Anemia

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Hemoglobin present in the red blood cell is responsible for oxygen transportation around the body. Anemia is a condition which develops when a person’s blood does not have enough healthy red blood cells (RBCs) or hemoglobin. The organs of a person suffering from anemia get lesser oxygen due to reduced oxygen carrying capacity in the bloodstream.

Types

  1. Anemia due to blood loss
  2. Anemia due to decreased or impaired red blood cell production
  1. Anemia due to excessive destruction of red blood cells
  2. Other types are pernicious anemia, hemolytic anemia, Fanconi anemia, etc.

Causes

Anemia can be caused by

  • Chronic blood loss due to gastritis, ulcers, piles, bowel cancer, etc.
  • Iron deficiency due to poor diet, heavy menstruation, poor absorption due to surgical removal of part of the stomach or small intestine, Crohn’s disease, etc.
  • Lack of folic acid due to poor diet, poor absorption as seen in conditions of the gut like coeliac disease, etc. and interfere with its utilization by medications like metformin, methotrexate, etc.
  • Vitamin B12 deficiency. Pernicious anemia is an autoimmune disease in which the body is unable to absorb vitamin B12 because antibodies are formed against a protein called intrinsic factor.
  • Genetic inheritance like sickle cell anemia and thalassemia
  • Diseases of the bone marrow like leukemia, etc. which affect blood production
  • Marked reduction or absence of stem cells due to infections, autoimmune diseases or certain drugs (aplastic anemia)
  • Health conditions that decrease the hormones needed for production of RBCs like cancer, advanced kidney disease, diabetes, hypothyroidism, etc.
  • Failure by the bone marrow to replace RBCs that are prematurely and excessively destroyed (hemolytic anemia) due to certain infections, toxins, blood disorders, drugs, etc.
  • Depleted iron stores due to increased metabolic demands during pregnancy or childhood growth spurts

Symptoms

Symptoms vary according to the causes and types. Some of the symptoms of anemia are:

  • Exhaustion, laziness, dizziness, breathlessness, paleness, muscle cramps, palpitations, etc. due to reduced amount of oxygen to the body tissues
  • Pica (craving for substances such as sand, ice, etc.), koilonychias (thin spoon-shaped fingernails), mouth sores, cracks or fissures at the corners of the mouth and smooth red painful tongue (iron deficiency anemia)
  • Loss of appetite and weight loss, weakness, sore tongue, irritability, behavioral disorders, slow growth, inability to concentrate (folic acid deficiency anemia)
  • Nerve problems like confusion, dementia, hallucinations, loss of touch sense, numbness, tingling sensation in the hands or feet, etc. (vitamin B12 deficiency anemia)
  • Delayed growth and development in children, susceptibility to infection, joint pain, etc. (sickle cell anemia)
  • Damage to the heart, liver and endocrine system due to iron overload, slow growth in children, bone deformity and increased risk of infection (thalassemia)
  • Yellow skin and eyes, bruises under the skin, red urine, abdominal pain, fatigue, fainting, shortness of breath, chest pain and fluid accumulation in the skin of the legs and in the abdominal cavity (hemolytic anemia)

Diagnosis

Anemia often goes undiagnosed and is usually detected during a routine blood test. Some of the tests used to diagnose anemia are:

  • Complete blood count
  • Serum iron test
  • Total iron binding capacity  (TIBC) test
  • Transferrin saturation/ Iron saturation test.
  • Tests to detect Vitamin B12 and folic acid levels
  • Blood test to detect intrinsic factor antibody to diagnose pernicious anemia
  • Blood and urine tests to identify breakdown products of red blood cells for suspected hemolytic anemia
  • Kidneys, liver, thyroid gland and other hormone tests to determine possible causes
  • Rarely, a bone marrow biopsy

Treatment

Treatment of anemia depends on the causative factor. Some of the treatment modalities are:

  • Changes in the diet and iron and folic acid supplements can help treat anemia due to their deficiency. Vitamin B12 oral tablets or injections need to be taken for life for pernicious anemia.
  • Tracing and attending to the bleeding source for anemia due to loss of blood
  • Children born with sickle-cell disease may need to take folic acid daily for life. Painkillers, blood transfusion and bone marrow transplant may also be recommended.
  • Regular blood transfusions to manage some forms of thalassemia
  • Blood transfusions or a bone marrow transplant for treatment for aplastic anemia
  • Suppressing the immune system with steroids or immune suppressant drugs, treating infections, transfusing blood, splenectomy (removal of spleen) etc. to manage hemolytic anemia
  • Avoiding the drug suspected to be causing the anemia

Alternative Therapies

  • In Ayurveda, anemia is described as ‘Pandu’, meaning pallor which defines one of the most important symptoms of anemia. It manifests from dysfunctional agni (fire) and formation of ama (un-metabolised waste). Anemia or “Pandu rog” predominantly involves the three doshas (Vata, Pitta or Kapha). [1,2,3] Certain herbal remedies like spirulina, alfalfa, dandelion root or leaf, gentian have been used in the treatment of Ayurveda. These herbs have the ability to fortify and cleanse blood which can help in anemia. [4,5,6]
  • Some homeopathic cures have been defined in treating anemia. Homeopaths usually consider anemia as symptomatic of an underlying condition and direct their treatment accordingly. Some homeopathic remedies that are being used are as follows:

 Ferrum phosphoricum [7]

