Anaemia

Definition of anaemia

Anaemia is a condition
that develops when an individual’s blood lacks enough healthy red blood cells or haemoglobin. Haemoglobin
is a main part of red blood cells and
binds oxygen. If an individual has too few or abnormal red blood cells, or when
haemoglobin is abnormal or low, the cells in the body will not get enough
oxygen.

There are many types of anaemia. All are very different
in their causes and treatments. Iron-deficiency anaemia, the most common type,
is very treatable with diet changes and iron supplements. Some
forms of anaemia – like the anaemia that develops during pregnancy – are even
considered normal. However, some types of anaemia may present lifelong health
problems.

Causes of anaemia

There are more than 400 types of anaemia, which are
divided into three groups:

·
Anaemia caused by blood loss

·
Anaemia caused by decreased or
faulty red blood cell production

·
Anaemia caused by destruction of
red blood cells

Common types of anaemia and their causes include:

·
Iron Deficiency Anaemia Iron
deficiency anaemia is caused by a shortage of the element iron in the body. The
bone marrow needs iron to make haemoglobin. Without adequate iron, the body can
not produce enough haemoglobin for red blood cells. This type of anaemia is
often caused by blood loss, such as from heavy menstrual bleeding, an ulcer,
cancer and prolonged use of aspirin or drugs known as non-steroidal
anti-inflammatory drugs (NSAIDs).

·
Vitamin Deficiency Anaemia: In
addition to iron, the body needs folate and vitamin B12 to produce
sufficient numbers of healthy red blood cells. A diet lacking in these and
other key nutrients can cause decreased red blood cell production. Additionally,
some people may eat enough B12, but their bodies are not able to
process the vitamin. This can lead to vitamin deficiency anaemia, also known as
pernicious anaemia.

·
Anaemia of Chronic Disease: Certain
chronic diseases — such as cancer, HIV/AIDS, rheumatoid arthritis, Crohn’s
disease and other chronic inflammatory diseases — can interfere with the
production of red blood cells, resulting in chronic anaemia. Kidney failure
also can cause anaemia.

·
Aplastic Anaemia: This
very rare life-threatening anaemia is caused by a decrease in the bone marrow’s
ability to produce red blood cells. Causes of aplastic anaemia include
infections, drugs and autoimmune diseases.

·
Anaemia associated with bone
marrow disease: A variety of diseases, such as leukaemia,
myelodysplasia or myelofibrosis, can cause anaemia by affecting blood
production in your bone marrow. The effects of these types of cancer and
cancer-like disorders vary from a mild alteration in blood production to a
complete life-threatening shutdown of the blood-making process. Other cancers
of the blood or bone marrow — such as multiple myeloma, myeloproliferative
disorders and lymphoma — also can cause anaemia.

·
Haemolytic Anaemia: This
group of anaemia develops when red blood cells are destroyed faster than bone
marrow can replace them. Certain blood diseases can cause increased red blood
cell destruction. An individual can inherit a haemolytic anaemia, or can
develop it later in life.

·
Sickle Cell Anaemia This
inherited and sometimes serious anaemia is caused by a defective form of haemoglobin
that forces red blood cells to assume an abnormal crescent (sickle) shape.
These irregular-shaped red blood cells die prematurely, resulting in a chronic
shortage of red blood cells.

·
Other Anaemias: There
are several other rarer forms of anaemia, such as thalassemia and anaemia
caused by defective haemoglobin.

Signs and symptoms of anaemia

Anaemia symptoms vary depending on the cause of
your anaemia but may include:

·
Fatigue

·
Weakness

·
Pale skin

·
A fast or irregular heartbeat

·
Shortness of breath

·
Chest pain

·
Dizziness

·
Cognitive problems

·
Cold hands and feet

·
Headache

Initially, anaemia can be so mild it goes
unnoticed. But symptoms increase as anaemia worsens.

Test and diagnosis of anaemia

Anaemia diagnosed in the following

·
Physical Examination: During a
physical examination, the care giver may listen to the patient heart beat and
breathing. The care giver may also place his or her hands on the patient’s abdomen
to feel the size of the liver and spleen.

·
Complete blood count (CBC). A CBC is
used to count the number of blood cells in a sample of the patient’s blood. For
anaemia, the care giver will be interested in the levels of the red blood cells
contained in the blood (hematocrit) and the haemoglobin in the blood. Normal
adult hematocrit values vary from one medical practice to another but are
generally between 40 and 52 percent for men and 35 and 47 percent for women.
Normal adult haemoglobin values are generally 14 to 18 grams per decilitre for
men and 12 to 16 grams per decilitre for women.

·
A test to determine the size and
shape of your red blood cells. Some of your red blood cells may
also be examined for unusual size, shape and colour. Doing so can help pinpoint
a diagnosis. For example, in iron deficiency anaemia, red blood cells are
smaller and paler in colour than normal. In vitamin deficiency anaemias, red
blood cells are enlarged and fewer in number.

