Anaemia

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[caption id="attachment_680652" align="alignnone" width="655"]What is anaemia - what is dengue infection - What is Iron deficiency - What is Iron deficit blood - How blood quality impacts spread of the dengue virus Anaemia is a blood disorder affecting millions across the world. According to the findings of a study published in the journal Nutrients, two-third of pregnant women in developing countries are hit by this condition. It is one of the major culprits behind maternal mortality and low birthweight.
This is a condition characterised by low count of red blood cells. You are diagnosed with this condition if your blood test reveals that you have low haemoglobin, the main protein of red blood cells. Its main function is to supply oxygen to different parts of the body. So, when the level of this protein is low, there is a depletion of oxygen in your vital organs or tissues. This condition gives you symptoms like easy fatigability, shortness of breath, so on and so forth. There are multiple triggers behind this blood disorder. However, the most common cause is iron deficiency.[/caption]

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Types

Iron-deficiency anaemia - This is a very common type of anaemia due to insufficient iron stores in an individual. It may occur because of the loss of blood or poor iron absorption and may be seen in pregnant individuals because of childbirth-related blood loss or post-surgery.

Vitamin-deficiency anaemia - This may occur because of the insufficient dietary intake of vitamin B12 or folic acid. When vitamin B12 cannot be absorbed from the gastrointestinal tract, it is called pernicious anaemia.

Aplastic anaemia - This type of anaemia occurs due to insufficient blood cell production from the bone marrow. This usually occurs because of an immune response in which one’s own body destroys the stem cells. Aplastic anaemia can be caused by certain radiations, toxic chemical exposure, or drugs.

Hemolytic anaemia - This occurs because of the breakdown of red blood cells in the spleen or in the bloodstream.  It may also occur because of infections, autoimmune disorders, certain mechanical causes such as defective heart valves, and certain abnormalities in the red blood cells, which may be congenital in nature. Certain types of anaemia can be inherited like thalassemia or glucose-6 phosphate dehydrogenase enzyme deficiency. The cause of the anaemia dictates the treatment.

Sickle cell anaemia - This type of anaemia is inherited. It causes an abnormality in the haemoglobin protein, which results in rigid red blood cells and may obstruct the blood flow through smaller blood vessels.

Anaemia caused by chronic diseases   - There are certain diseases like kidney disease, which result in insufficient production of the hormone erythropoietin; it is required to stimulate the bone marrow to produce additional red blood cells. This results in reduced production of red blood cells. Moreover, a side effect of chemotherapy may result in anaemia because of the impaired ability of the body to produce more red blood cells. Some diseases can affect the body's ability to make red blood cells.

Stages

In terms of iron-deficiency anaemia, which is the most common type of anaemia, three stages exist.

Stage 1 - In this stage, the iron levels and ferritin levels become low. Signs and symptoms may not be seen at this stage.

Stage 2 - In this stage, there are reduced transferrin levels, which results in decreased transport of iron within the body. The time taken for heme to be produced is lesser. At this juncture, the individual will have decreased energy levels, lethargy, decreased cognitive abilities; moreover, pica (in which individuals may crave non-food items such as clay, paste or ice) may be observed too.

Stage 3 - This stage is that of iron deficiency in which RBCs take on a pale (hypochromic) or small (microcytic) appearance. An individual may have weakness, fatigue on exertion, pallor, headaches, and poor immunity.

Symptoms

The symptoms of anaemia may vary depending on the underlying cause behind this blood disorder, severity and associated complications. However, there could be some generic manifestations too. Here are some of them:


  • Fatigue

  • Depleted energy levels

  • Abnormally rapid heartbeat

  • Shortness of breath

  • Headache, particularly with exercise

  • Difficulty concentrating

  • Dizziness

  • Pale skin

  • Leg cramps

  • Insomnia

  • Irregular heartbeats

  • Change in temperature in hands and feet too cold to touch.

