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A review on anaemia – types, causes, symptoms and their treatments.

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Abstract

Anaemia is a common nutritional deficiency disorder and global public health problem which affects both developing and developed countries with major consequences for human health and their social and economic development (WHO 2005). According to WHO (2004) reports, one third of the global populations (over 2 billion) are anaemic due to imbalance in their nutritious food intake. So in this review we investigate anaemia – types, causes, symptoms and their treatments
Journal of science and technology investigation -ISSN: 2456-8082
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A REVIEW ON ANAEMIA TYPES, CAUSES, SYMPTOMS AND THEIR
TREATMENTS
Soundarya N* and Suganthi P.
Assistant Professors, Department of Medical Laboratory Technology, Holy Cross College (Autonomous),
Affiliated to AIMLTA (Patna), Tiruchirappalli, Tamil Nadu-620002.
*Corresponding Author: E-mail: radhachezhiyan86@gmail.com
Abstract
Anaemia is a common nutritional deficiency disorder and global public health problem which
affects both developing and developed countries with major consequences for human health and
their social and economic development (WHO 2005). According to WHO (2004) reports, one third
of the global populations (over 2 billion) are anaemic due to imbalance in their nutritious food
intake. So in this review we investigate anaemia types, causes, symptoms and their treatments
1. Introduction
Anaemia is a common nutritional deficiency disorder and global public health problem which
affects both developing and developed countries with major consequences for human health and
their social and economic development (WHO 2005). According to WHO (2004) reports, one third
of the global populations (over 2 billion) are anaemic due to imbalance in their nutritious food
intake.
WHO estimates that even among the South Asian countries, India has the highest prevalence of
anaemia. What is even more important is the fact that about half of the global maternal deaths due
to anaemia occur in South Asian countries; India contributes to about 80 per cent of the maternal
deaths due to anaemia in South Asia (Ezzati et al., 2002).
2. Types of Anaemia
There are several types and classifications of anaemia. The occurrence of anaemia is due to the
various red cell defects such as production defect (aplastic anaemia), maturation defect
(megaloblastic anaemia), defects in haemoglobin synthesis (iron deficiency anaemia), genetic
defects of haemoglobin maturation (thalassaemia) or due to the synthesis of abnormal
haemoglobin (haemoglobinopathies, sickle cell anaemia and thalassaemia) and physical loss of
red cells (haemolytic anaemias) (Mukherjee and Ghosh, 2012).
This is a condition in which the body lacks the amount of red blood cells to keep up with
the body’s demand for oxygen. Understanding the different classifications can help to recognize
the symptoms and also to avoid anaemia in the first place.
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Source: Ministry of Family and Health Welfare, 2002/2003.
2.1 Iron-Deficiency Anaemia
Iron is essential for the various activities of the human body especially in the haemoglobin
synthesis. The following figure shows the distribution and storage of iron (Fe) in the various
parts of the human body. Iron deficiency anaemia is a condition in which the body has too little
iron in the bloodstream. This form of anaemia is more common in adolescents and in women
before menopause. Blood loss from heavy periods, internal bleeding from the gastrointestinal tract,
or donating too much blood can all contribute to this disease.
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A low level of iron, leading to anaemia, can result from various causes. The causes of iron-
deficiency anaemia are pregnancy or childhood growth spurts, Heavy menstrual periods, Poor
absorption of iron, Bleeding from the gut (intestines), dietary factors (iron poor or restricted diet),
medication (aspirin ibuprofen, naproxen and diclofenac), Lack of certain vitamins (folic acid and
vitamin B12), Bleeding from the kidney, Hookworm infection, Red blood cell problems, Bone
marrow problems (Harper et al., 2015).
Symptoms
Tiredness, lethargy, feeling faint and becoming breathless easily, headaches, irregular heartbeats
(palpitations), altered taste, sore mouth and ringing in the ears (tinnitus). Anaemia in pregnancy
increases the risk of complications in both mother and baby such as low birth weight baby, preterm
(premature) delivery and postnatal depression. Low iron reserves in the baby may also lead to
anaemia in the newborn baby (Pasricha et al., 2010).
2.2. Pernicious anaemia
Pernicious anaemia is the most common cause of Vitamin B12 deficiency Vitamin B12 is essential
for life. It is needed to make new cells in the body such as the many new red blood cells which are
made every day. Vitamin B12 is found in meat, fish, eggs, and milk. A lack of vitamin B12 leads
to anaemia and sometimes to other problems. A lack of vitamin B12 (B12 deficiency) is one cause
of anaemia. Pernicious anaemia usually develops over the age of 50. Women are more commonly
affected than men, and it tends to run in families. It occurs more commonly in people who have
other autoimmune diseases. Certain medicines used also may affect the absorbtion of vitamin B12.
