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

2. 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

3. 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

4. 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

5. 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!

6. 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

7. 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)

8. 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:

9. 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

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

11. 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

12. 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

13. 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:

14. 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!

15. 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)

16. 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):
Mayo Clinic, patient care and health information, tests and procedures
WHO website
Web MD A to Z guides. Understanding Anaemia, the basics
Kidney health, Australia
On line picture library