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HEALTH WATCH

When the iron bond weakens

Dr. SHARDA JAIN

Anaemia has a devastating effect on a person's health and yet many are not aware of its adverse impact.



Eat a varied diet: A poor diet is the primary cause for anaemia. Photo: V. Sudershan

Symptoms of anaemia may not show up in an otherwise healthy person until the haemoglobin or the red pigment drops below 10g/dl. The first symptoms are usually a feeling of tiredness and palpitations (rapid or irregular heart beat). Later shortness of breath and dizziness is also felt. If the anaemia is severe, indications include chest pain (angina), headache and leg pains.

Besides these general indications, long-term cases have unique symptoms. These are felt more in the area of tongue and throat and include burning sensation in the tongue; dry mouth and throat, cracks or sores in the mouth's corners, smooth tongue and an altered sense of touch. In severe cases, nails may become brittle and break easily. They could also be spoon shaped with vertical stripes. Other indications of severity are craving for specific foods, pale skin, loss of weight, brittle hair and difficulty in swallowing.

Pernicious anaemia, if left untreated, can affect the nervous system causing tingling of fingers and toes, muscle weakness, difficulty in walking, depression and confusion. Megablastic anaemia caused by deficiency of folic acid leads to a sore tongue, indigestion and diarrhoea. Haemolytic anaemia often causes an enlarged spleen due to ruptured red cells. Aplastic anaemia causes fever, sore throat, bruising, bleeding and blood spots, pale skin and signs of heart failure.

TODAY India is acknowledged as an emerging economy, but rampant anaemia among youngsters is neither good for them nor for the economy. Moderate to severe anaemia is recognised as a leading cause of morbidity and mortality in children, while mild anaemia adversely affects the mental and motor development and the behaviour of children.

There is also evidence that development deficit that occurs due to iron deficiency anaemia during young age is irreversible.

Widespread

India is among the youngest countries in the world. More than half of the country is under 25 years of age and more than one third is under 15 years of age. The developed world hardly sees any adolescent anaemia; whereas a District Level Health Survey by the Ministry of Health and Family Welfare and Department of Women and Child Development shows that 95 per cent of adolescent girls (10-19 years) and 92 per cent of children less than three years were anaemic. No national data is available on the incidence of anaemia in boys and men.

A sample survey in four Delhi schools conducted in 2003 by the Delhi Gyanecologist Forum showed the incidence of anaemia in boys to be 73 per cent in boys. A screening of over 5,060 schoolboys between 10 and 19 years in East Delhi in 2005 showed that incidence of anaemia in boys is around 50 per cent. However the anaemia drive has been on for three years in these schools and so these surveys may not represent the true picture.

On Doctor's Day (July 31), boys in a government school in Kerala were screened for anaemia on the initiative of Dr. Ashokan, Indian Medical Association, former president, Kerala state. All boys were found to be anaemic using 13 gm Hb as the cut off figure.

Thus, control of Iron Deficiency Anaemia in young children and adolescents is necessary to improve the quality of life for youngsters. In addition, detection and treatment of anaemia can fuel an economic miracle, as much productivity is lost due to weakness caused by the silent epidemic of anaemia.

Join hands

Compulsory screening and treatment of all children and adolescents is necessary. Short of screening, no child and youngster will comply with treatment and diet modification. Results are quick and rewarding. Since State Governments can't do it alone, it could be addressed best if government and private resources are pooled. Children, adolescents, parents and teachers should be made aware of this problem. The future generation should also be educated and actively involved in the fight against anaemia. Government should provide funds and maintain regular supply of quality Iron Folic tablets and deworming tablets.

The writer is the Chairperson of the Women Doctor's Wing of the Indian Medical Association and is based in New Delhi.

ANAEMIA is caused by a reduction in the number of red blood cells. This adversely impacts the blood's oxygen carrying capacity. The deficiency may be caused either by reduced production or increased loss of the red blood cells, which are manufactured in the bone marrow. The average life expectancy of a red blood cell is four months. The most important items required for the production of red blood cells are iron, vitamin B 12 and folic acid. If one or more are lacking, the result is anaemia.

Importance

Why are the red blood cells important? The heart's pumping action pushes the blood around the body through the arteries. The red blood cells circulate in the blood and carry the oxygen from the lungs to the various cells in the body. The oxygen is used to produce energy by burning sugar and fat by oxidation. A waste product of this process is carbon dioxide, which clings on to the red blood cells that have delivered their oxygen. The carbon dioxide is taken back to the lungs where it is exchanged for oxygen got by breathing.

A poor diet with little iron is the primary cause for most cases of anaemia. In adults, the most common cause is losing blood faster than it can be made. Lack of iron-rich diet is common in vegetarians because the main source in terms of diet is red meat. Premature babies can develop iron deficiency since the storage of iron is not over till the last stage of pregnancy. In times when a large amount of cell division occurs, for example, pregnancy or rapid growth in childhood, there is an increased need for iron.

Diseases of the small intestine like gluten intolerance and Crohn's Disease can also cause reduced absorption of iron from the intestine paving the way to development of anaemia. Other causes could be small ruptures in the intestine due to polyps or cancer. Ulcers can also lead to iron deficiency anaemia. Iron deficiency is seen more in women who smoke, whose diet is low in iron and who have heavy periods.

How is anaemia diagnosed? A blood test is the usual way to check if a person has anaemia. The blood test result usually includes an analysis of the red blood cells. In cases of extreme iron deficiency, the red blood cells will show up small and pale. Iron deficiency is identified by techniques that examine the proteins (ferritin and transferrin), which store and transport iron through the blood.

Treatment

How is anaemia treated? A doctor will examine the patient and prescribe appropriate treatment for the illness. An iron supplement will also be prescribed. Iron tablets usually lead to a rapid reversal of anaemia if the underlying cause of blood loss has been treatment. However, these tablets can cause irritation of the stomach and are better taken after food. Iron tablets may cause discolouration of stools (black) and may cause constipation or diarrhoea depending on the individual's reaction. In rare cases, intramuscular iron injections may need to be given instead of tablets.


Did you know?

India has highest number of cases of anaemia in world.

Over 90 per cent Indian women, adolescent girls and children are anaemic.

Anaemia adversely affects a child's mental and motor development, and behaviour. It also hampers their linear growth.

Anaemic mothers bear anaemic children and their I.Q is 5-10 points less.

Moderate to severe anaemia causes death. It significantly decreases physical/mental stamina.

Anaemia is responsible for 40 per cent of the 1,00,000 maternal deaths a year due to complications of pregnancy and childbirth.

In India more than $ 2 billion are lost due to loss of man-hours and productivity.

To avoid anaemia

Eat a varied diet.

Good sources of iron include red meats, wholemeal bread, and eggs

Consult a doctor if there is loss of blood through stools or urine. Women should seek medical advice about persistently heavy periods.

Pregnant women or those planning a pregnancy should talk to a doctor about iron supplements.

Vegetarian sources of iron include beet greens, bulgur, blackstrap molasses figs, kidney beans, lentils, lima beans, prune juice spinach, Swiss chard, dried apricots, broccoli, wholegrain cereals and wholemeal bread.

Vitamin C enhances the absorption of iron from food so to get the most from vegetarian food, include vitamin C-rich foods with meals, for example vegetables or drinks, such as fresh orange juice

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