Anemia is the most common blood condition that develops when blood lacks adequate healthy red blood cells (RBCs) or haemoglobin (Hb). To understand anemia, let us know the blood components. There are two major components in human blood viz. plasma and formed elements (blood cells). Plasma is a clear fluid and mixture of proteins, enzymes, nutrients, wastes, hormones and gases. Formed elements are red blood cells (RBCs), white blood cells (WBCs) and Platelets.
RBCs contain blood pigment called haemoglobin (Hb) which carries oxygen to various tissues of the body. The red color of human blood is due to the presence of haemoglobin.
WBCs are responsible for defence against various infections like bacterial, viral or fungal. WBCs provide natural immunity to the body against various infective illnesses.
Platelets help in blood clotting and prevent risk of excessive bleeding.
Anemia is a condition affecting RBCs and haemoglobin. It is a very common disease in India with a total prevalence of about 40%. The prevalence is even higher among Indian women, with around 50% of women having low Hb levels. The studies have shown that poor eating habits and lack of access to healthcare are the main causes for high prevalence of this condition in Indian population. The complexity of this situation is further aggravated as more than 50% of people with anemia are unaware of this condition due to mild and non-specific symptoms.
Anemia is categorized into three groups with 400 different types.
- Anemia due to blood loss eg, active bleeding from gut, excessive menses, bleeding piles, worm infestations, blood loss due to injury or major surgeries, major cancers, and drug induced blood loss.
- Decreased or defective production of RBCs: There is reduced formation of RBCs or abnormal RBCs are not functioning correctly. Some of the anemia in this category are Iron deficiency anemia (the most common type due to poor dietary habits or increased demand of nutrients during pregnancy), deficiency of folic acid and vitamin B12 (megaloblastic and pernicious anemia), bone marrow suppression after chemotherapy or radiotherapy.
- Destruction of RBCs: RBCs are fragile and rupture prematurely causing anemia (hemolytic anemias). Hemolytic anemias can be present at birth or appear later in life. The causes of hemolytic anemia are sometimes unknown and could be due to abnormal immune activity.
The known causes of hemolytic anemia are inherited conditions like sickle cell anemia and thalassemia, toxins from advanced liver and kidney diseases, infections, malaria, snake bite, certain food, severe burns, exposure to certain chemicals and enlarged spleen.
- Anemia of chronic diseases: Certain diseases like cancer, HIV/AIDS, rheumatoid arthritis, chronic kidney diseases, thyroid dysfunction and other chronic diseases may cause anemia.
The symptoms and signs of anemia depends on severity and cause of anemia. The following are usual symptoms presented by the patient:
- Shortness of breath
- Dizziness or light-headedness
- Chest pain
- Cold hands or feet
- Leg cramps
- Sleep disturbances.
- People with iron deficiency anemia may feel hunger for strange substances such as ice, dirt, paper etc. This condition is referred as Pica. Besides there could be spoon shaped nails (koilonychia) and soreness of mouth with cracks at the corner in iron deficiency anemia.
- People with Vitamin B12 deficiency may have tingling sensation in hands or feet, loss of touch sense, difficulty walking and even dementia ( loss of memory).
The patient looks pale or has yellowish skin and may have irregular heartbeats.
The risk factors for anemia are as follows:
- Poor diet: The most common risk factor is diet deficient in iron, vitamin B12, folic acid and other vitamins.
- Reproductive females: Females within reproductive age group (15-45 years ) have high risk of anemia due to blood loss during menses.
- Pregnancy: There is an increased demand of nutrients and can lead to anemia.
- Chronic diseases
- Family history of an inherited anemia like thalassemia and sickle cell anemia
- Age: People over 65 years of age are at increased risk of anemia.
- Frequent blood donations
- Endurance training
- Certain digestive conditions or surgical removal of part of stomach or intestine.
- Certain foods, drugs and caffeinated drinks
- Overcooking of vegetables
- Alcohol abuse
Severe or long standing anemia may cause following complications;
- Severe fatigue affecting daily routine activities
- Anemia during pregnancy may lead to premature birth
- Heart complications like rapid hearbeat or irregular heart beat (arrythmia)
- Life threatening complications may be seen with sickle cell anemia or excessive blood loss.
Most of the anemia can’t be prevented. Only iron deficiency anemia and vitamin deficiency anemia can be prevented with diets rich in iron and various vitamins.
- Iron: Iron rich food include meat, beans, pulses, green leafy vegetables and dried fruits.
- Folic acid: Folate or folic acid is found in fruits and fruit juices, dark green leafy vegetables, green peas, beans, and peanuts.
- Vitamin B-12: Rich sources of vitamin B-12 are meat, liver, and dairy products.
- Vitamin C: It facilitates the absorption of iron through gut thus helps in prevention of iron deficiency anemia.
Additionally, patients can be prescribed multivitamin preparations if the doctor find suitable for him.
In patient with sickle cell anemia or thalassemia, genetic counselling may help prevent further transmission of disease in their children.
Anemia is diagnosed by medical history, clinical examination and Complete Blood Count (CBC). Normal adult haemoglobin (Hb) values are generally between 14-18 gm/dl for men and 12-16 gm/dl for women. Besides Hb value, some of the RBCs may be found in unusual size, shape and color.
Once the diagnosis of anemia is made, it is necessary to find out the cause of anemia and requires further investigations like serum iron levels, identifying any bleeding sites, and any other concomitant illness. Occasionally, patient may require to undergo bone marrow examination in which a sample of bone marrow is taken to study the cause of anemia.
The treatment of anemia depends on its cause.
- Iron deficiency anemia: Patient is recommended to take iron supplementation in form of tablets, capsules or liquid preparations. Also advised to change the dietary habits for rich intake of iron containing foods.
Besides iron supplementations, patients should also be treated for any underlying causes of blood loss like excessive menses, worm infestations, bleeding piles etc.
- Anemia due to deficiency of Folic acid and/or Vita B12: The treatment involves supplementation of folic acid and/or vitamin B12. In case of poor absorption of Vitamin B12 from the gut, patient can be given injections for quick and optimum recovery.
- Anemia of chronic diseases: The treatment requires treatment of underlying diseases like kidney diseases, AIDS, thyroid disease etc. In few cases patients may require blood transfusion or specific biological drug to stimulate the bone marrow and enhance the production of RBCs.
In severe anemia due to any cause, patient may be given blood transfusion for rapid restoration of RBCs and haemoglobin. In anemia due to bone marrow disease, specific medications, chemotherapy or bone marrow transplantation (BMT) may be needed. In certain cases of hemolytic anemias, patient may undergo complete removal of spleen (splenectomy).
Anemia is a common condition often overlooked by the patients and treating doctor. A simple medical history, physical examination and CBC can diagnose this condition. Further investigations may be required to find out the cause of anemia and provide specific treatment.