Syeda Tamanna Yasmin and Surovee Das
Research Scholar, Dept. of Microbiology, Assam Don Bosco University, Guwahati, Assam, email- [email protected]
Post Graduated, Dept. of Nutrition and Dietetics, Martin Luther Christian University, Shillong, Meghalaya
ABSTRACT
Anaemia is a condition in which the number of red blood cells (and consequently their oxygen-carrying capacity) is insufficient to meet the body’s physiologic needs. Mild anaemia is normal during pregnancy. During pregnancy, the amount of blood produced by the body increases by up to 30 per cent. There are several types and classifications of anaemia. The occurrence of anaemia can be of any reason. Anaemia has significant consequences for human health, as well as for social and economic development. Although the prevalence of anaemia is on the decline in industrialized countries, developing countries are not yet experiencing such a trend. Proper care such be taken. Keywords- Anaemia, Iron deficiency, Pregnant lady, Red Blood cells.
INTRODUCTION:
Anaemia is classified as mild, moderate or severe based on the concentrations of haemoglobin in the blood. Anaemia is a condition in which the number of red blood cells (and consequently their oxygen carrying capacity) is insufficient to meet the body’s physiologic needs. Mild anaemia corresponds to a level of haemoglobin concentration of 10.0-10.9 g/dl for pregnant women and children under age 5 and 10.0- 11.9 g/dl for nonpregnant women. For all of the tested groups, moderate anaemia corresponds to a level of 7.0-9.9 g/dl, while severe anaemia corresponds to a level less than 7.0 g/dl. Mild anaemia is normal during pregnancy. During pregnancy, the amount of blood produced by the body increases by up to 30 percent, meaning that the body requires more iron in order to produce sufficient haemoglobin. If the body does not receive enough iron to, anaemia can be the result. This is especially common in the second and third trimesters. Anaemia is a global public health problem; affecting 1.62 billion people worldwide (Beard J et al., 2003). Although the highest prevalence is found preschool-age children (47.4%), the greatest number of individuals affected are non-pregnant women (468.4 million). Iron deficiency anaemia (IDA) is by far the most common cause of anaemia (Kassebaum NJ et al., 2014). Although as few as 50% of cases of anaemia in Sub Saharan Africa may be attributable to iron deficiency, the proportion of anaemia caused by iron deficiency increases to >70% among pre-menopausal women in India (Kline M et al., 2018).
TYPES OF ANEMIA AND CLASSIFICATION :
There are several types and classifications of anaemia. The occurrence of anaemia can be of any reason, can be because of red cell defects such as production defect (aplastic anaemia), maturation defect (megaloblastic anaemia), genetic defects of haemoglobin (haemolytic anaemias) (Mukherjee and Ghosh et al.,2012). Some types of anaemia are: The Iron-Deficiency Anaemia is a condition where the body has too little iron in the bloodstream and is mostly common in case of adolescents and in women before menopause s (Harper et al., 2015). The Pernicious anaemia is the most common cause of Vitamin B12 deficiency. It usually develops over the age of 50 (Turner and Talbot et. al., 2009). The Haemolytic anaemia is a condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan. Acquired haemolytic anaemias include Immune haemolytic anaemia, Autoimmune haemolytic anaemia, Alloimmune haemolytic anaemia, Drug-induced haemolytic anaemia, Mechanical haemolytic anaemias, Paroxysmal, nocturnal haemoglobinuria, Certain infections and substances can also damage red blood cells and lead to haemolytic anaemia (Natasha and Yasmin et. al., 2010). Sickle cell anaemia is a condition in which the body makes sickle-shaped ("C"-shaped) red blood cells. Sickle cells usually die after 10 to 20 days (approx.) and the body can’t reproduce red blood cells fast enough to replace the dying ones. Thalassaemia is an inherited blood disorder which causes the body to make fewer healthy red blood cells and less haemoglobin. The two major types of thalassaemia are alpha- and beta thalassaemia. The Aplastic anaemia is a blood disorder in which the body’s bone marrow doesn’t make enough new blood cells. This results in number of health problems including arrhythmias, an enlarged heart, heart failure, infections and bleeding. Damage to the bone marrow’s stem cells causes aplastic anaemia (Scheinberg and Young et. al., 2012).