The most common example is metformin, colchicine, neomycin, and some anticonvulsants used
to treat epilepsy (Turner and Talbot, 2009).
Symptoms
Psychological problems like depression, confusion, difficulty with memory or even dementia and
Nervous problems like numbness, pins and needles, vision changes and unsteadiness. can develop.
Prolonged or severe vitamin B12 deficiency may therefore cause permanent brain or nerve
damage.
2.3. Haemolytic Anaemia
Haemolytic anaemia is a condition in which red blood cells are destroyed and removed from the
bloodstream before their normal lifespan is up. Haemolytic anaemia can affect people of all ages,
races and sexes. Haemolytic anaemia can lead to various health problems such as fatigue, pain,
arrhythmias, an enlarged heart and heart failure. Inherited haemolytic anaemias include Sickle cell
anaemia, Thalassaemias, hereditary spherocytosis, hereditary elliptocytosis, Glucose-6-phosphate
dehydrogenase (G6PD) deficiency, Pyruvate kinase deficiency. Acquired haemolytic anaemias
include Immune haemolytic anaemia, Autoimmune haemolytic anaemia, Alloimmune haemolytic
anaemia, Drug-induced haemolytic anaemia, Mechanical haemolytic anaemias, Paroxysmal
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nocturnal haemoglobinuria, Certain infections and substances can also damage red blood cells and
lead to haemolytic anaemia.
Symptoms
The most common symptom of anaemia is fatigue. A low red blood cell count can also cause
shortness of breath, dizziness, headache, coldness in your hands or feet, pale skin, gums and nail
beds, as well as chest pain. Symptoms of haemolytic anaemia include Jaundice, Pain in the upper
abdomen, Leg ulcers and pain, A severe reaction to a blood transfusion. Treatments for haemolytic
anaemia include blood transfusions, medicines, plasmapheresis, surgery, blood and marrow stem
cell transplants and lifestyle changes (Natasha and Yasmin 2010).
2.4. Sickle cell anaemia
Anaemia in which the body makes sickle-shaped ("C"-shaped) red blood cells is called Sickle Cell
anaemia. It contain abnormal haemoglobin which causes sickle shape and can’t move easily
through the blood vessels. The clumps of sickle cells block blood flow that lead to the limbs and
organs. Blocked blood vessels causes pain, serious infections, and organ damage. Sickle cells
usually die after about 10 to 20 days and the body cant reproduce red blood cells fast enough to
replace the dying ones, which causes anaemia.
Symptoms
Sickle cell anaemia is an inherited, lifelong disease and most common in Africa, South or Central
America, Caribbean islands, Mediterranean countries, India and Saudi Arabia. symptoms include
Fatigue, Shortness of breath, Dizziness, Headache, Coldness in the hands and feet, Pale skin, Chest
pain.
2.5. Thalassaemia
Thalassaemia is an inherited blood disorder which cause the body to make fewer healthy red blood
cells and less haemoglobin. The two major types of thalassaemia are alpha- and beta thalassaemia.
The most severe form of alpha thalassaemia is known as alpha thalassaemia major or hydrops
fetalis, while the severe form of beta thalassaemia is known as thalassaemia major or Cooleys
anaemia. Thalassaemias affect both males and females and occur most often in people of Italian,
Greek, Middle Eastern, Asian, and African descent.
Haemoglobin in red blood cells has two kinds of protein chains: alpha globin and beta globin. If
your body doesnt make enough of these protein chains, red blood cells dont form properly and
cant carry enough oxygen. Genes control how the body makes haemoglobin protein chains. When
these genes are missing or altered, thalassaemias occur. Thalassaemias are passed on from parents
to their children through genes.
Symptoms
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Symptoms of thalassaemias are caused by a lack of oxygen in the blood stream. The severity of
symptoms depends on the severity of the disorder. People who have alpha or beta thalassaemia
can have mild anaemia, People with beta thalassaemia intermedia have mild to moderate anaemia.
They may also have other health problems including slowed growth and delayed puberty, bone
problems and an enlarged spleen.
