Anemia- types, consequences, causes, symptoms treatment.

Anemia- Iron deficiency disease 

Anemia is a condition in which the hemoglobin content of blood is lower than normal as a result of deficiency of one or more essential nutrients, or some other related causes.

Anemia is the most common blood disorder, affecting about a third of the global population. Iron-deficiency anemia affects nearly 1 billion people. In 2013, anemia due to iron deficiency resulted in about 183,000 deaths – down from 213,000 deaths in 1990. It is more common in women than men, during pregnancy, and in children and the elderly. Anemia increases the costs of medical care and lowers a person's productivity through a decreased ability to work.

Types of Anemia: Anemia can be classified in various ways, the most common classification being the following:

(A) Nutritional Anemia: Nutritional anemia may be defined as the condition that results from the inability of the body to maintain a normal hemoglobin concentration on account of an inadequate supply of one or more nutrients leading to a reduction in the total circulating hemoglobin. The nutrients involved are iron, calcium, copper, Cobalt, Vitamin-C, Folic acid, Vitamin-B12, Vitamin-B6, niacin, riboflavin, pantothenic acid and Vitamin-E, protein, and amino acids.

Nutritional Anemia may be of the following types-

(I) Microcytic Hypochromic Anemia: If iron is insufficient in hemoglobin formation is affected, leading to the RBC's becoming pale (hypochromic) and small (microcytic).

(II) Megaloblastic/Macrocytic Anemia: This results from the deficiency of Vitamin B12 and/or Folic acid which are coenzymes from DNA synthesis. As a result of this hemoglobin synthesis is faulty and anemia is seen.

(III) Dimorphic Anemia: If both iron and other for late or vitamin B12 are deficient it gives rise to dimorphic or hypochromic macrocytic anemia.

(IV) Normocytic Hypochromic Anemia: The shape and size of the RBCs are normal but the concentration of hemoglobin is low. This is seen in the case of Survey (Vitamin C deficiency) or iodine deficiency (thyroid hormone deficiency).

(B) Hemolytic Anemia: Hemolysis refers to the splitting up alliances of RBCs leading to loss of hemoglobin and anemia. Hemolytic may result from poisons, Mismatching of blood during transfusions, snakebite, malaria, etc. 

(C) Hemorrhagic Anemia: Excessive loss of blood is referred to as hemorrhage. Due to accidents or any other cause, hemorrhage Mein orca, causing blood loss and therefore anemia.

(D) Genetic Anemia: Several types of animals may be considered to be genetic or hereditary for example Thalassemia, Sickle Cell anemia, etc. are some types of genetic anemia.

(E) Aplastic Anemia: Defect of the bone marrow due to chemical poisoning, radiation, cancer, etc. may cause aplastic anemia. The life span of RBCs is 120 days after which the RBC is being generated in the bone marrow. But if the marrow is defective then anemia would result due to improper RBC synthesis.

Basic Anemia: Basic anemia occurs due to a lack of awareness of food values, inadequate food security, inadequate carrying capacity, poverty, inadequate health policy/program.

Underlying Anemia: Underlying animals caused due to inadequate diet in quantity/quality, poor environments such as water, sanitation, food hygiene, and poor health care e.g. no immunization. And excessive menstruation, childbirth, malaria parasitism-hookworm schistosomiasis, trauma. 

Intermediate Anemia: This is caused due to deficiency of a certain nutrition intake such as iron, folate, Vitamin B complex, Vitamin C, protein. This can lead to conditions such as respiratory infections and diarrhea and also cause increased blood loss with inadequate iron intake.

Iron Deficiency Anemia(IDA): IDA is the most common micronutrient deficiency in the world particularly in developing countries like India.

Anemia occurs when hemoglobin (a pigment that contains iron and present in the blood) production is considerably reduced, leading to a fall in its level in the blood. Anemia may be due to several factors of which the most prominent is Iron deficiency followed by Folic acid and Vitamin B12 deficiency.

Consequences of Anemia: Iron deficiency and anemia reduce the 

work capacity of individuals and their populations, bringing serious economic consequences and obstacles to National Development.

For children, health consequences include premature birth, low birth weight, infections, and elevated risk of death. Physical and cognitive development is impaired, resulting in lowering school performance. For pregnant women, anemia contributes to 20% of all maternal death.

