
c) The third stage is that of overt iron deficiency when there is a decrease in the concentration
of circulating hemoglobin due to impaired hemoglobin synthesis.
2. Vitamin deficiency anaemia
• It is a lack of healthy RBC caused when you have lower than normal amounts of certain
vitamins needed to produce RBC.
• Vitamins linked to vitamin deficiency anaemia include Folate, Vitamin B12 or Vitamin C.
• It can occur if you don’t eat enough foods containing folate, Vitamin B12 and Vitamin C
or it can occur if your body has trouble absorbing or processing these vitamins.
• Anaemias caused by a lack of Vitamin B12 or a lack of Folate are two types of
“Megaloblastic Anaemia.”
i) Vitamin B12 deficiency
Pernicious anaemia is a type of B12
deficiency.
It causes due to vitamin B12 deficiency
in some people or due to malabsorption
in some people.
Malabsorption is due to absence of
Gastric intrinsic factor (GIH) which is
secreted by parietal cells in ileum.
The red cell count is often less than 2.5
million and a large proportion of the
cells are macrocytic.
• This anaemia occurs chiefly in
middle-aged and elderly persons and
may be a genetic defect.
ii) Folic acid (vitamin B9) deficiency
• Folic acid is a B vitamin that helps our body make RBC. So the deficiency
of folate leads to anaemia.
• In tropical countries, most cases of megaloblastic anaemia are due to
folate deficiency associated with malnutrition infection and pregnancy.
• It is common in the age group 20 to 30 years.
• In this anaemia, RBC are larger than normal and there are fewer cells
and oval shaped.
• Folate deficiency is due to poor dietary intake of Folic acid , low
absorption, alcoholism, infestation and infection, intake of certain drugs
and increased requirements.
• Chronic infections and parasitic infestation, oral contraceptives (in some
women) may impair absorption of folic acid.
3. Protein deficiency anaemia
• Decreased dietary intake of protein may
lead to mild to moderate anaemia.
• This type of anaemia is seen in vegans,
vegetarians, elderly and endurance
athletes, anorexia nervosa and people
with diminished intake of protein for any
cause.
• The protein deficiency anaemia is also
called hypoproliferative anaemia.
• It may even develop in people with
chronic liver disease, chronic kidney
disease, and low function thyroid.
• The mechanism involved in protein
deficiency anaemia is simple as shown
in the picture.
d) APLASTIC ANAEMIA
• Aplastic anaemia is a rare condition in
which the body stops producing enough
new blood cells.
• It develops as a result of bone marrow
damage.
• Damage may be present at birth or occur
after exposure to radiation,
chemotherapy, toxic chemicals, some
drugs or infection.
• In this anaemia, symptoms may develop
slowly or suddenly. Fatigue, Frequent
infections, rapid heart rate and bleeding
may occur.
e) ANAEMIA DUE TO CHRONIC DISEASES
• Certain chronic diseases such as Cancer, HIV or AIDS, Rheumatoid arthritis, Crohn’s
disease and other chronic inflammatory diseases, can interfere with the production
of Red blood cells resulting in chronic anaemia. Kidney failure can also cause
anaemia. This condition is also called Anaemia of inflammation (AI) or Anaemia of
inflammation and chronic disease (ACD).
• It is the second most common type of anaemia after anaemia due to iron
deficiency.
COMPLICATIONS OF ANAEMIA
• Impaired cognitive performance at all stages of life.
• Significant reduction of physical work capacity and productivity.
• Increased morbidity from infectious diseases.
• Greater risk of death of pregnant women during the perinatal period.
• Negative foetal outcome intrauterine growth retardation, low birth weight,
prematurity.
DIAGNOSIS AND TREATMENT OF ANAEMIA
• TREATMENT OF ANEMIA:
• Diet taken should meet the above diet principle and the RDA.
• Anaemia can be prevented by taking proper diet. By regular consumption of green
leafy vegetables, cereals such as wheat, ragi, jowar and bajra, pulses, jaggery and
foods of animal origin anaemia can be prevented. Fruits rich in vitamin C help in
the absorption of erythropoietic nutrients.
• Some suggestions for Anaemia:
- Take animal foods that provide iron, protein and high doses of vitamin B12.
- Try to combine cereals, bread and vegetables with milk or egg.
- Finish meals with a fruit rich in vitamin C that increases iron absorption.
- Take dried fruit and nuts between meals to provide iron all day.
- Green vegetables every day: they are the best source of dietary folic acid.
• Haeme iron from animal foods is better absorbed than non-haeme iron present in plant sources. Liver is
the best source of iron. Iron is also absorbed well from red meat like beef and lamb.
• Non-haeme iron is present in cereals, millets, pulses and green leafy vegetables. Of the cereal grains,
wheat and millets like bajra and ragi are very good sources of iron. Inclusion of green leafy vegetables
which are rich in iron can meet a fair proportion of Iron needs.
• 1gm of protein per kg body weight should be taken daily.