Anaemia is the condition when there is a decreased level of haemoglobin (Hb) in the red blood cells (RBC), which function by carrying oxygen to various tissues and organs. While anaemia can occur due to a variety of conditions including concomitant chronic diseases such as heart and kidney diseases, arthritis, bowel inflammation etc, malignancy, hematological conditions including blood cancers and precancerous conditions, breakdown of RBCs, bone marrow failure, hereditary diseases (thalassemia, sickle cell disease) or infectious diseases such as tuberculosis, HIV; nutritional deficiency remains the most common and easily treatable cause. More than two billion people word wide are affected by anaemia. As per the National Family Health Survey- 5 data, its prevalence is highest in India, comprising 39.86% of total world population of anaemia. Almost 59% of children, 53% non-pregnant women and 50% pregnant women are affected.
Deficiency of essential dietary elements and micronutrients such as iron, vitamin B12 and folic acid gives rise to nutritional anaemia. This can be due to either a lack of these substances in the diet, an increased loss that cannot be compensated by diet alone or an increased unmet demand during pregnancy and lactation.
A large percentage of the Indian population does not consume a balanced diet sufficient in iron, vitamin B complexes or folic acid. Moreover, hookworm infestation remains a real problem for developing countries, which contributes to decreased absorption and increased loss of these elements. Chronic gastrointestinal conditions such as celiac disease and other inflammatory bowel disorders, Helicobacter pylori infection or gastric bypass surgeries may result in the inability to absorb these micronutrients from food.
Deficiency anaemia also result due to increased loss, which is mainly seen in women of the reproductive age group due to heavy menstrual bleed. Iron deficiency in the elderly age group, and in men can be indicative of serious underlying conditions such as a gastrointestinal malignancy, and hence, should be investigated promptly and thoroughly. While chronic blood loss result in iron deficiency, vitamin B12 and folic acid deficiency mainly occurs when there is a dietary insufficiency, particularly in vegans or due to chronic malabsorption.
Pregnant and lactating women are particularly at risk of developing iron deficiency. Anaemia occurs physiologically in the initial stages of pregnancy due to increased fluid retention by the body resulting in haemodilution. The requirement for iron increases over time due to the growing foetus, potentiating the risk of iron deficiency.
Frequent or multiple pregnancies coupled with insufficient dietary supplement contributes to the burden of this disease. There is a much higher risk of foetal growth retardation, spontaneous abortions, premature birth and maternal and neonatal mortality and morbidity in women with iron deficiency during pregnancy. Similarly, lactating mothers are also at an increased risk of developing iron deficiency due to a much higher demand during this period.
Symptoms of nutritional deficiency anaemia:
– Generalized fatigue and weakness
– Irritability, memory impairment
– Shortness of breath, palpitation
– Pale skin
– Hair loss, brittle nails
– Tingling, numbness of hands and feet
– Cravings for non-food items such as chalk, ice, mud
– Ulcers over the tongue or around the lips
– Cold sensitivity
– Dizziness, headache
How to diagnose?
– Complete blood count (CBC) and blood film examination are usually the first and most essential steps to diagnose abnormalities of the RBCs and Hb. It also provides additional information to help differentiate between the various types of deficiency by parameters such as the RBC size, volume, colour, shape, number. White blood cells and platelets help provide additional information they may point towards a hematological disease.
– Serum iron studies including iron levels, ferritin, total iron binding capacity and percentage saturation
– Serum vitamin B12 and folic acid levels
– Stool tests to detect occult blood or parasites
– Advanced diagnostic options such as endoscopy and colonoscopy to detect gastrointestinal sources of blood loss
– Imaging/ ultrasound scans for detecting fibroids or other causes of heavy menstrual bleed
Prevention and treatment
The simplest way to prevent deficiency anaemia is by ensuring balanced and adequate diet rich in iron, vitamin B12 and folate.
Pregnant and lactating mothers should ensure fulfilment of daily additional requirements to prevent their depletion. Moreover, supplementation with vitamin C helps in improved iron absorption.
Foods’s rich in iron include meat, sea food, eggs, beans, legumes, spinach, nuts, raisins, green leafy vegetables. Vitamin B12 sources include meat, fish, eggs and dairy products while folic acid is found in green leafy vegetables, beans, sprouts, chickpeas and broccoli. Cereals fortified with iron or vitamins are also good sources of these elements.
Dietary supplementation is usually inadequate to replete stores in deficiency conditions and supplementation with iron, vitamin B12 and folic acid is required. These are available in both oral and injectable formulations. However, it is essential to identify and treat the underlying cause such as a gastrointestinal bleed, abnormal periods, or parasitic infestations.
Although statistics may show staggering data, it is essential to utilize the information productively, to help promote awareness and preventive strategies for this potentially serious condition, thereby reducing its burden of mortality and morbidity over the Indian population.