Signs and Symptoms of Anemia: The manifestation of iron deficiency anemia are as follows:

1. Paleness in various parts of the body like tongue, conjunctiva, mucosa of the soft palate, skin, etc. 

2. Swelling of feet due to edema.

3. Koilonychias (nails of fingers and toes become papery thin and bent upwards to assume the shape of a spoon).

4. Reduced work capacity.

5. Fatigue/tiredness.

6. Breathlessness.

7. Immuno Incompetence (reduced immunity).

8. Improper cognitive development.

9. Maternal and perinatal mortality.

Causes of anemia in different age groups:

(A) Infancy: 

1. Inadequate iron stores at birth due to low birth weight or preterm.

2. Multiple Births.

3. Infant who is breastfed by a mother who is a strict vegetarian.

4. Infant who is on a milk diet without proper weaning foods.

5. Late weaning.

6. Impaired absorption of folate. 

7. Regional entities, Crohn's disease, celiac disease.

(B) Childhood:

1. Dietary deficiency.

2. Due to hookworm infestation-occult blood loss.

3. Inflammatory bowel disease.

4. Neglect of a female child.

5. Chronic diarrhea may be associated with considerable unrecognized blood loss.

(C) Adolescence:

1. Menarche

2. Growth spurt with sub-optimal hematopoietic contents.

3. Gender discrimination.

4. Intensive exercise conditioning as occurs in competitive athletics, iron depletion in girls.

5. Early marriage with pregnancy.

6. Excess blood loss during menstruation.

Treatment: Once anemia is developed, dietary modification cannot correct the anemia. Supplementation is required. Oral iron is the preferred method of treatment of IDA. The dosage is decided depending on the severity of the condition. Oral administration of inorganic iron in the ferrous form-ferrous sulfate 52-200mg (60 mg Iron) 3 times daily for adults and 60mg/kg for the child should be given.

Since ascorbic acid can greatly increase the absorption of iron coma its Intake should be stressed upon.

Prevention: As in the case of Vitamin A deficiency, correction, and 

prevention of dietary inadequacy of iron and important sustainable methods of prevention of iron deficiency anemia. However, this is a long-term strategy requiring not only improvement in increasing the availability of iron in the diets. The available methods of prevention and control of anemia are-

1. Dietary Improvement: Dietary improvement can help to prevent anemia. The following are some of the methods-

(a) More intake of heme-iron sources like meat, fish, chicken, etc. 

(b) Intake of the liver, which is an excellent source of iron.

(c) Vitamin C helps in iron absorption and its Intake should also be regulated.

(d) Regular consumption of iron-rich foods like jaggery, dates, nuts, etc.

(e) Consumption of sprouted pulses regularly.

(f) Incorporating green leafy vegetables in the diet.

2. Supplementation: Under the reproductive and Child Health Programme (1997) young children and adolescent girls are given Iron and Folic acid. Children between 6 to 24 months can be given 20-milligram elemental iron and 10 ugs of Folic acid in syrup form. Children below 5 years can be given 20 grams of elemental iron and 100ug of Folic acid for hundred days in a year. Adolescent girls should consume a weekly dosage of IFA tablet containing 100-milligram elemental iron and 500 ugs of Folic acid pregnant mothers should be given 60 milligrams of elemental iron and 500ug of folic acid for 100 days after the first trimester of pregnancy.

3. Fortification: Food fortification is one of the alternatives that 

ensure consumption of the nutrients regularly in the diet. Fortification is the addition of iron to food items that are regularly consumed by at 'risk groups' of populations. However the food items should be centrally produced and inexpensive, consumed in uniform quantities Delhi, should not alter the cooking quality of the food item or the test or color of the food for stop salt satisfies all the criteria and so used for fortification. Other food items used are- wheat flour, rice, sugar, milk, fish, sauce, curry powder, breakfast cereals, infant weaning food, etc.

4. Dietary Diversification: It aims to ensure that their efficient populations have access to food rich in Iron and also foods rich in vitamin C. Home gardening and horticulture are important strategies in this respect.

5. Education: Nutrition education related to iron and anemia are as follows-

(a) Promotion of consumption of iron-rich foods.

(b) Creating awareness in mothers attending antenatal clinics, immunization sessions, Anganwadi centers, etc.

(c) Addition iron-rich foods to the weaning food of infants.

(d) Regular consumption of foods rich in vitamin C like Amla, guava, etc.

(e) Promoting home-gardening

(f) Discouraging the consumption of beverages like tea and coffee as well as food like tamarind that inhibit iron absorption.

(g) Control of parasitic worms and malaria.

6. Other strategies: 

(a) Behavioral change communication.

(b) Strengthening the public health measure.