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Saturday, March 28, 2009

Anaemia

What happens when you suffer from anaemia?

Anaemia is a condition in which the quantity of heamoglobin in the body goes down. Heamoglobin, as we know, is a protein that is very essential to the body. It supplies oxygen to different parts of the body and it does many other functions. If it is low, each and every part of the body gets affected. The first implication would come because there is not sufficient oxygen being transported to different areas. All parts of the body would start feeling weak.

What diet should be prescribed for an anaemic person?

I must clarify that anaemia by itself is not a disease. Anaemia is a manifestation of a particular disease. The real treatment would be to treat the cause. Say, if diet is responsible for anaemia, then taking a good diet could make a difference. There is usually a deficiency of iron or another vitamin. It could be vitamin B12, it could be folic acid or it could be pyridoxine. Deficiency of these things in the diet can lead to anaemia. In case there is iron deficiency, then one has to ensure that whatever food item one takes should contain enough of iron and it should be made available to the body; that means it should get absorbed also.

Should one take supplements or natural forms of iron?

There is no doubt that the natural forms are the best ways of supplementing. But having said it, there are certain problems. Vitamin B12 is not found in vegetarian diet. It is largely a vitamin found in non-vegetarian diet. I would not want any vegetarian to change to a non-vegetarian for the sake of vitamin B12. It is much cheaper, it is more effective and it is more social to supplement with the tablets of B12.

So, basically, if you are not getting it from your daily intake of food, then you have to supplement it with pills. What are the tests to diagnose anaemia?

Anaemia is the reduction of the haemoglobin level in the body. Normally this varies with the age and gender of the individual. According to the WHO criteria, an adult male having the haemoglobin of less than 13, an adult non-pregnant female having a haemoglobin of less than 12 and a pregnant lady having a haemoglobin of less than 11 is diagnosed as anaemic. A simple test is a complete blood count, which gives us a value of haemoglobin and certain other rates and indexes that help us to diagnose a patient as anaemic.

What are the levels of haemoglobin in children?

The values in children tend to vary from the time of birth till about the age of 12 years, though the gender differences do not come till puberty. The value for a newborn is round 13. They vary from the age of six months to one year, two years to six years and again 12 years. So, these are the criteria, which decide whether the child is anaemic or not.

How does a newborn supplement iron? Does it come entirely from the mother’s milk?

When a child is born his haemoglobin is more than the adult’s hemoglobin. Milk that he consumes is deficient in iron, just remember milk is deficient in iron, and that goes on for the whole first year of his life. That is the time by end of first year his haemoglobin drops down to as low as 11, that is normal for them. What we have to remember is that during this time he should be given iron supplementation.

Are only women affected by anaemia?

Not at all, this is a wrong notion that women are the only ones to get affected. However, women have a regular monthly blood loss. In addition to that, married women also might have blood loss during pregnancy or might even have to give away some of their iron and essential elements to the child. This is the reason why women tend to have more prevalence of anaemia as compared to men.

Is there a reserve of iron in the body?

If body needs about 100 mg of iron on a day-to-day basis, 99% of it is recycled and one milligram is taken from the diet. Now, that one milligram is sufficient to manage the requirement of 100 mg because the rest is recycled. Since it is such an essential element in the human body, nature has created a separate reserve for it. So even if somebody does not take iron for a month it should not affect him because he can fall back upon that reserve. By the time anaemia develops, these reserves would have been used up altogether.

Is it true that vegetarians are more likely to be anaemic than non-vegetarians?

The risk of a vegetarian getting into an anaemic state occurs only because of B12 deficiency. We have a large population in our country that is vegetarian. In our clinical practice, we see that most of them do not become deficient in this essential vitamin. So, a healthy person is not likely to get anaemic but there are chances that a vegetarian might get deficient in B12, which may or may not lead to anaemia.

How is thalassaemia related to anaemia?

Thalassaemia is a hereditary disorder, which presents itself as anaemia. It is a very frequent problem in India because we have a large gene pool of beta thalassaemics in India. And it presents itself, in a fashion, in a laboratory very similar to iron deficient anaemia, but there are simple tests which are available which help us distinguish between a thalassaemic and an iron deficient individual. A simple estimation of haemoglobin A2 levels and a fetal hemoglobin level estimation with the examination of the complete blood count should by and large be able to give the diagnosis.

What is bone marrow biopsy and does it help in determining anaemia?

A bone marrow biopsy is an investigative technique in which a small needle is inserted into the bone and a piece of the marrow tissue is taken out. As far as the diagnosis of anaemia is concerned, this is rarely restored to, even though staining of the bone marrow iron is supposed to be the most definitive test for iron deficiency. If a patient’s bone marrow does not stain positive for iron it means the patient is completely depleted of iron. But being an invasive technique and with the presence of so many more simple techniques available to us, we do not resort to it. However, it is an important investigation as part of the diagnosis of a patient who is having unexplained anaemia in which he would like to rule out the secondary causes of anaemia, like cancers, like leukaemia or myelodysplastic syndromes in an elderly individual.

Are chemotherapy patients more likely to be anaemic?

Certain groups of anticancer drugs, which act against the folate metabolism can cause anaemia.

By and large all anticancer drugs would have some affect on the bone marrow. Bone marrow is a factory for the production of haemoglobin. Whenever there is anaemia, it is important to check the factory, whether it is working or not. All anticancer drugs can have an affect on this bone marrow.

Is there any way to prevent anaemia?

Yes, and I think that is the best strategy. We have preventive strategies for both kind of anaemias - the hereditary type of anaemia and those that are acquired. I will take the acquired one first because they are more common. Acquired, they are from the deficiency of iron or one of the vitamins such as — B12 or deficiency of protein. It is very easy for anybody to take a healthy diet, a nutritious diet and a balanced diet. Highly processed foods destroy folic acid resulting in anaemia. One should avoid taking tea; one can take some lemon or vitamin C that helps absorb iron. When it comes to the hereditary causes, like thalassaemia: one can prevent it; in fact, some of the countries are going to eradicate thalassaemia by genetic conunselling, which is a preventive and curative measure.

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