What is Anaemia ?

Anaemia means decrease in oxygen carrying capacity of blood as a result of significant

reduction in red blood cells (RBCs). Decrease in red cell concentration in peripheral blood or
decrease of hemoglobin is the main indicator of anaemia. Decrease in hemoglobin
concentration by more than 10% below the average values signifies anaemia.

What are the signs and symptoms of anaemia ?

The anaemia is characterised by weakness, fatigue, palpitation, light headedness, pica

(habit of eating mud), difficulty in swallowing, loss of appetite, nausea, constipation,
diarrhea, stomatitis etc.

The patient is pale, the nail may be dry and brittle, and tongue may be inflammed. In
severe anaemia, heart failure and edema can occur. Gastointestinal symptoms are more
common in megaloblastic anaemia. Severe anaemia in young children may cause growth
retardation.

What is the importance of Red Blood Cells (RBCs, Erythrocytes) ?

The blood performs the function of transporting the oxygen with the help of Red Blood Cells
(RBCs).

Mature human RBC is a circular, biconcave cell without a nucleus. The average diameter of
RBC is 7.2 micron. RBCs bigger than normal size are known as macrocytes and smaller than
normal size as microcytes,.

The RBCs are filled with hemoglobin (Hb) which imparts red colour to these cells. Normal
average RBC count is 4.8 and 5.2 million/cubic mm. in females and males, respectively. The
absence of nucleus gives RBC biconcave shape and allows more room for haemoglobin.

Where are the RBCs produced in the body ?

RBCs are produced in the bone marrow. The cells of the bone marrow undergo multiplication
and maturation producing and realeasing the RBCs in the blood. Immature RBCs are larger
than the mature RBCs.

What factors are responsible for the production of RBCs ?

1. Dietary components, such as iron, Vitamin. B12, Folic acid, trace elements, proteins,
and Vitamin C & B complex are essential for the production of RBCs. These vital substances
are obtained from the food articles like meat, fish, eggs, green vegetables and fruits.
2. Lack of oxygen (Hypoxia) stimulates release of a hormone- erythropoietin - from the
kidney. Erythropoietin is the most potent stimulant of RBC production and causes substantial
increase in RBC count and haemoglobin concentration in the blood.

Do the RBCs remain in the blood throughout the life time of an individual ?

No. The RBCs survive in the blood for an average of 120 days and are replaced by the fresh
cells from the bone marrow. The destruction of RBCs occur in the reticuloendothelial
system. Haemoglobin is released from the disintegrated RBCs. The released haemoglobin is
broken into protein (globin) and haem. The iron present in haem is utilized again and rest of
the haem molecule is converted into bilirubin (bile pigment).

What is Haemoglobin ?

Hemoglobin is the red pigment of RBCs. It consists of two parts : 96% of it is a protein
known as globin and 4% is an iron containing pigment called haem. The iron content of
hemoglobin is 0.34%. The most important property of hemoglobin is to transport oxygen by
combining with it to form oxyhaemoglobin in lungs and to dissociate from it in the tissues.

What is normal Haemoglobin level in the blood ?

The average adult male has about 14.8 gm Hb/100 ml of blood. It is about 13.4 Gm Hb/100
ml of blood in adult females.

How is Iron balance maintained ?

Under normal conditions iron balance is strictly maintained. The amount of iron obtained
from diet replaces the iron lost from the skin, gastrointestinal tract, and genitourinary
tract.

Normally the loss of iron is 1 mg daily. In menstruating females the additional requirement
due to blood loss is about 0.5 mg daily. A normal diet contains about 10-15 mg iron which is
sufficient for daily requirement, and about 5 to 10% of dietary iron is absorbed. Iron from
vegetarian diet is poorly absorbed.

What are the sources of iron ?

The iron is available in vegetarian and non-vegetarian foods. Meats like liver and heart, fish,
egg yolk, crab and oysters are rich in iron. The iron in meats is known as haem iron and it is
better absorbed than non-haem iron. Green leafy vegetables, peas, lentils, cereals and some
fruits contain iron in ferric form. The availability of iron from vegetarian diet is poor due to
various factors.

What is Iron deficiency ?

Iron deficiency is common in human beings and its victims are in millions. Some 20-40%
of population is particularly prone to iron deficiency e.g. infants and pregnant females.
Prevalence of iron deficiency in females is very high in developing countries like India.
Iron deficiency is mainly due to dietary deficiency, malabsorption, worm infestations, or
increased requirement due to increased loss, pregnancy, or disease like cancer.

Deficiency of iron is well known to cause anaemia because of inadequate synthesis of

haemoglobin. However, in addition to anaemia, it leads to reduced muscular stamina and
endurance, behavioral and learning problems in children due to disturbances in brain
functions, and abnormalities of body temperature regulation.

What is the role of Iron in human body ?

