What is Anaemia?

Anaemia is characterized by a lower-than-normal haemoglobin level or a reduced number of red blood cells in the body.

Haemoglobin is a protein found in red blood cells that plays a vital role in transporting oxygen from the lungs to various organs and tissues in the body. When someone has anaemia, the reduced haemoglobin level or the decreased number of red blood cells leads to a diminished capacity to carry oxygen effectively. As a result, organs and tissues may not receive an adequate oxygen supply, leading to symptoms such as fatigue, weakness, shortness of breath, and overall reduced physical endurance.

Anaemia is not a disease but rather an abnormal condition that can occur due to various underlying medical conditions, diseases, or medications. It is a symptom or indication of an underlying health issue rather than a standalone illness. 

In India, anaemia affects an estimated 50% of the population. The problem is more severe in women than in men.  It is estimated that about 20-40% of maternal deaths are due to anaemia and one in every two Indian women suffers from some form of anaemia.

(Reference: Kaur K. Anaemia ‘a silent killer’ among women in India: Present scenario. European Journal of Zoological Research, 2014, 3 (1):32-36 )   

What are the causes of anaemia?

Anaemia can have various causes, and it is necessary to identify the underlying reason to determine the most appropriate treatment. Here are some common causes of anaemia:

  • Iron deficiency anaemia: This is the most common type of anaemia. It occurs when there is insufficient iron in the body to produce adequate haemoglobin. Iron deficiency can be caused by factors such as poor dietary intake of iron, chronic blood loss (such as from heavy menstrual periods or gastrointestinal bleeding), or conditions that impair iron absorption.
  • Vitamin deficiency anaemia: Deficiencies in certain vitamins, such as vitamin B12 or folate, can lead to anaemia. This can occur due to inadequate dietary intake, poor absorption of vitamins in the digestive tract, or medical conditions that interfere with their absorption.
  • Chronic diseases: Some chronic diseases, such as kidney disease, cancer, and autoimmune diseases, can contribute to anaemia. These conditions can affect red blood cells’ production, lifespan, or function.
  • Aplastic anaemia: Aplastic anaemia occurs when the bone marrow fails to produce enough new blood cells, including red blood cells. It can be caused by certain medications, radiation or chemotherapy treatment, autoimmune disorders, or inherited conditions.
  • Hemolytic anaemia: Hemolytic anaemia happens when red blood cells are destroyed prematurely, either due to hereditary conditions, autoimmune disorders, certain medications, infections, or complications from blood transfusions.
  • Sickle cell anaemia: Sickle cell anaemia is a hereditary blood disorder in which red blood cells become abnormally shaped and prone to breakage, leading to a chronic shortage of red blood cells.

Who are at high risk of anaemia?

Certain groups are considered to be at a higher risk of developing anaemia.

  • People over the age of 65
  • Menstruating women
  • Pregnant and breastfeeding women
  • Premature babies and children going through puberty
  • Individuals following a vegan or vegetarian diet
  • Individuals with chronic diseases such as diabetes, cancer, kidney disease, Crohn’s disease, etc.

What are the signs and symptoms of anaemia?

The signs and symptoms of anaemia can vary based on the severity and cause of the condition. In the early stages, anaemia may be so mild that it goes unnoticed. However, symptoms tend to become more pronounced as the anaemia worsens.

Fatigue is the most prominent symptom of anaemia, making it difficult to perform daily activities due to a general feeling of tiredness and exhaustion. Other symptoms may include:

  • Shortness of breath: This is the sensation of being unable to breathe normally or feeling suffocated.
  • Dizziness: Feeling giddiness or unsteady in the legs.
  • Fast or irregular heartbeat (Arrhythmia): Your heart may beat too fast, too slow, or with an irregular rhythm.
  • Pounding or whooshing sound in the ear (pulsatile tinnitus): A swooshing or whooshing sound in the ear that may come and go.
  • Headache: Iron deficiency and anaemia caused by low haemoglobin can cause headaches.
  • Pale or yellow skin: Your skin colour may become lighter than normal.
  • Chest pain: when you feel discomfort in the chest.
  • Cold hands or feet
  • Poor concentration
  • Mouth ulcers
  • Irritability.

What are the risk factors for developing anaemia?