Prevention of anaemia

Many types of anaemia cannot be prevented. However,
one can avoid iron deficiency anaemia and vitamin deficiency anaemias by
choosing a diet that includes a variety of vitamins and nutrients, including:

·
Iron:
Iron-rich foods include beef and other meats, beans, lentils, iron-fortified
cereals, dark green leafy vegetables, and dried fruit.

·
Folate: This
nutrient, and its synthetic form folic acid, this can be found in citrus fruits
and juices, bananas, dark green leafy vegetables, legumes, and fortified
breads, cereals and pasta.

·
Vitamin B12: This
vitamin is found naturally in meat and dairy products. It’s also added to some
cereals and soy products, such as soy milk.

·
Vitamin C: Foods
containing vitamin C — such as citrus fruits, melons and berries — help
increase iron absorption.

For the prevention of hereditary related anaemia, genetic
counselling is very important, especially for people from family with history
of anaemia. For individual with a family history of inherited anaemia,
such as sickle cell anaemia or thalassemia, genetic counselling is required.

Dietary management of anaemia

The dietary management of anaemia is depended on the type of anaemia:

Iron-Deficiency Anaemia

In order to maintain the balance of iron in the body,
we must match the iron we absorb with the iron that we lose. The following
foods contains iron, therefore they can be very useful in the management of
iron deficiency anaemia. These include:

·
Red meat and offal – e.g., beef, lamb, pork, kidneys, liver, heart,
black pudding (note pregnant women should avoid liver).

·
Fish and shellfish – e.g., sardines, crab, shrimps, mussels.

·
Eggs.

·
Cereal and cereal products – e.g., bread, Rice, corn flakes, Ready bran
flakes, oatcakes,

·
Nuts and seeds – e.g., peanuts, pecans, walnuts, sesame seeds,
sunflower seeds, pine nuts.

·
Green leafy vegetables – eg, broccoli, spinach, watercress, kale.

·
Beans and pulses – eg, baked beans, peas, lentils, chickpeas,
black-eyed beans, kidney beans.

·
Dried fruit – eg, raisins, apricots, prunes, currants, figs.

Folic Acid-Deficiency Anaemia

Management of folic acid deficiency anaemia
involves consumption of food which contain or can boost its production. Good
sources of folic acid include:

·
Fresh, raw or cooked Brussels sprouts, asparagus, spinach, kale,
broccoli, spring beans, green beans, cabbage, cauliflower, okra, lettuce,
parsnips, peas, beansprouts.

·
Cooked black-eyed beans and chickpeas.

·
Breakfast cereals (with folic acid added to them).

·
Liver (note, pregnant women should avoid liver).

·
Kidneys, yeast and beef extracts.

Vitamin B12 Deficiency

Vitamin B12 deficiency from a lack of
dietary vitamin B12 is rare. Vitamin B12 is found in
foods such as meat, fish, cheese, milk and eggs. It is generally not
found in plant foods, so people who follow a vegan diet or have a poor diet for
a long time are at significant risk. Deficiency over a prolonged period of time
can lead to pernicious anaemia.

Pernicious Anaemia

Normally, when you eat foods with vitamin B12,
the vitamin combines with a protein called intrinsic factor in the stomach. The
combined vitamin B12/intrinsic factor is then absorbed into the body further
down the gut at the end of the small intestine. (Intrinsic factor is made by
cells in the lining of the stomach and is needed for vitamin B12 to be
absorbed.) The following foods are good sources of vitamin B12. Including these
foods regularly in the diet should help to prevent vitamin B12 deficiency:

Liver
Eggs.
Cheese.
Milk.
Meat
– eg, beef, lamb, pork.
Fish.
Fortified
breakfast cereals.
Fortified
oat, rice and soya milks.
Fortified
soya yoghurts.
Fortified
spreads.
Fortified
yeast extract.

References

Bernadette, F. (2007). Haematology : clinical principles and
applications (3rd ed.). Philadelphia: Saunders.

Fausto, N. (2012). Robbins Basic Pathology (8th ed.). Philadelphia:
Saunders.

Halterman, J.S. (2011). “Iron Deficiency and Cognitive Achievement
Among School-Aged Children and Adolescents in the United States”. Pediatrics
107
(6): 1381–1386.

Janz, T., Johnson, R. & Rubenstein, S. (2013). “Anaemia in the
emergency department: evaluation and treatment.”. Emergency medicine
practice 15 (11): 1–15

Smith, R.E. (2010). “The clinical and economic burden of anaemia.”.
The American journal of managed care. 16: 59–66.

World Health Organization (2008). Worldwide prevalence of anaemia 1993–2005. Geneva:
World Health Organization.