– Ferrum metalicum

– Pulsatilla

– Arsenicum

– Helonias

– Natrum mriaticum

  •  If you’re anemia is due to iron deficiency, then replenishing the blood with adequate amounts of iron is very important. The most easy and best way to do this would be to incorporate some dietary changes such as including foods which have high iron content. Fruits like apples, pomegranate along with dried fruits like dates, apricots and raisins can help replenish the lost iron. Including vegetables like tomatoes, spinach, olives, bottle gourd, ash gourd, parsley in your daily meals can also prove beneficial in improving the iron deficiency.[8]
  • Our body absorbs dietary iron better than the non-heme iron which we acquire from plant based foods. Animal liver is the richest source of this dietary iron which is very important when suffering from anemia. For vegetarians, legumes, whole grains and nuts can compensate for the lost iron. [9,10,11]
  • Yoga can help in anemia by increasing the RBC count and  improving circulation which can enhance the functioning of the entire immune system. Breathing exercises like Ujjayi (Loud Breathing), Suryabhedana Pranayama (Single Nostril Breath Pose), Anuloma Viloma (Alternate Nostril Breathing) and Kapalbhati (Hatha Yoga) are believed to be helpful in improving the circulation. Sarvangasana (Shoulder stand), Paschimottanasana (Seated Forward Bend), Uttanpadasana (Leg Raised Pose), Viparita-karani-mudra (Half Shoulder Stand) and Shavasana (Corpse Pose) also help in promoting good circulation. [12]

Prevention

Choosing a diet rich in variety of vitamins and nutrients can help prevent most common types of anemia.

  • Include more green leafy veggies like spinach and fenugreek in the diet
  • Eat more legumes like chickpeas, lentils and soya bean which are one of the richest sources of iron. Sesame seeds are a good source of iron too.
  • Iron from animal sources is absorbed much faster than plant sources non-vegetarians can eat more meat (especially the red variety), fish and eggs.
  • Avoid combining tea, coffee, etc. and calcium rich foods such as milk and milk products along with iron-rich foods because they block iron absorption.
  • Vitamin C promotes iron absorption. Combine foods rich in vitamin C with iron-rich foods. Pomegranate is a fruit that is not only rich in iron but also contains vitamin C. Dates contain vitamin C and are an excellent source of iron too.
  • Good sources of folic acid foods include pulses, green leafy vegetables, cluster beans, okra, liver and eggs.

Replace sugar with jaggery wherever possible. Regular consumption of jaggery can help improve hemoglobin levels.

 

References
1.Rupapara AV, Donga SB, Dei L. A comparative study on the effect of Pandughnivati and Dhatrilauhavati in the management of Garbhinipandu (Iron Deficiency Anemia). Ayu. 2013 Jul;34(3):276-80. doi: 10.4103/0974-8520.123120. PubMed PMID: 24501523; PubMed Central PMCID: PMC3902594.

2. Kumar A, Garai AK. A clinical study on Pandu Roga, iron deficiency anemia, with Trikatrayadi Lauha suspension in children. J Ayurveda Integr Med. 2012 Oct;3(4):215-22. doi: 10.4103/0975-9476.104446. PubMed PMID: 23326094; PubMed Central PMCID: PMC3545243.

3. Satani KG, Vyas HA, Vyas MK. Clinical efficacy of panchakola on raktakshaya. Ayu. 2013 Apr;34(2):184-8. doi: 10.4103/0974-8520.119675. PubMed PMID: 24250128;  PubMed Central PMCID: PMC3821248.

4. Selmi C, Leung PS, Fischer L, German B, Yang CY, Kenny TP, Cysewski GR, Gershwin ME. The effects of Spirulina on anemia and immune function in senior citizens. Cell Mol Immunol. 2011 May;8(3):248-54. doi: 10.1038/cmi.2010.76. Epub  2011 Jan 31. PubMed PMID: 21278762; PubMed Central PMCID: PMC4012879.

5. Chamorro G, Salazar M, Araújo KG, dos Santos CP, Ceballos G, Castillo LF. [Update on the pharmacology of Spirulina (Arthrospira), an unconventional food].  Arch Latinoam Nutr. 2002 Sep;52(3):232-40. Review. Spanish. PubMed PMID:12448336.

6. Yun SI, Cho HR, Choi HS. Anticoagulant from Taraxacum platycarpum. Biosci Biotechnol Biochem. 2002 Sep;66(9):1859-64. PubMed PMID: 12400684.

7. SEIDEL RE. Ferrum phosphoricum. J Am Inst Homeopath. 1946 Dec;39(12):403. PubMed PMID: 20246110

8. Marsh K, Zeuschner C, Saunders A, Reid M. Meeting nutritional needs on a vegetarian diet. Aust Fam Physician. 2009 Aug;38(8):600-2. PubMed PMID: 19893782.

9. Mudryj AN, Yu N, Aukema HM. Nutritional and health benefits of pulses. Appl Physiol Nutr Metab. 2014 Jun 13:1-8. [Epub ahead of print] PubMed PMID: 25061763.

10. Messina V. Nutritional and health benefits of dried beans. Am J Clin Nutr. 2014 May 28;100(Supplement 1):437S-442S. [Epub ahead of print] PubMed PMID: 24871476.

11. Ross AB. Whole grains beyond fibre: what can metabolomics tell us about mechanisms? Proc Nutr Soc. 2014 Oct 23:1-8. [Epub ahead of print] PubMed PMID: 25338549.

12. Morgan N, Irwin MR, Chung M, Wang C. The effects of mind-body therapies on the immune system: meta-analysis. PLoS One. 2014 Jul 2;9(7):e100903. doi: 10.1371/journal.pone.0100903. eCollection 2014. PubMed PMID: 24988414; PubMed Central PMCID: PMC4079606.

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