  • Fragile nails

  • Loss of hair

  • Pica craving for strange substances like ice, paste, or clay

Causes And Risk Factors

Causes

There could be innumerable culprits behind anaemia. Here are the most common causes behind this blood disorder:


  • Blood loss

  • Iron deficiency

  • Distorted shape of your red blood cells (Sickle cell anaemia)

  • Deficiency of vitamins, especially B12 or Folate

  • Destruction of red blood cells


Risk Factors

Certain chronic conditions don’t allow your body to produce hormones responsible for the synthesis of red blood cells. These increase your risk of getting anaemia:

Age and exposure to toxic metals like lead can also be major risk factors for anaemia.

Prevention

Anaemia caused due to genetic predisposition cannot be prevented. However, eating a well-balanced diet rich in iron and vitamin B 12 can reduce your risk of certain forms of this blood disorder. Here are the steps to follow:


  • If your work exposes you to lead-containing materials such as batteries, petroleum and house paints, maintain the safety guidelines.

  • Increase you’re the intake of vitamin C as this nutrient improves your body’s capacity to absorb iron.

  • Be careful about the consumption of caffeinated beverages. They can affect your iron absorption capacities.

  • To prevent nutritional anaemias, taking a multivitamin every day, can help.

Diagnosis

In order to detect anaemia, your doctor will first review your medical and family health history and follow it up with a physical exam. He may also want to assess your risk factors of this condition. So, expect questions on your exposure to environmental toxins which can increase your risk of this blood disorder. If your physician finds suspects anaemia, he may suggest the following tests:

Blood tests


It reveals the count of red and white blood cells as well as platelets. Abnormal range indicates anaemia.

  • Serum iron levels


It tells your doctor if iron deficiency is the culprit behind this blood disorder.

  • Ferritin test


This is another blood test that reveals your iron reserves.

Depleted blood level of this vitamin can be another indicator of anaemia.

Apart from these, your doctor may also suggest additional blood tests to check the levels of vitamin B 12, folate, fragility of red blood cells, defects in certain enzymes and clotting issues.

Bone marrow biopsy - This is required on rare occasions and will be performed only in a hospital setting.

Investigations to assess sites of bleeding - These include colonoscopy (a visualisation of the colon via a scope), endoscopy (visualisation of the gut via a scope), and gynaecological examination to rule out bleeding in any reproductive organs and cystoscopy (visualisation of the bladder via a scope).

Treatment

The line of treatment for this blood disorder depends on the underlying cause and severity of the condition. You may need additional treatments in case of associated complications.

Anaemia caused by blood loss: In this case, the source of bleeding is identified first and then efforts are made at stopping it. Oxygen therapy and blood transfusion may be required.

Anaemia caused by iron deficiency: Iron supplementation is the usual line of treatment. Generally, the ferrous form of iron is prescribed as it’s easier for your body to absorb it. Taking your iron capsule with orange juice or any other vitamin C works best. Your doctor will also suggest you to increase dietary intake of iron with the help of foods like red meat, beans, egg yolk, whole-grain products, nuts, and seafood. In rare cases you may need intravenous iron injections and blood transfusion. During the course of treatment, your red blood cell count, ferritin (an iron containing protein) and haemoglobin levels will be regularly monitored.

Anaemia caused by distorted red blood cells (Sickle cell anaemia): The aim of treatment is symptom relief. Oral medications for managing symptoms like pain, headache, nausea, diarrhoea, fatigue, etc. may be prescribed. While some may require blood transfusion, kids and teenagers may require a stem cell transplant.

Anaemia caused by deficiency of vitamins: Your doctor may prescribe vitamin B12 injections or pills while advising you to increase your dietary intake of this vitamin. Good food sources include meat, fish, oysters, milk, cheese, and eggs. In case of folate deficiency, folic acid supplements may be advised. Including fresh fruits, green leafy vegetables, dairy products and whole grain cereals will be a good idea. Do not overcook the vegetables if you want to retain the nutritional value.

Anaemia caused by destruction of red blood cells: The trigger behind cell destruction needs to be identified. And avoiding it altogether can lead to remission without any treatment. Surgical intervention may be required for associated complications like faulty heart valves, tumour or abnormal blood vessels. In extreme cases the spleen may need to be removed as the last resort. Supportive treatment may include pain medication, intravenous fluids, steroids (to prevent the immune cells from attacking red blood cells) and blood transfusion.

Lifestyle/management

If an individual has anaemia, there are certain lifestyle changes that an individual should be aware of.