Several factors can increase the risk of developing anaemia, including:

  • Nutritional deficiencies: Inadequate iron, vitamin B12, and folate intake can lead to anaemia.
  • Intestinal disorders:  Intestinal disorders like inflammatory bowel disease, Crohn’s disease, or celiac disease affect the absorption of nutrients from small intestines, which puts you at risk of anaemia.
  • Chronic diseases: Certain chronic conditions, such as kidney disease and cancer, can increase the risk of anaemia. Regular and gradual blood loss from an ulcer or another internal source can reduce the body’s iron stores, eventually leading to iron deficiency anaemia.
  • Family history: A family history of inherited anaemia, such as sickle cell anaemia, can increase your risk of developing the condition.
  • Age: Older adults over 65 are at increased risk of anaemia due to a higher likelihood of nutritional deficiencies and chronic illnesses.
  • Blood loss: Any condition that causes significant blood loss, such as heavy menstruation or gastrointestinal bleeding can increase the risk of anaemia.
  • Pregnancy: During pregnancy, a woman’s body requires more iron to support the growing fetus, making her more susceptible to anaemia.
  • Certain medications: Some medications can interfere with the production of red blood cells and increase the risk of anaemia.

How is anaemia diagnosed?

When diagnosing anaemia, your healthcare provider will typically inquire about your medical and family history, conduct a physical examination, and order certain blood tests, which may include CBC and peripheral blood smear.

Physical examination:  The healthcare provider will 

  • Check your tongue, nails, or the inner lining of your eyelids to see if they are pale. 
  • Check fingernails to see if they are pale or brittle and how quickly they refill with blood.
  • Listen to your heart for a rapid or irregular heartbeat and your lungs for rapid or uneven breathing.

Blood tests

  • CBC: A blood test called a complete blood count (CBC). This test checks haemoglobin and hematocrit levels. A low level of haemoglobin or hematocrit is a sign of anaemia.

Typically, healthy adult hematocrit levels fall within the range of 38.3 % to 48.6% for men and 35.5% to 44.9% for women. Healthy adult haemoglobin levels range between 13.2 to 16.6 gm/dL for men and 11.6 to 15 gm/dL for women. These values may vary slightly across different medical practices.

  • Peripheral blood smear:  The purpose of examining a blood smear is to check the size, shape, and number of red blood cells and is used to diagnose blood disorders.

What is the treatment of anaemia?

Anaemia is often easily treatable. However, the treatment approach that your healthcare provider selects will vary depending on your anaemia type, the underlying cause, and the severity of your symptoms. They may refer you to a haematologist, a healthcare provider specialising in blood disorders.

  • Healthcare providers may suggest modifying your diet or taking supplements to treat iron-deficiency anaemia or pernicious anaemia.
  • In cases where anaemia arises due to a chronic illness, the provider will focus on treating the underlying condition and may prescribe medication to stimulate red blood cell production.
  • For anaemias resulting from abnormal red blood cells, such as aplastic or hemolytic anaemia, healthcare providers may administer medications like immunosuppressants or treatments such as blood transfusions.

How to prevent anaemia?

Nutritional deficiency anaemia can be prevented by eating a diet that includes a variety of vitamins and minerals, including:

  • Iron: Meats, beans, lentils, dark green leafy vegetables, iron-fortified cereals, and dried fruit are all good sources of iron. Cooking in iron vessels also improves iron content in the diet.
  • Folate: This can be found in fruits and fruit juices, dark green leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products like bread, cereal, and rice.
  • Vitamin B-12: Meat, dairy products, fortified cereal, and soy products are all excellent sources of vitamin B-12.
  • Vitamin C: Citrus fruits and juices, amla, peppers, broccoli, tomatoes, melons, kiwi, and strawberries are all rich in vitamin C, which can also help increase iron absorption.

In conclusion, anaemia is a common condition characterized by a lower-than-normal level of haemoglobin or a reduced number of red blood cells in the body. It is essential to understand that anaemia itself is not a disease but rather a signal of an underlying health concern. There are various causes of anaemia, including deficiencies in iron or vitamins, chronic diseases, genetic disorders, medications, and other factors. Recognizing the symptoms of anaemia, such as fatigue, weakness, shortness of breath, and pale skin, is crucial for early detection and proper management. For example, we all have days when we feel worn out. But if you feel exhausted for several days despite rest, consider talking to your healthcare provider. Anaemia is usually a short-term issue easily treated by changing your diet or taking supplements. Untreated anaemia may cause serious medical problems. Your healthcare provider will work with you to identify the underlying cause of your anaemia and develop an appropriate treatment plan, including changes in your diet, iron supplements, or other medications. By understanding anaemia and working closely with your healthcare team, you can take steps towards managing and improving your condition, leading to a better quality of life.

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