ANEMIA

Anemia is a condition in which body lack enough healthy red blood cells to carry adequate oxygen to body’s tissues. Anemia can be temporary or long term, and it can range from mild to severe.

Introduction

Anemia is a condition in which body lack enough healthy red blood cells to carry adequate oxygen to body’s tissues. Anemia can be temporary or long term, and it can range from mild to severe.

Treatments for anemia range from taking supplements to undergoing medical procedures. Prevention of anemia includes eating a healthy, varied diet.

ANEMIA by Nutrition Hopes

Prevalence

According to WHO, in children age from 0.5 to 14.99 (from preschool age to the last two considered school age of children) the Hb level is about 11, 11.5, and 12 g/dL. Globally, the prevalence of anemia in preschool-age children is 47.4% and it varies in school-going children. 

According to World Health Organization Who, around 528.7 million (29.4%) woman of reproductive age are anemic worldwide, which of 20.2 million women are severely anemic.

Nearly 49% of the population in Southeast Asia aged 13-39 are anemic. In Pakistan 50% of female of reproductive age suffer from iron deficiency, while in urban Punjab 21.8% of the female aged 9-29 are having mild to severe anemia.

Types of anemia

  1. Aplastic anemia
  2. Iron deficiency anemia
  3. Sickle cell anemia
  4. Thalassemia
  5. Pernicious anemia  
  6. Copper deficiency anemia

 

Aplastic Anemia:

Aplastic anemia is a condition that occurs when your body stops producing enough new blood cells. The condition leaves you fatigued and more prone to infections and uncontrolled bleeding.

Iron deficiency anemia:

Iron deficiency is the most common nutritional disorder worldwide and accounts for approximately one-half of anemia cases. The diagnosis of iron deficiency anemia is confirmed by the findings of low iron stores and a hemoglobin level two standard deviations below normal.

Sickle cell anemia:

Sickle cell disease (SCD) is a group of inherited disorders caused by mutations in HBB, which encodes hemoglobin subunit β. The incidence is estimated to be between 300,000 and 400,000 neonates globally each year, the majority in sub-Saharan Africa.

Thalassemia:

Thalassemia is a genetic disorder that involves abnormal hemoglobin formation. The two main categories of thalassemia are alpha and beta thalassemia. Some mild forms of thalassemia might even go unnoticed and only cause mild anemia and iron deficiency problems in patients, other more severe forms of thalassemia can even result in death.

Pernicious anemia:

Vitamin B12 (Cobalamin) is a water-soluble vitamin that is derived from animal products such as red meat, dairy, and eggs. Intrinsic factor is a glycoprotein that is produced by parietal cells in the stomach and necessary for the absorption of B12 in the terminal ileum. B12 deficiency called as pernicious anemia and can lead to hematologic and neurologic symptoms.

Copper deficiency anemia:

Another important nutrient copper is important for the absorption of iron from intestine. Superoxide dismutase and cytochrome oxidase is responsible for the transport of iron, optimal function of erythrocyte and heam synthesis. Low level of copper in body can cause iron deficiency anemia.

 

Sign and Symptoms of Anemia

  • Retinal Damage
  • Cold Skin
  • Pallor
  • Headaches
  • Dizziness
  • Vertigo
  • Cognitive function.
  • Malabsorption
  • Irregular Bowel movement
  • Indigestion
  • Water Retention
  • Proteinuria
  • Edema
  • Amenorrhea
  • Brittle Nails
  • Swollen Legs
  • Dyspnea

Treatments for anemia range from taking supplements to undergoing medical procedures. Prevention of anemia includes eating a healthy, varied diet.

Sign and Symptoms of Anemia

Diagnose

  • Red platelets in Anemia are normally portrayed as being microcytic (i.e., mean corpuscular volume under 80 μm3 [80 fL]) and hypochromic, anyway the sign of iron insufficiency happens in a few phases.
  • Patients with a serum Ferritin fixation under 25 ng for each mL (25 mcg for every L) have a high likelihood of being iron lacking. The most precise beginning symptomatic test for anemia is the serum Ferritin estimation. Serum Ferritin esteems more noteworthy than 100 ng for each mL (100 mcg for every L) shows satisfactory iron stores.
  • The serum transferrin receptor examine is a more up to date way to deal with estimating iron status at the cell level. Transferrin immersion is suggested as subsequent tests in patients with a moderate Ferritin level as a system to lessen the requirement for bone marrow biopsy.

Measure

Normal

Anemia

Bone marrow iron

2 – 3a

≥ 1a

TIBC, μg/dL

330 ± 30

< 330

Ferritin, μg/L

100 ± 60

10 – 25

Iron absorption, %

5-10

10 – 20

Plasma iron, μg/dL

115 ± 50

< 40

Transferrin saturation, %

35 ± 15

15 – 30

Erythrocyte protoporphyrin,

μg/dL

30

30 – 200

Erythrocytes

Normal

Microcytic hypochromic

Serum transferring receptors

Normal

High

Treatment and management of anemia according to type

Macrocytic anemia:

  • Megaloblastic anemia: B12supplementation or b12 rich food must be given to the patient with proper follow ups.
  • Pernicious anemia: Blood transfusion when Hb is 4g/dl transfusion should be in PCV along with frusemide 40-80mg. Inj of b12 100microgram for first week, iron: tab ferrous sulphate 200mg.
  • Megaloblastic anemia due to folic acid deficiency: Folic acid 5mg orally/day. Folic acid should not be given before b12, in b12 deficiency anemia.