People with haemoglobin H disease or beta thalassaemia major have severe thalassaemia and other
serious health problems Pale and listless appearance, Poor appetite, Dark urine, Slowed growth
and delayed puberty, Jaundice, Enlarged spleen, liver and heart, Bone problems. Three “standard
treatments” are used to treat moderate and severe forms of thalassaemia, these include blood
transfusions, iron chelation therapy, and folic acid supplements.
2.6. Aplastic Anaemia
Aplastic anaemia is a blood disorder in which the bodys bone marrow doesnt make enough new
blood cells. This may result in a number of health problems including arrhythmias, an enlarged
heart, heart failure, infections and bleeding. Damage to the bone marrows stem cells causes
aplastic anaemia (Scheinberg and Young, 2012).
A number of acquired diseases, conditions, and factors can cause aplastic anaemia including
Toxins, such as pesticides, arsenic, and benzene, Radiation and chemotherapy, Medicines such as
chloramphenicol, Infectious diseases such as hepatitis, Epstein-Barr virus, cytomegalovirus,
parvovirus B19, and HIV, Autoimmune disorders such as lupus and rheumatoid arthritis. Inherited
conditions, such as Fanconi anaemia, Shwachman-Diamond syndrome, dyskeratosis and
Diamond-Blackfan anaemia may also cause aplastic anaemia (Brodsky and Jones, 2005).
The most common symptoms of aplastic anaemia are Fatigue, Shortness of breath, Dizziness,
Headache, Coldness in your hands or feet, Pale skin, gums and nail beds, Chest pains. Treatment
for aplastic anaemia includes blood transfusions, blood and marrow stem cell transplants, and
medication. These treatments can prevent or limit complications, relieve symptoms, and improve
quality of life. Blood and marrow stem cell transplants may cure the disorder.
3. Causes of anaemia
A normal balanced diet will usually contain enough iron for your bodys needs. The low dietary
intake of iron, folic acid and food stuffs that promote iron absorption, coupled with poor
bioavailability of iron are the major factor responsible for very high prevalence of anaemia (Prema,
1989 & 1992). Poor iron stores at birth (Kilbridge et al.,1999), low iron content of breast milk and
low dietary iron intake through infancy and childhood results in high prevalence of anaemia in
childhood (Toteja and Singh, 2004; Kapur et al., 2002).
4. Nutritional Treatment of Anaemia
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Treating anemia is a matter of how much food we eat that aid in hemoglobin synthesis. In general,
to treat anemia, focus should be placed on foods that are good sources of iron, copper, zinc, folic
acid, Vitamin B-12 and protein. The combination of iron and B-vitamins is especially good for
treating anemia.
4.1 VITAMIN B12
Low levels of vitamin B12 can lead to pernicious anemia. This type of anemia often is treated with
vitamin B12 supplements. Food sources of vitamin B12 include Breakfast cereals with added
vitamin B12, Meats such as beef, liver, poultry, and fish, Eggs and dairy products (such as milk,
yogurt, and cheese), Foods fortified with vitamin B12, such as soy-based beverages and vegetarian
burgers.
4.2 Folic Acid
Folic acid (folate) is a form of vitamin B thats found in foods. Your body needs folic acid to make
and maintain new cells. Folic acid also is very important for pregnant women. It helps them avoid
anemia and promotes healthy growth of the fetus.Good sources of folic acid include Bread, pasta,
and rice with added folic acid, Spinach and other dark green leafy vegetables, Black-eyed peas and
dried beans, Beef liver, Eggs, Bananas, oranges, orange juice, and some other , fruits and juices.
4.3 Vitamin C
Vitamin C helps the body absorb iron. Good sources of vitamin C are vegetables and fruits,
especially citrus fruits. Citrus fruits include oranges, grapefruits, tangerines, and similar fruits.
Fresh and frozen fruits, vegetables, and juices usually have more vitamin C than canned ones.
Other fruits rich in vitamin C include kiwi fruit, strawberries, and cantaloupes. Vegetables rich in
vitamin C include broccoli, peppers, Brussels sprouts, tomatoes, cabbage, potatoes, and leafy green
vegetables like turnip greens and spinach.
5. Foods to Eat For Anemia
Anemia is characterized by the deficiency of the quality and quantity of hemoglobin, a molecule
found in the red blood cells. Hemoglobin is important as it carries oxygen from the lungs to the
tissues in the human body. When the hemoglobin is unable to carry oxygen to the bodys tissues,
the body develops anemia. An individual who has anemia may experience symptoms such as
incessant fatigue, insomnia, dizziness, pale skin, shortness of breath, a loss of regular menstrual
cycle and an unusually rapid heartbeat.
