Anemia is a condition in which there is a reduction in the total circulating hemoglobin. It is defined by W.H.O. as “a condition in which the hemoglobin content of blood is lower than normal, as a result of deficiency of one or more essential nutrients (iron, calcium, copper, cobalt, Vitamin C, folic acid, Vitamin B12, Vitamin B6, niacin riboflavin, pantothenic acid and Vitamin E, protein and amino acids) regardless of the cause of such deficiency.”
Infants and children often develop iron deficiency anemia during periods of rapid growth when their iron intake is not equal to the demands of the constantly increasing tissue mass, be it for hemoglobin or myoglobin. An infant who has been kept on an exclusively milk diet for a long period or on an inadequate mixed diet is predisposed to be development of iron deficiency. An infant inherits its iron in the form of circulating hemoglobin and has very little tissue stores.
Young adolescent girls require more iron to meet the requirements of increased blood volumes in the menstrual flow. Excessive menstrual flow, which is quite common can more than double the loss.
Pregnancy imposes substantial demands upon the iron supply to provide for the growing foetus, to build up the infant’s iron reserves and, provides for blood loss during parturition (delivery). Repeated closely spaced pregnancies exhaust iron stores.
Individuals staying at a high altitude have an increased demand of iron. This is because there is less oxygen at higher altitudes and the hemoglobin of the blood of directly connected with the oxygen up take.
Chronic blood loss may lead to severe exhaustion of the body’s iron stores. Individuals who harbor intestinal parasites or who suffer from chronically bleeding hemorrhoids, peptic ulcers or recurrent nose bleeds are particularly prone to iron deficiency.
Iron deficiency anemia follows a specific sequence. The iron reserves start getting depleted and the transferring (transport form of iron) level of blood goes on increasing with the result that the plasma iron is reduced. The blood cells formed at this stage are pale, fewer in number and smaller in size. This condition is known as hypochromic (less colour during pregnancy) microcytic (small size cell) anemia.
Symptoms of Anemia
Anemia often develops slowly. The patient may unknowingly reduce his physical activity, Lowered hemoglobin results in decreased ability to carry oxygen to the cells/ and to return carbon dioxide to the lungs for exhalation. With less oxygen and more carbon dioxide in the cells, body processes become sluggish and efficiency is lowered. A person in this condition is usually listless and dispirited. He is pale in appearance because the colour-bearing red hemoglobin of his blood is reduced in amount. The severity is dependent not only on the degree of anemia but on the rapidity of its development.
Common symptoms are weakness, getting easily tired, lassitude and breathlessness with a little exertion. A constant feeling of tiredness, giddiness, dimness of vision, headache, insomnia, palpitation, anorexia (loss of appetite), dyspepsia (indigestion accompanied with burning sensation and upset stomach). Reduction of hemoglobin breakdown products (Crystal serum and pale urine), damage of all proliferating tissues, especially corners of the mouth, oesophagus; atrophy of the papillae of the tongue are some of the symptoms. There is poor hair growth, the hair often disheveled. The nails become brittle, and longitudinally ridged with fissures, or even concave and spoon shaped (koilonychia).
Iron deficiency in pregnant women often leads to pica-a desire to ingest bizarre items such as chalk, sand, insects, mud, clay, slate, etc.
Prevention and Treatment of Anemia
Prevention of anemia solely depends on a satisfactory diet giving an adequate supply of iron for normal expansion of the tissue mass and blood volume. Of all nutrients it is the most difficult to provide in diet. Thus anemia is better understood when we know the individual iron requirement and the sources supplying it.
Protein foods are concentrated sources of iron. Organ meats such as liver, lean muscle meat of all kinds and dried legumes, dark green leafy vegetables (represented by spinach), dried fruits, egg yolk, shellfish, molasses, whole grain, enriched cereals and breads are all good sources of iron.
Milk, cheese and ice cream are poor sources of iron. This is the reason why diets of infants must be fortified with iron-rich foods like flour at an early age. The iron stores of children are exhausted by the age of six months. Therefore, anemia during infancy can be prevented by giving them egg yolk and iron tonics.
Anemic, pregnant and lactating women benefit by consuming iron rich foods. In addition to these, oral and parental therapy can be resorted to whenever necessary-e.g. ferrous sulphate tablets and inferno injections.
Cooking procedures play an important role in retaining the iron content, for mineral salts is leached out when large amounts of water are used and discarded. In many Indian houses iron utensils are still used which appreciably adds to the daily intake of iron.
Calcium is an essential element required for the formation and maintenance of skeleton and teeth. Children need relatively more calcium, compared to adults, to meet their growth requirements. In pregnancy too there is an increased need for calcium for the growing foetus. Considerable utilization and drain of calcium takes place during pregnancy and lactation when adequate supply of this element has to be ensured. Deficiency during these conditions can be prevented by a generous intake of milk and green leafy vegetables.
Retarded calcification of bones and teeth in the young is the result of calcium deficiency. Bones start bending and there is enlargement of the ankles and wrists in such deficiency conditions. This disease is known as rickets in children and osteomalacia in adults. A reason for calcium deficiency in women could also be inadequate dietary intake coupled with repeated pregnancies.
Phosphorus is a major element required in the body, next in importance to calcium. The utilization of these two elements is closely linked because most of the calcium in the body is deposited as calcium phosphate in the bone and teeth.
The average daily requirement of phosphorus in diet is about a gramme. This is invariably obtained even from a poor vegetarian diet having sufficient cereals. Phosphorus deficiency is therefore a rare phenomenon in India.
Iodine deficiency is very common all over the world. It is estimated that over 120 to 150 million people suffer from this deficiency. 60 to 75% of the iodine needed is obtained from the iodine present in the diet and the rest from the iodine content of water. In an endemic goiter area iodine is deficient in the soil, water and locally grown foods. Apart from this, certain compounds (goitrogens) present in food, particularly in vegetables of Brassica species interfere with iodine utilization in the body and lead to goiter which is characterised by the swelling of the thyroid gland in the neck.
Iodine deficiency during foetal stage could lead to mental retardation and retardation of body growth in later life. Iodine deficiency disease, i.e., goiter, forms a major public health problem in our country. Endemic goiter is prevalent in sub-Himalayan areas, Maharashtra and sub-Vindhya region including Aurangabad where 50% of the population suffer from goiter. One of the most important ways to control iodine deficiency disease is the distribution of iodized salt to people. Daily consumption of iodized salt containing 15 ug of iodine per gm could meet the daily iodine requirement.