 

Aplastic anemia:

    • Blood transfusion PCV, antibiotics for infection
    • Bone marrow transplantation
    • Immunosuppressive therapy
    • Treatment to stimulate hemopoiesis

Medical nutrition therapy for Anemia

  • Dietary modification by giving more bioavailable iron.
  • Supplementation
  • Haem iron like meat, poultry, fish, and seafood
  • Ascorbic acid or vitamin C, present in fruits, juices, potatoes and some tubers, and vegetables like green leaves, cauliflower, and cabbage and some germinated food. These could be applicable as an absorption enhancer of iron.
  • Phytates, are supposed to be the inhibitors of iron absorption which present in food like cereal bran, cereal grains, high-extraction flour, legumes, nuts, and seeds.
  • Iron-binding phenolic compounds tannins, iron absorption inhibitors
  • Foods that contain the most potent inhibitors resistant to the influence of enhancers include tea, coffee, cocoa, herbal infusions in general, certain spices (e.g. oregano), and some vegetables; and calcium, particularly from milk and milk products.
  • Factors in vegetable fiber may inhibit non-heme iron absorption.
  • This has been seen if we take meal with tea or coffee, it may reduce the absorption of iron by 50%.
  • Phosvitin reduce the absorption of iron present in egg yolk.

 

Nutritionist should give a diet plan according to the need of the patient and severity of the diseases which vary person to person, but at larger scale like at the scale of population public health nutritionist should take step and come out with fine policy to tackle the disease in the population in better way.

 

Public Health Measures

Interventions for anemia are:

    • Supplementation (Iron and folic acid), especially pregnant women, in reproductive age, children below 2 years
    • Fortification
    • Enrichment
    • Bio-fortification
    • Education and dietary diversification

References

  1. Kassebaum, N. J., Jasrasaria, R., Naghavi, M., Wulf, S. K., Johns, N., Lozano, R., . . . Eisele, T. P. (2014). A systematic analysis of global anemia burden from 1990 to 2010. Blood, 123(5), 615-624.
  2. Allali, S., Brousse, V., Sacri, A.-S., Chalumeau, M., & de Montalembert, M. (2017). Anemia in children: prevalence, causes, diagnostic work-up, and long-term consequences. Expert review of hematology, 10(11), 1023-1028.
  3. Walker, S., Wachs, T., Gardner, J. M., Lozoff, B., Wasserman, G., Pollitt, E., & Carter, J. (2007). International Child Development Steering Group: Child development: risk factors for adverse outcomes in developing countries. Lancet, 369(9556), 145-157.
  4. Camitta, B. M., Rappeport, J. M., Parkman, R., & Nathan, D. G. (1975). Selection of patients for bone marrow transplantation in severe aplastic anemia.
  5. Anaemia, I. D., & Assessment, P. (2001). Control: A Guide for Programme Managers. World Health Organisation: Geneva, Switzerland.
  6. Figueiredo, M. S. (2015). The compound state: Hb S/beta-thalassemia. Revista brasileira de hematologia e hemoterapia, 37(3), 150-152.
  7. Vij, R., & Machado, R. F. (2010). Pulmonary complications of hemoglobinopathies. Chest, 138(4), 973-983.
  8. Joly, P., Pondarre, C., & Badens, C. (2014). Beta-thalassemias: molecular, epidemiological, diagnostical and clinical aspects. Paper presented at the Annales de biologie clinique.
  9. Layden, A. J., Täse, K., & Finkelstein, J. L. (2018). Neglected tropical diseases and vitamin B12: a review of the current evidence. Transactions of The Royal Society of Tropical Medicine and Hygiene, 112(10), 423-435.
  10. Myint, Z. W., Oo, T. H., Thein, K. Z., Tun, A. M., & Saeed, H. (2018). Copper deficiency anemia. Annals of hematology, 97(9), 1527-1534.
  11. Ludwig, H., & Strasser, K. (2001). Symptomatology of anemia. Paper presented at the Seminars in oncology.
  12. Killip, S., Bennett, J. M., & Chambers, M. D. (2007). Iron deficiency anemia. American family physician, 75(5), 671-678.
  13. Warner, M. J., & Kamran, M. T. (2020). Anemia, iron deficiency. StatPearls [Internet].
  14. Ralston, S. H., Penman, I. D., Strachan, M. W., & Hobson, R. (2018). Davidson’s Principles and Practice of Medicine E-Book: Elsevier Health Sciences.
  15. Escott-Stump, S., & Mahan, L. K. (2000).Krause’s food, nutrition, & diet therapy: WB Saunders.