5.1 Fruits
Fruits such as iron-rich apples and tomatoes are great to eat when treating anemia. Other fruits
that effectively treat anemia are plums, bananas, lemons, grapes, raisins, oranges, figs, carrots and
raisins when eaten in large quantities.
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5.2 Honey
Honey is a potent source of iron, copper and manganese. When these elements are combined they
aid in hemoglobin synthesis. Honey is therefore a powerful weapon against anemia.
5.3 Meats
Red meats such as kidney, heart and liver are effective at treating anemia. Also poultry, fish and
oyster are effective against anemia.
5.4 Vegetables
Vegetables such as spinach, lettuce, beet, broccoli, fenugreek, celery and kale are iron-rich,
energy-filled vegetables that treat anemia effectively. These vegetables are not only rich in iron
but also Vitamin B-12 and folic acid, energy-boosting nutrients that the body needs to heal from
anemia. Beetroot juice is an iron-rich vegetable juice that those suffering from anemia can drink
as a tonic against fatigue and lethargy.
5.5 Legumes And Nuts
Legumes and nuts such as pulses, almonds, whole grain cereals, dry dates, peanuts and walnuts
are effective against the symptoms and causes of anemia.
Conclusion
Anaemia is the important global health risk factor faced by the teenagers and pregnant women
nowadays. Anaemia should be diagnosed earlier and treated to get a healthy generation.
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• Iron deficiency anaemia (IDA) remains prevalent in Australia and worldwide, especially among high‐risk groups. • IDA may be effectively diagnosed in most cases by full blood examination and serum ferritin level. Serum iron levels should not be used to diagnose iron deficiency. • Although iron deficiency may be due to physiological demands in growing children, adolescents and pregnant women, the underlying cause(s) should be sought. • Patients without a clear physiological explanation for iron deficiency (especially men and postmenopausal women) should be evaluated by gastroscopy/colonoscopy to exclude a source of gastrointestinal bleeding, particularly a malignant lesion. • Patients with IDA should be assessed for coeliac disease. • Oral iron therapy, in appropriate doses and for a sufficient duration, is an effective first‐line strategy for most patients. • In selected patients for whom intravenous (IV) iron therapy is indicated, current formulations can be safely administered in outpatient treatment centres and are relatively inexpensive. • Red cell transfusion is inappropriate therapy for IDA unless an immediate increase in oxygen delivery is required, such as when the patient is experiencing end‐organ compromise (eg, angina pectoris or cardiac failure), or IDA is complicated by serious, acute ongoing bleeding. • Consensus methods for administration of available IV iron products are needed to improve the utilisation of these formulations in Australia and reduce inappropriate transfusion. • New‐generation IV products, supported by high‐quality evidence of safety and efficacy, may facilitate rapid administration of higher doses of iron, and may make it easier to integrate IV iron replacement into routine care.
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A high prevalence of 50-65% iron-deficiency anaemia in mothers and infants in Jordan was reported by the United Nations Relief and Works Agency (UNRWA) in 1990. Iron-deficiency in infancy has been shown to delay cognitive and psychomotor development with long-term consequences. While socioeconomic deprivation and inadequate nutrition are known underlying factors, it is unclear whether iron endowment at birth is compromised when mothers are anaemic, further jeopardizing iron status during infancy. A prospective case-control study of infants from birth to one year was conducted in a lower middle-class urban setting in Amman, Jordan. The study objective was to examine the relationship between maternal anaemia and iron-deficiency anaemia during infancy. A sample of 107 anaemic (Hb < 11 g/dl) and 125 non-anaemic mothers was selected at 37 weeks' gestation and matched for age and parity, and infant data at birth obtained. The infants were reviewed at 3, 6, 9 and 12 months, to assess growth, current nutrition, infection rates and iron status. The main outcome measure was the incidence of iron-deficiency anaemia in the two groups of infants, defined in the study as Hb < 11 g/dl and either plasma ferritin < 12 mcg/l or zinc protoporphyrin > 35 mcg/dl. Iron endowment in cord blood samples appeared similar between the two groups. The incidence of iron-deficiency anaemia was very high in these infants, at 72% by research criteria, (51% if Hb < 10.5 g/dl), but significantly higher in the infants born to anaemic mothers at all stages of the year, with overall incidence of 81% (n = 91), compared to 65% in controls (n = 112). This was not explained by differences in environmental risk factors. Anaemic mothers had not recovered adequate iron status at 6 months' postpartum, with implications for future pregnancy iron demands. Anaemia during pregnancy compromises the health of mothers in traditional cultures, where women tend to have several children close together after marriage, with an inadequate interval to replenish nutritional stores. Their infants also appear to be at increased risk of developing iron-deficiency anaemia, undetected at birth.
