ANAEMIA
- Anaemia, the word which we hear these days, continues to be a significant health concern.
- It refers to a condition where there is an insufficient number of healthy red blood cells (RBC) or hemoglobin (Hb) to effectively transport oxygen to the body's tissues.
CAUSES OF ANAEMIA
- Hemoglobin, an iron-rich protein found in red blood cells, is responsible for the red color of blood.
- The primary role of red blood cells is to transport oxygen from the lungs to all organs in the body, while simultaneously carrying carbon dioxide from other body parts back to the lungs for exhalation.
- Erythropoietin, produced in the bone marrow (the spongy tissue within larger bones), plays a crucial role in the production of red blood cells and hemoglobin.
- Adequate intake of iron and other essential nutrients from food is necessary for the healthy production of red blood cells and hemoglobin.
- Anaemia can occur when
| a. | The body does not make enough RBCs or Hb. |
| b. | Major bleeding episodes cause loss of RBCs and Hb at a greater rate than replacement level. |
| c. | Destruction of RBCs and the Hb by the body itself in certain medical conditions. |
TYPES OF ANAEMIA:
There are several types of Anaemia, and they are named as per the causative factor or morphological features like
- Iron Deficiency Anaemia (most common)
- Vitamin Deficiency Anaemia (resulting from inadequate nutrition)
- Aplastic Anaemia (caused by damage to stem cells, leading to a lack of RBC production)
- Sickle Cell Anaemia (characterized by abnormally shaped red blood cells)
- Microcytic and Macrocytic Anaemia (based on the size of red blood cells)
Among all, Iron Deficiency Anaemia is the most encountered variant, characterized by insufficient iron levels in the body, as implied by its name.
IRON DEFICIENCY Anaemia
Iron deficiency is one of the most common reasons for Anaemia among Indians, and it leads to the body being not able to make enough red blood cells.
The World Health Organization (WHO) defines Iron Deficiency Anaemia as a hemoglobin (Hb) level of less than 13 g/dl in men and 12 g/dl in women.
SYMPTOMS OF IRON DEFICIENCY ANAEMIA
Symptoms may not be there to minimal, especially in mild and moderate cases.
Most common symptoms include:
| a. | Weakness |
| b. | Lack of energy/fatigue |
| c. | Dizziness |
| d. | Shortness of breath |
| e. | Irritability |
| f. | Headache |
| g. | Pale or yellow complexion more obvious on white skin than on black or brown |
| h. | Strange cravings to eat unusual items with no nutritional value, such as dirt, clay, and soil- a standard manifestation of iron deficiency |
Other associated symptoms include:
| a. | Noticeable heartbeats (fast or irregular) |
| b. | Chest pain |
| c. | Tongue swelling and/or soreness |
| d. | Cold hands and feet |
| e. | Brittle nails |
| f. | Hearing sounds that come from inside the body rather than from an outside source |
| g. | Hair Loss |
| h. | Altered sense of taste, feeling itchy, difficulty swallowing, painful open sores (ulcers) on the corners of the mouth |
MAJORLY AFFECTED POPULATION:
FEMALES ARE MORE AFFECTED THAN MALES.
- WOMEN WITH HEAVY MENSTRUAL PERIODS:
- 1. Studies indicates that approximately 5% of women in their reproductive years’ experience Iron Deficiency Anaemia at some point, primarily due to significant blood loss during menstruation.
- 2. Blood contains iron within red blood cells, and iron gets depleted if blood is lost in massive quantities.
- 3. The presence of endometriosis, a condition characterized by the growth of the uterine lining outside of the uterus, can further exacerbate blood loss during menstrual periods.
- Pregnant women:
- 1. Approximately one in six pregnant women experience Iron Deficiency Anaemia.
- 2. Pregnant women have an increased blood volume requirement and need to provide hemoglobin for the developing fetus.
- 3. Iron deficiency poses complications for both the mother and the fetus, highlighting the importance of addressing and treating this condition during pregnancy.
