What is Anemia?
Anemia is a medical condition generally caused by the deficiency of Iron & vitamin B12. Women are more prone to anemia and, as per an article published in The Times of India (24 Jan 2022), about 63% Indian women are anemic. 46% of girls under 15, 53.2% non-pregnant women, and 50.4% pregnant women are anemic in India.
State-wise Ranking: Anemia Mukt Bharat(2022-2023) | ||
Location | Percentage of Mothers provided full course of 180 Iron + Folic Acid tablets after Delivery | Rank |
INDIA | 58.9 |
|
TELANGANA | 95 | 1 |
CHANDIGARH | 95 | 2 |
TAMIL NADU | 86.2 | 3 |
GOA | 80.5 | 4 |
KARNATAKA | 74.9 | 5 |
JHARKHAND | 73.2 | 6 |
GUJARAT | 71.6 | 7 |
MADHYA PRADESH | 71.4 | 8 |
MAHARASHTRA | 71.6 | 9 |
ANDAMAN AND NICOBAR ISLANDS | 66.3 | 10 |
ODISHA | 64.6 | 11 |
ASSAM | 63.2 | 12 |
ANDHRA PRADESH | 63.7 | 13 |
CHHATTISGARH | 60.9 | 14 |
SIKKIM | 60.7 | 15 |
HIMACHAL PRADESH | 58.4 | 16 |
UTTARAKHAND | 56.9 | 17 |
WEST BENGAL | 57.5 | 18 |
RAJASTHAN | 51.8 | 19 |
LADAKH | 47.4 | 20 |
JAMMU AND KASHMIR | 48.2 | 21 |
PUNJAB | 48.4 | 22 |
HARYANA | 43.2 | 23 |
THE DADRA AND NAGAR HAVELI AND DAMAN AND DIU | 44.1 | 24 |
MEGHALAYA | 42.7 | 25 |
KERALA | 38.2 | 26 |
ARUNACHAL PRADESH | 35.5 | 27 |
PUDUCHERRY | 34.8 | 28 |
TRIPURA | 31.6 | 29 |
BIHAR | 30.5 | 30 |
LAKSHADWEEP | 29.8 | 31 |
DELHI | 28.4 | 32 |
UTTAR PRADESH | 24.1 | 33 |
NAGALAND | 22.4 | 34 |
MIZORAM | 20.1 | 35 |
MANIPUR | 10 | 36 |
Classifications and Types of Anemia
There are more than 400 types of anemia, and they may be classified into three groups:
1. Anemia caused by blood loss
2. Anemia caused by decreased or faulty red blood cell production
3. Anemia caused by destruction of red blood cells
There are majorly 4 types of Anemia:
1. Iron deficiency Anemia.
2. Pernicious Anemia: Deficiency of Vitamin B12.
3. Aplastic Anemia: Most of the Red Blood Cells are made in the bone marrow. Bone Marrow is a soft tissue that resides in the center of the bones. Aplastic anemia is when our body’s bone marrow cannot make sufficient RBC (Red Blood Cells) and WBC (White Blood Cells). This may happen because our bone marrow was injured by medications, radiation, chemotherapy, or infection. Other malignancies that commonly effect the bone marrow include multiple myeloma or leukemia and others.
4. Hemolytic Anemia: When our body has a low number of Red Blood Cells (RBC). This condition may arise due to autoimmune reactions, physical damage, body exposure to toxic chemicals, bone marrow failure etc.
Few more common types of Anemia are:
· Anemia due to folate (folic acid) deficiency
· Anemia of chronic disease
· Hemolytic anemia
· Idiopathic aplastic anemia
· Megaloblastic anemia
· Pernicious anemia
· Sickle cell anemia
· Thalassemia
A healthy RBC last between 90 and 120 days, and later gets replaced by new RBC. Our kidneys make a hormone called erythropoietin (epo), which signals our bone marrow to make more red blood cells.
Hemoglobin is the oxygen-carrying protein inside red blood cells, which gives colour to RBC. People with anemia do not have enough hemoglobin.’’
Causes of Anemia
· Poor or unbalanced diet resulting deficiency of Iron, Folic Acid, Vitamin B12.
· Inability to absorb iron due to changes in the lining of the stomach or intestines that affect how well nutrients are absorbed (for example, celiac disease). Another reason may be surgical removal of small intestine or a part of stomach.
· Pregnancy, as iron is needed by fetus also.
· Heavy bleedings (eg heavy periods) or internal bleeding owing to peptic ulcer or colorectal cancer.
· Certain medicines.
