Anemia | انیمیا

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When number of red blood cells are reduced than the normal number of red blood cells in the blood, the condition is known as anemia.

Red blood cells contain hemoglobin, which is a protein attached with iron molecule. Hemoglobin carries oxygen to all body tissues as well as gives red colour to the blood.IMG_0004

All body cells require oxygen to perform normal functioning of the body. Oxygen is carried by red blood cells. Anemia occurs when body cells do not receive enough oxygen through blood. As a result, patient may feel weakness, tiredness, dizziness, headache or feeling on being un-well. Severe anemia could also cause damage to important organs of the body.

Red blood cells are made in bone marrow, which is present inside the spaces in some of the large bones. Bone marrow requires vitamin B-12, iron, folate and other nutrients to produce healthy red blood cells.

Main causes of Anemia

Generally there are three main causes of anemia:

  • Lack of production of red blood cells (e.g. due to deficiency of iron, folate or vitamin B12)
  • Loss of blood (due to open injury, surgery, bleeding disorders)
  • Increased rates of destruction of red blood cells (due to some genetic disorders or chemotherapy drugs)

Since there are various types of anemia having different causes, iron, folate and Vitamin B-12 deficiency anemia are the most common types worldwide and in Pakistan.

This leaflet focuses on anemia due to iron-deficiency, folate deficiency and vitamin B-12 deficiency

Iron deficiency Anemia

In iron deficiency anemia, deficiency of iron in the body causes decreased number of red blood cells. It occurs when body lacks iron in diet or unable to absorb it.

Iron is required for hemoglobin production. Depletion in iron reduces hemoglobin formation that further lowers red blood cells production. This leads to decreased oxygen supply to different organs and tissues of the body.

Vitamin deficiency Anemia

Red blood cells production is also affected when body lacks vitamin B-12 and folate. Due to lack of vitamin B-12 or folate the body produces red blood cells, which cannot function properly. As a result, oxygen supply to all body parts is affected causing various symptoms.

Most common symptoms of Iron deficiency anemia are:

  • Lack of energy or tiredness
  • Shortness of breath
  • Paleness or yellowing of skin and nails
  • Irregular heartbeats
  • Feeling of being unwell

Common symptoms of vitamin B-12 and folate deficiency are:

  • Lack of energy, Tiredness
  • Felling of unwell
  • Sensation of pins and needles in body
  • Red or sore tongue
  • Depression
  • Muscle weakness
  • Problems in understanding or memory

Less common symptoms include:

  • Different sense of taste
  • Hearing sounds that come from inside of the body
  • Loss of hair
  • Spoon-shaped nails
  • Diet that regularly lacks iron, folate and Vitamin B-12
  • Disorder in absorption of these substances due to some digestive disease
  • In some cases, body’s own immune system attacks cells of stomach hindering in digestion and absorption of these vitamins

Risk Factors of anemia include:

  • Bleeding in intestines and stomach
  • Digestive system disorder such as Crohn’ disease
  • Pregnancy
  • Other disease such as kidney disease, cancer may also cause anemia
  • Various medicines can also cause anemia
  • Heavy menstrual periods
  • Family history
  • People above 65 years

Diagnosis is usually made based on medical history of the patient, physical assessment and lab tests.

Common lab tests for diagnosis of Anemia include:

  • Complete blood count
  • Blood smear
  • Ferritin test
  • Iron test
  • Vitamin B12 and folate test
  • Total iron binding capacity (TIBC) and transferrin test
  • Reticulocyte count test

Treatment of Iron deficiency Anemia

Iron supplements are the mainstay of treating iron deficiency anemia. This will increase iron’s level in the body and is quite effective.

Monthly monitoring will be done to see the rate of improvement in the level of iron.

Moreover, underlying cause behind this type of anemia needs to be treated so that anemia does not re-occur. Increasing iron intake will also help in the treatment. Green leafy vegetables, brown rice, pulses, beans, eggs, dried fruit, nuts, fish and meat are among some good sources of iron.

Treatment of Vitamin B12 or Folate deficiency Anemia:

Various cases of this type of anemia are treated with help of medicines or injections of these vitamins. Supplements of vitamin B12 are given by injection first. If the cause of anemia is dietary deficiency of these vitamins then tablets are given between meals or sometimes, regular injections are also given to increase amount of these vitamins in the body. Tablets of folic acid are also available which increases the amount of folate in body.

Meat, dairy products, peas, green vegetables and eggs are among some good sources of these vitamins and should be made a part of normal diet.

Vitamin B12 or folate deficiency anemia is more common in older people and iron deficiency anemia is more common in pregnant ladies.

If anemia is not treated properly then following complication could occur:

  • Severe tiredness: When there is anemia of severe degree, then a person becomes too tired for carrying the daily tasks.
  • Heart problems: Anemia could cause irregular or rapid heartbeat because in this condition heart pumps more blood in order to compensate for the reduced oxygen in blood and therefore, it could sometimes lead to heart failure or enlarged heart.
  • Complication during pregnancy: Premature birth of the baby could be one of the complications of folate deficiency anemia.
  • Death: Losing great amount of blood suddenly, because of severe anemia could lead to death.

Some types of anemia could be prevented with the type of diet taken. Many could be treated with supplements, medicines or injections. People having signs and symptoms of anemia should see their doctor. Treatment will depend upon the severity and cause of anemia.

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