PRE-MATURE BABIES, INFANTS, AND TEENAGERS
- Certain groups, particularly individuals experiencing periods of rapid growth and development, have an increased requirement for iron
- Inadequate intake of iron-rich foods over an extended period can lead to the development of Iron Deficiency Anaemia
FREQUENT BLOOD DONORS
- Iron stores can deplete during blood donation
- Without proper maintenance of iron intake, frequent blood donation can potentially lead to the development of Iron Deficiency Anaemia
Vegetarians
- Our body tends to absorb more iron from non-vegetarian food sources compared to plant-based sources
- Vegetarians need to increase their iron intake to compensate for the lower absorption rate and ensure they obtain the same amount of iron as non-vegetarians. More details on this are provided later under ‘VEGETARIANISM AMONG INDIANS AND ITS IMPLICATION’
AGE
- Individuals who are aged sixty-five and above are at an increased risk of developing Iron Deficiency Anaemia, primarily due to the presence of comorbid conditions such as kidney diseases and diabetes.
PREVALENCE OF ANAEMIA IN INDIA:
- Anaemia is a major public health concern wherein 53% of women between the ages of 15 and 49 years in India have Anaemia as per the report by the World Health Organization (WHO).
- The most common reason behind Anaemia is nutrition deficiency be either iron or Vitamin B12 / Folic acid.
- As per the Global Nutrition Assessment 2016, India is among the countries with the highest rates of iron deficiency, placing 170th out of 180 for women’s Anaemia.
- WHO estimates 37% of pregnant women worldwide are anemic. However, the numbers stand at 50% for pregnant women in India.
- From 2005 to 2016, the Iron Deficiency Anaemia in India decreased by only 3.5% for women aged between 15 and 49 years.
- In fact, during the above period Iron Deficiency Anaemia increased in eight states including the highest-ranked states on the state Human Development Index like Kerala.
RECOMMENDED IRON INTAKE (RDA) FOR INDIAN WOMEN BY INDIAN COUNCIL FOR MEDICAL RESEARCH (ICMR)
| Age group | RDA |
| Women | 29mg |
| Pregnant Women | 27mg |
| Lactating women | 23mg |
| Girls (10-18 years) | 28-32mg |
RDA - Recommended Dietary Allowance
IRON SUPPLEMENTATION - THE WORLD HEALTH ORGANIZATION (WHO) SUGGESTED A SCHEME* FOR ADULT WOMEN AND ADOLESCENT GIRLS
| Target Group | Menstruating adult women and adolescent girls (non-pregnant females) |
| Supplementation | 30–60 mg elemental iron per day |
| Duration | Three consecutive months in a year |
| Settings | Where the prevalence of anaemia is 40% or higher |
*WHO 2016 – Daily Iron Supplementation in adult women and adolescent girls
OTHER CONDITIONS CAUSING ANAEMIA:
INCREASED REQUIREMENT
- High-performance and endurance athletes, such as marathon runners, have increased iron requirements to meet the demands during intense physical activity.
- Iron deficiency can have a significant impact on an athlete's stamina, endurance, and strength, potentially hindering their performance.
MEDICAL CONDITIONS
- Certain conditions, such as peptic ulcers, hiatal hernias, and colon polyps, can cause slow and chronic blood loss within the body. Over time, this internal bleeding can lead to Iron Deficiency Anaemia.
- Individuals with a history of specific infections, blood disorders, and autoimmune conditions are at an increased risk of developing Anaemia.
- Excessive alcohol consumption and the prolonged use of certain medications like Aspirin can affect the production of red blood cells and lead to the development of Anaemia.
INABILITY TO ABSORB IRON
- The small intestine plays a crucial role in the absorption of iron into the bloodstream.
- Any disorder in the intestine, in cases where the small intestine is has bypassed or removed surgically, iron absorption gets hampered.
GENETICS
- Genetic conditions or mutations can lead to the excessive production of hepcidin in the body.
- Hepcidin is a hormone that can block the intestines from absorbing iron.
- Other genetic conditions may contribute to Anaemia by causing abnormal bleeding, example: Hemophilia.
VEGETARIANISM AMONG INDIANS AND ITS IMPLICATION
- India has one of the highest proportions of vegetarian populations in the world, with over 70% of the population following a vegetarian diet.
- About 75% of Indian vegetarians are lactovegetarians not consuming meat or eggs.
- While a vegetarian diet can include iron-rich foods , the absorption of plant-based iron tends to be lower in comparison to iron from animal sources.
- Nutritionists recommend that vegetarians need to increase dietary iron by 80% to compensate for a lower iron availability of 10% from a vegetarian diet compared with 18% from an omnivorous diet.