· Destruction of red blood cells earlier than normal (which may be caused by immune system problems)
· Chronic diseases such as chronic kidney disease (CKD), cancer, ulcerative colitis, or rheumatoid arthritis
· Heredity
· Problems with bone marrow such as lymphoma, leukemia, myelodysplasia, multiple myeloma, or aplastic anemia
· Sudden heavy blood loss
Sign and Symptoms of Anemia
You may have no symptoms if the anemia is mild or if the problem develops slowly. Symptoms that may occur first include:
· Fatigue
· Feeling weak or tired more often than usual, or with exercise
· Headaches
· Lack of concentration
· Irritability
· Loss of appetite
· Numbness and tingling of hands and feet
· Blue color to the whites of the eyes
· Brittle nails
· Pale skin color
· Desire to eat ice or other non-food things (pica syndrome)
· Lightheadedness when you stand up
· Shortness of breath with mild activity or even at rest
· Sore or inflamed tongue
· Mouth ulcers
· Abnormal or increased menstrual bleeding in females
· Loss of sexual desire in men
Possible Complications
Severe anemia can cause low oxygen levels in vital organs such as the heart, and can lead to heart failure.
Exams and Tests
The provider will perform a physical examination, and may find:
· A heart murmur
· Low blood pressure, especially when you stand up
· Slight fever
· Pale skin
· Rapid heart rate
Blood tests used to diagnose some common types of anemia may include:
· Blood levels of iron, vitamin B12, folic acid, and other vitamins and minerals
· Complete blood count
· Reticulocyte count
Treatment of Anemia
· For Iron / B12 / Folic Acid deficiency anemia, the patient will be given suppliments of Iron, Vitamin B12 and Folic Acid supplement.
· Blood transfusions in the case of aplastic anemia
· Corticosteroids or other medicines that suppress the immune system
· Erythropoietin, a medicine that helps your bone marrow make more blood cells
Frequently Asked Questions on Anemia and Iron Supplements
- Is anemia dangerous?
Ans: Severe iron deficiency anemia may increase one’s risk of developing complications that may affect the heart or lungs, such as an abnormally fast heartbeat (tachycardia) or heart failure, where your heart is unable to pump enough blood around your body at the right pressure.
- Can anemia be cured?
Ans: Your treatment for anemia will depend on its cause and how serious it is. People who have mild anemia may not need treatment. Consult your doctor if you feel any symptom of anemia. Depending upon the condition and reason of anemia, S/he may prescribe you some Iron supplement or take another corrective action or will guide you with your diet.
- What will happen if anemia is not treated?
Ans: Undiagnosed or untreated iron-deficiency anemia may cause serious complications such as fatigue, headaches, restless legs syndrome, heart problems, pregnancy complications, and developmental delays in children. Iron-deficiency anemia can also make other chronic conditions worse or cause their treatments to work poorly.
- Can stress cause anemia?
Ans: Yes, excessive and sustained stress hinders the manufacture of hydrochloric acid in our body, which is very important for the integration of iron and proteins. The deficiency of iron leads to lack of haemoglobin and thus, anaemia.
- Can lack of sleep cause anemia?
Ans. Yes, the result showed that short sleep time could lead to low hemoglobin concentration, and disturbed sleep also increased the risk of anemia
- Can anemia stop periods?
Ans. Yes, anemia may cause a delay or irregularities in your menstrual cycle.
- Can I consume Iron and Calcium supplements together?
Ans: Iron and calcium both are minerals which are not so easily digested. So, if they’re consumed together, they interact with each other and calcium inhibits iron absorption. In fact, one should not consume calcium rich food, like milk and dairy products, with Iron supplement. There must be a gap of at least 2-3 hours between iron and calcium supplements.
- What is the best time to consume an Iron supplement?
Ans: There is a hormone in human body called Hepcidin. This hormone decreases iron absorption. Hipcidin gets more active with exercise (after about 3 hours of exercise) or with some physical activities. So, one must consume iron supplement in the morning for its best absorption. If you are exercising in the morning, consume iron supplement within 30 minutes of finishing your exercise. This gives fair time to iron supplement to get absorbed. But, you must consume some food or fruits before taking iron supplement. Consuming citrus fruit like orange in the morning, immediately before taking iron supplement, in fact, helps absorb iron supplements.
- How can I improve iron absorption?
Ans: Consider following steps for best results:
- Select a good iron salt.
- Take the supplement in the morning.
- Avoid calcium and calcium rich foods for at least 2 hours after consuming Iron supplement.
- Add vitamin C in your diet. It helps absorb iron in our body.
- Is there any drug which is to be avoided with Iron supplements?