Iron is a very important element of the body. The total body iron is about 3.5 to 5 gram of
which about 70-75% is an essential component of hemoglobin. Iron, therefore, is very
importantly involved in the oxygen carrying activity of red blood cells. Additionally, it is an
essential component of the muscle protein, myoglobin and several enzymes.

What happens in case of Iron deficiency ?

Deficiency of iron leads to microcytic hypochromic (iron deficiency) anaemia, reduced

muscular stamina, behavioral and learning problems in children, abnormal catecholamine
metabolism, and disturbances in heat regulating mechanisms.

Iron deficiency anaemia is the commonest deficiency disease all over the world. It is
often associated with other deficiencies and is a major cause of morbidity and mortality.

What are the causes of anaemia ?

Anaemia is caused by one or a combination of more than one of the following factors:

1. Dietary deficiency of iron, vitamin- B12 and Folic acid.

2. Increased demand of the above nutrients due to growth in children, pregnancy,
lactation and menstrual blood loss in women.
3. Chronic blood loss due to heavy menstrual bleeding in women, bleeding disorders of
gastrointestinal tract, worm infestations and surgical procedures.
4. Increased destruction of RBCs as in case of haemolytic disorders that occur due to
various factors e.g. abnormal hemoglobin (thalassaemia), antigen antibody reactions
(autoimmune anaemia), and abnormal shape of RBCs as in hereditary spherocytosis.
5. Reduced production of RBCs due to bone marrow failure due to variety of this
orders including drug toxicities.

What are the types of anaemia ?

Based on the causes of anaemia listed above, the anaemia is classified as:

1. Deficiency anaemia - Iron deficiency anaemia is the most common deficiency anaemia
in the world, particularly in the developing countries among women.

Deficiency anaemia also occurs due to increased demands as in case of growing children,
pregnant women, lactating mothers, and in menstruating women.
2. Haemolytic anaemia - It occurs due to increased destruction of RBCs as described
above.
3. Aplastic anaemia - It occurs due to bone marrow failure as described above.

On the basis of the appearance of RBCs under the microscope, doctors classify anaemia as :

1. Microcytic, hypochromic anaemia (small RBC, less hemoglobin) e.g. iron deficiency.
2. Megaloblastic anaemia: The RBC are macrocytic (bigger than normal) because of
imcomplete maturation in the bone marrow due to the deficiency of vitamin B12 and Folic
acid.
3. Dimorphic anaemia : In this anaemia both small and large RBCs appear in the
circulation due to combined iron, Folic acid, and vitamin B12 deficiency.
What are the causes of iron deficiency anaemia ?

Increased requirements:

Iron requirements are increased during the period of growth e.g. in infancy and during
adolescence. Pregnancy imposes a requirement of about 500 to 750 mg elemental iron.
Daily iron requirements in pregnancy are about three times higher and more than 50%
of pregnant women have iron deficiency. Although some iron is conserved during pregnancy
this is offset by increased requirement for fetus and loss of blood during delivery. Iron is
also present in breast milk which increases the requirement of iron in lactating mothers. In
preschool children,maximum deficiency occurs at the age of 1 to 2 because the children
mainly depend on milk diet which is the poorest source of iron.

Inadequate intake:

Although the average diet contains sufficient iron for daily requirements its
bioavailability is poor specially with vegetarian diets. Unbalanced diet, specially in
children and elderly, is most responsible for iron deficiency. Elderly patients often have poor
appetite which leads to iron deficiency.

Decreased absorption:

Chronic diarrhea and dysentery, malabsorption, biliary disorders, surgery, increased motility
of intestine and interfering substance in food or drugs decrease iron absorption.

Increased blood loss:

It is an important cause in adults. Most frequent cause in females is menstrual loss. The
average iron requirement in menstruating female is 1,5 to 2 mg of elemental iron per
day in comparison to 1 mg daily in an adult male. Intestinal parasites are very
important cause of blood loss. Hookworm anaemia is a very well recognized condition.
Worms not only suck blood but they also compete for dietary proteins, minerals and also
damage the intestinal mucosa or cause diarrhea. Chronic blood loss from peptic ulcer, piles
or cancer are other cause of anaemia. Usually there is also a deficiency of other dietary
constituents like Vitamin. B12, Folic acid etc.

How can anaemia be treated ?

For the treatment of anaemia, it is important to determine its underlying cause. The
underlying cause may be a situation of increased demand for nutrients, as in case of growing
children, pregnant women, lactating mothers or it may be due to chronic blood loss due to
menstruation or certain bleeding disorders, worm infestations and a disease like malaria
which causes destruction of RBCs. Treatment of these diseases will naturally lead to the
correction of anaemia. However, in situations of increased demand, administration of
supplemental iron, vitamins and other minerals would be of utmost importance in
treating the anaemia. Please consult your doctor for the treatment of anaemia.