- Plant-based diets commonly consumed in India contain an abundance of phytates and polyphenols, which can inhibit the absorption of dietary nonheme iron by forming insoluble complexes that make it more challenging for the body to absorb iron from plant sources.
- A study has shown that the polyphenols from black tea can lead to a significant reduction of 50–70% in iron absorption.
- Vegetarianism carries significant implications for maternal iron deficiency in India.
DIAGNOSIS:
- Raising awareness about Anaemia is crucial for the early identification of mild and moderate cases.
- In India, Anaemia is mostly diagnosed during a routine blood test where the red blood cells and Hemoglobin level are measured.
- Iron binding test is a diagnostic test that is recommended to confirm the exact quantity of iron in the blood.
COMPLICATIONS OF IRON DEFICIENCY ANAEMIA:
Iron Deficiency Anaemia, if untreated can become severe and lead to health problems, including:
- TIREDNESS: Severe Anaemia can result in extreme fatigue and make it challenging to perform everyday tasks.
- HEART PROBLEMS: Anaemia puts additional strain on the heart as it needs to pump more blood to compensate for the reduced oxygen-carrying capacity. Over time, this can lead to complications such as an enlarged heart or heart failure.
- PREGNANCY-ASSOCIATED: Severe Iron Deficiency Anaemia is linked to
- Premature births
- Low birth weight babies and
- Increased bleeding after delivery.
- GROWTH PROBLEMS: Infants and children with Anaemia may experience delayed growth and development, along with an increased vulnerability to infections.
- OTHERS: Inherited Anaemias, such as sickle cell Anaemia, can lead to life-threatening complications.
TREATING IRON DEFICIENCY ANAEMIA
- Iron needs of our body are generally met by the food we take.
- Mild Iron Deficiency Anaemia usually does not cause complications and can be corrected using iron supplementation.
- Treatment for Iron Deficiency Anaemia usually involves oral iron therapy, where iron supplements are taken orally.
- In certain circumstances, healthcare providers may recommend the administration of iron through injections.
PARENTERAL IRON THERAPY
- Parenteral administration (iron infusion) may be necessary for patients intolerant or non-compliant with oral iron therapy or with severe Anaemia.
ORAL IRON THERAPY
- Salts and Formulations and various forms of oral therapy are available, like tablets, capsules, drops, syrups, slow-release tablets, and chewable tablets.
- The selection of formulation depends upon the bioavailability, side effects, and patient’s tolerance to a given preparation.
- Ferrous salts like sulfate, fumarate, gluconate, succinate, glutamate, ascorbate, and lactate are commonly used for oral iron supplementation.
- Ferric salts like ammonium citrate and carbonyl iron, amino-acid chelates, and iron-poly maltose complex (IPC) are also available.
COMMON PROBLEMS WITH IRON THERAPY
- Oral iron supplementation is the ideal way to replace iron stores as it uses the body's normal mechanisms. But the common side effects of oral Iron supplements are
- High incidence of gastrointestinal side effects (abdominal pain)
- Constipation or diarrhea
- Heartburn
- Nausea and vomiting
- Metallic taste
- Feeling sick
- Epigastric distress
- Black stools (feces)
- Teeth staining with liquid preparations.
- Oral iron supplements can be associated with higher gastrointestinal side effects.
- To minimize the adverse effects of oral iron therapy, the dosing regimen can be adjusted or taken with food.
- Oral iron may interfere with the absorption of other medications like methyldopa/levodopa, fluoroquinolones, penicillin, or tetracyclines.
- Injectable iron therapy carries the risk of infusion site reactions and, in rare cases, anaphylaxis.
HOW TO PREVENT IRON DEFICIENCY ANAEMIA:
As we all know, for any condition, prevention is better than cure. In the case of Iron Deficiency Anaemia, intake of foods rich in iron is recommended. Some of the iron-rich sources include:
| Red meat | Beans | Dried fruit such as dates, raisins, and apricots |
| Pork | Peas | Dark green leafy vegetables such as spinach |
| Poultry | Tofu | Iron-fortified cereals, Ragi (Finger millet), Metha (Fenugreek), Gud (Jaggery) |
| Seafood | Kidney beans | Having citrus juice or fruit rich in vitamin C with high-iron foods can enhance iron absorption |
| Eggs | Lentils |