Ans: Iron supplements may reduce the absorption and efficacy of the following medications. Consult your doctor before taking any of the following with iron supplement.
- Levodopa
- Levothyroxine
- Penicillamine
- Quinolones
- Tetracyclines
- Ciprofloxacin
- Bisphosphonates
- Medications that decrease stomach acidity, such as antacids, (H2) receptor antagonists, proton pump inhibitors may impair iron absorption
- Cholestyramine
- Allopurinol may increase iron storage in the liver
Iron : Sources & Supplements
.Iron is a mineral which is needed to make hemoglobin which is part of red blood cells that carry oxygen throughout our body. Iron supplements are often prescribed to treat anemia caused by:
· Pregnancy
· Heavy menstrual periods
· Kidney disease
· Chemotherapy
Dose:
· Girls (14 yrs to 18 yrs) – 15 mg per day
· Women (reproductive age) – 18 mg per day
· Breastfeeding Women – 9-10 mg per day (because there is no menstruation during this period)
· Pregnant Women – 27 mg per day
· Boys (14 – 18 years) – 11 mg per day
· Men (19+ years) – 8 mg per day
Choosing 2 Best Iron Supplements
Iron supplements are available in many forms like Carbonyl Iron, Ferrous Ascorbate, Ferrous Sulfate, Ferrous Gluconate, Ferrous Fumarate, Ferrous Bisglycinate, Heme Iron Polypeptide, Lyposomal Iron etc. Sometime, patient complains heartburn, GI upset, nausea, and constipation on consuming most iron supplements. Still, of all these forms of iron supplements, Ferrous Ascorbate is an easily available and the most economical option, whereas Liposomal Iron and Heme Iron Polypeptide have better functionality. Most of the patients don’t complains heartburn, GI upset, nausea, and constipation on consuming Liposomal Iron and / or Heme Iron.
Liposomal Iron is micronised (causing increased surface area of the Iron), and micro encapsulated and thus a lipid bi-layer is formed. This allows it to pass through stomach and reach intestinal lumen intact. Thus it is better absorbed and leaves almost nil residual and minimise Iron induced constipation or GI irritation. So, we can decide between these two best Iron supplements bases our needs as follows:
I. Liposomal Iron: In pregnancy and in general anemia when patient feels nausea on consuming any other form of iron supplement like Ferrous Ascorbate or Ferrous Bisglycinate, or any other iron form, Liposomal Iron is the best possible option. Also, its tablet has no metallic taste.
II. Heme Iron Polypeptide: This iron supplement form is useful when there is severe drop in hemoglobin level and higher oral supplementation of Iron is required. Heme Iron is about 10 times better absorbed than ferrous sulphate.
Natural Sources of Iron: The Do’s & Don’ts
Do’s:
Include sesame seeds, pumpkin seeds, flaxseeds, spinach, sweet potatoes, peas, broccoli, beans, raisins, apricots, poultry, red meat and fish etc in your daily diet (food) to avoid anemia.
How to Improve Iron Absorption:
· Consume vitamin C (sources are citrus fruits like orange, lemon etc).
· Heme Iron and Liposomal Iron are easier to absorb with respect to other forms of Iron.
· Take Iron supplement after 2 hours of meal (in not so full stomach).
Don’ts
· Oxalic Acid & Phytic Acid: Avoid oxalic acid (found in many green vegetables) and phytic acid (found in white grains) as they interfere with Iron absorption.
· Caffeine: Tea, coffee and chocolates also interferes with Iron absorption
Iron Poisoning
An overdose of Iron may result in Iron poisoning.
· Early Stage Symptoms:
ü Abdominal Pain
ü Diarrhea, & vomiting (may contain blood)
ü Lethargy
· Late Stage Symptoms:
ü Iron builds – up in the organs
ü Decrease in blood sugar levels
ü Fever
Death usually occurs due to buildup of Iron in the heart, liver, and endocrine glands (eg pancreas).
Caution: Don’t take iron without its deficiency and without consulting a doctor
Treatment of Iron Poisoning:
In late stage of poisoning, treatment consists cleaning of the Iron from the blood, using a chealating agent such as Deferoxamine. If it fails, dialysis is the next step.
Conclusion
Anemia is generally caused by the deficiency of Iron & vitamin B12. Women are more prone to anemia. Iron is a mineral which is needed to make hemoglobin which is part of red blood cells that carry oxygen throughout our body. Iron supplements are available in many forms. Of these forms, Ferrous Ascorbate is an easily available and most economical option, whereas Liposomal Iron and Heme Iron Polypeptide have better functionality and are easily absorbed. Take iron supplement only if you have deficiency of it and that after consulting your doctor.
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