  • Consume a healthy and balanced diet, including vegetables, fruits, meat, fish, eggs and carbohydrates. Stay hydrated by drinking adequate water.

  • Exercise daily to stay healthy. Check with the physician if there are any restrictions on exercise before starting an exercise routine.

  • Maintain hygiene to prevent infection like washing hands.

  • Follow good dental hygiene practices like brushing, flossing and visiting a dentist annually.

  • Look out for changes in symptoms like blood in urine or stool and inform the physician of the same. Maintain a record of symptoms to inform your doctor of the same.

  • Keep the physician informed if you are taking any alternative medicines as this may react with the medications that you are on.Anaemia DietHaving a well-balanced meal diet is a must if the culprit behind your anaemia is iron deficiency. Your doctor and nutritionist may advise you to include these iron-rich foods for healing this form of anaemia:

    • Leafy greens like spinach and poultry

    • Meat and poultry

    • Seafood

    • Beans

    • Nuts and Seeds



Prognosis And Complications

Prognosis

Most people who have anaemia can live a normal life provided they receive appropriate treatment. Prognosis depends on the cause, intensity and overall health of the affected individual. If anaemia is caused by infections or certain medications, it will be resolved soon. If chronic diseases cause anaemia, it is tenacious but not severe. Individuals respond well to treatment if they have autoimmune hemolytic anaemia. For inherited anaemias, the prognosis is based on the severity of the inherited disease.

 

Complications

Complications of anaemia, can be life-threatening; if left untreated, they can be chronic or severe in intensity. Some of the complications are listed below.


  • Organ damage - This may occur because of insufficient oxygen supply to that particular organ.

  • Arrythmias - This may occur because of inadequate oxygen in the blood, which may result in heart failure.

  • Weakened immune system - In case individuals already have a weak immune system, because of diseases such as HIV/AIDS, cancer or certain infections, the prognosis will be poor. In children, iron-deficiency anaemia can result in Pb poisoning or reduced development in motor, behavioural, or mental abilities.

  • Complications in pregnant women - If pregnant women have iron-deficiency anaemia, their infant may be born premature or with low birth weight. Post-partum depression may be associated with anaemia. Pregnant women who have low iron stores may require blood transfusion.

References

 


  1. Anaemia. American Society of Hematology. Available at: https://www.hematology.org/education/patients/anemia. Accessed on: March 25, 2021. (https://www.hematology.org/education/patients/anemia)

  2. Iron-Deficiency Anaemia. LibreTexts. Available at: https://med.libretexts.org/Courses/American_Public_University/APUS%3A_An_Introduction_to_Nutrition_(Byerley)/Text/11%3A_Nutrients_Involved_in_Hematopoietic_System/11.05%3A_Iron-Deficiency_Anemia. Accessed on: March 25, 2021. (https://med.libretexts.org/Courses/American_Public_University/APUS%3A_An_Introduction_to_Nutrition_(Byerley)/Text/11%3A_Nutrients_Involved_in_Hematopoietic_System/11.05%3A_Iron-Deficiency_Anemia)

  3. Anaemia. Familydoctor.org. Available at: https://familydoctor.org/condition/anemia/.  Accessed on: March 25, 2021. (https://familydoctor.org/condition/anemia/)

  4. Anaemia. NHS. Available at: http://www.dgft.nhs.uk/wp-content/uploads/2018/02/anaemia.pdf. Accessed on: March 25, 2021. (http://www.dgft.nhs.uk/wp-content/uploads/2018/02/anaemia.pdf)

  5. Anaemia. Cleveland Clinic. Available at: https://my.clevelandclinic.org/health/diseases/3929-anemia. Accessed on: March 25, 2021. (https://my.clevelandclinic.org/health/diseases/3929-anemia)

  6. Anaemia. Harvard Health Publishing. Available at: https://www.health.harvard.edu/a_to_z/anemia-overview-a-to-z#:~:text=Anemia%20caused%20by%20chronic%20diseases,inherited%20illness%20and%20its%20severity. Accessed on: March 25, 2021. (https://www.health.harvard.edu/a_to_z/anemia-overview-a-to-z#:~:text=Anemia%20caused%20by%20chronic%20diseases,inherited%20illness%20and%20its%20severity)


 

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