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Survival in severe aplastic anemia (SAA) has markedly improved in the past 4 decades because of advances in hematopoietic stem cell transplantation, immunosuppressive biologics and drugs, and supportive care. However, management of SAA patients remains challenging, both acutely in addressing the immediate consequences of pancytopenia and in the long term because of the disease's natural history and the consequences of therapy. Recent insights into pathophysiology have practical implications. We review key aspects of differential diagnosis, considerations in the choice of first- and second-line therapies, and the management of patients after immunosuppression, based on both a critical review of the recent literature and our large personal and research protocol experience of bone marrow failure in the Hematology Branch of the National Heart, Lung, and Blood Institute.
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We describe a case of functional vitamin B12 deficiency where the repeated measurement of a serum B12 level within the normal range led to delay in the diagnosis of subacute combined degeneration of the spinal cord, and possibly permanent neurological damage as a result. Failure of intracellular transport of B12 by transcobalamin-2 can lead to functional B12 deficiency but with apparently normal serum levels, and is suggested by raised levels of either serum methylmalonic acid or homocysteine, associated with low levels of transcobalamin-2. Such patients may respond to repeated high-dose injections of B12.
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To assess the magnitude/severity and possible etiology of anemia and iron deficiency among children 9-36 months of age. A population-based study on the prevalence, etiology of anemia and iron status in 545 children, 9-36 months of age, was conducted in an urban slum ICDS (Integrated Child Development Services) project in North-East Delhi. Hemoglobin and serum ferritin was estimated and information on socio-economic, demographic, parasitic infection/infestation and dietary intake was collected. Prevalence of anemia (using WHO cut-off values of Hb >11.0 g/dl) among children, 9-36 months of age, was 64%, of these 7.8% had severe anemia (Hb >7.0 g/dl). Using 10.0 g/dl as the Hb cut-off point 44% children less than 18 months of age in the present study population were anemic. On a sub-sample study, 88% children were estimated to be iron deficient, with serum ferritin concentration less than 12 microg/L. The peripheral smear red cell morphology showed 33.9% as microcytic-hypochromic and 37.1% as dimorphic. Dimorphic anemia was 55% in moderate anemia group. The energy and iron intakes were 56% and 45%, respectively of the Recommended Dietary Allowances (RDA). The parasitic infestation/infection was not related to the prevalence or severity of anemia. In Delhi, high prevalence of moderate to severe anemia and iron deficiency with vitamins folate and/or B12 among children under 3 years of age in an ICDS block in operation for 20 years is of concern. Dietary origin was the main cause of anemia in this age group.
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Aplastic anaemia is a rare haemopoietic stem-cell disorder that results in pancytopenia and hypocellular bone marrow. Although most cases are acquired, there are unusual inherited forms. The pathophysiology of acquired aplastic anaemia is immune mediated in most cases; autoreactive lymphocytes mediate the destruction of haemopoietic stem cells. Environmental exposures, such as to drugs, viruses, and toxins, are thought to trigger the aberrant immune response in some patients, but most cases are classified as idiopathic. Similarly to other autoimmune diseases, aplastic anaemia has a varied clinical course; some patients have mild symptoms that necessitate little or no therapy, whereas others present with life-threatening pancytopenia representing a medical emergency. Paroxysmal nocturnal haemoglobinuria and myelodysplastic syndrome commonly arise in patients with aplastic anaemia, showing a pathophysiological link between these disorders. Acquired aplastic anaemia can be effectively treated by allogeneic bone-marrow transplantation, immunosuppression (generally antithymocyte globulin and ciclosporin), and high-dose cyclophosphamide.
Guidelines for the management of iron deficiency anaemia
Guidelines for the management of iron deficiency anaemia, British Society of Gastroenterology (March 2011)
Iron Deficiency Anemia:Practice essentials
  • J L Harper
  • E C Marcel
  • C B Emmanuel
Harper, J.L., Marcel, E.C. and Emmanuel, C. B., 2015. Iron Deficiency Anemia:Practice essentials, Pathophysiology and Etiology.Medscape.
Medical laboratory Technology
  • K L Mukherjee
  • S Ghosh
Mukherjee, K.L., Ghosh, S., 2012. Medical laboratory Technology. Procedure Manual for Routine Diagnostic Tests. Vol I (Second edition), 263-266.