MEDICAL NUTRITION ANEMIA:
A review by Emmanuel Ifeanyi Obeagu (2018) confirms Nutritional anaemia is defined as reduction in haemoglobin concentration due to an inadequate supply of haernopoietic nutrients. Anaemia of nutritional origin is acquired problem caused by diets that lack sufficient quantity of bioavailable essential hematopoietic nutrients to meet the need for haemoglobin and red blood cell synthesis. Environmental factors that may lead to infection like hookworm, schistosomiasis, and other parasites which causes excessive loss of hematopoietic nutrients. In functional iron deficiency Anaemia is the most easily identifiable manifestation. The nutritional anemias has an acquired nature which is complex and requires multiple considerations to find the appropriate kind of remedial measures. (Whipple G H, Robscheit-Robbins FS et. al.,1926). According to WHO, there are very few data regarding global prevalence of vitamin B12 deficiency, which may cause megaloblastic anaemia. Ronquist SN (2002) stated Folic acid deficiency can also produce a megaloblastic, macrocytic anemia.
CONSEQUENCES OF ANEMIA:
Anemia has significant consequences for human health, as well as for social and economic development. According to a survey by Viteri (1998), Iron deficiency anemia affected almost two billion subsets of the people worldwide those are nutritionally iron deficient. Therefore, the health burden of iron deficiency is extrapolated from global prevalence of anemia. Studies such as Sabatine MS et. al., 2005, Aronson D et. al., 2007,Rao SV et. al., 2007, . Figueiredo ACMG et. al., 2018,Rahman MM et. al., 2016 and cCann JC & Ames BN et. al., 2007 demonstrated the association between haemoglobin concentrations and adverse cardiovascular events and other researches that is beneficial to find the effect of transfusion on clinical outcomes .also found that Anaemia been associated with negative health and development outcomes, including neonatal and perinatal mortality, low birth weight, premature birth, and delayed child development. Study by Kassebaum NJ et. al., 2014 showedin 2010, anaemia accounted for 68.4 million years of life lived with disability, or 9% of the total global disability burden from all conditions. Beard J 2003 mentioned about the negative effects of anaemia on health and development because of which it impacts on oxygen delivery to tissues decreases where multiple organ systems may be affected. Study by Quan-Zhou Feng (2011) graphically represented their result showing group wise on effect of haemoglobin concentration on the clinical outcomes in patients with acute myocardial infarction and the factors related to haemoglobin where it was clear that lower hemoglobin concentration had higher cardiac death, and more likely suffered from cardiogenic shock, congestive heart failure and postinfarction angina, than the groups with higher hemoglobin concentration on admission. The likelihood of cardiogenic shock, heart failure, postinfarction angina, and cardiac death was significantly related to baseline haemoglobin.
FACTORS OF ANEMIA:
Through multiple mechanisms many diseases are directly or indirectly associated with anaemia including disease-specific effects on blood loss, hemolysis or erythropoiesis, and through the effects of inflammation on iron metabolism .The presence of an inappropriately low reticulocyte count for the degree of anemia is used clinically to indicate conditions due to nutritional deficiencies, decreased erythropoietin levels, aplastic anemia, or inherited bone marrow failure syndromes ( Kline M et. al., 2018). An analysis by Kassebaum NJ (2014) they found between 1990 and 2010, hookworm, schistosomiasis, and malaria constituted three are the primary causes of anemia.
SOLVING THE GLOBAL PROBLEM OF IRON DEFICIENCY BY IRON FORTIFICATION:
The mainstay of efforts aimed for treatment or prevention of iron deficiency anemia Iron by Iron fortification. The menstruating and pregnant women along with their children are the largest at-risk population. In underdeveloped countries, iron may be provided with other micronutrients to reduce anemia in school going children (Ahmed et. al., 2010; Best et. al., 2011; Lemaire et. al., 2011). Food preparations with iron supplements are an alternate in hopme cooked food to industrial scale supplementation of grains or commercial food products (Lynch et. al.,2011). Also, various oral preparations and dosing regimens are available for menstruating and pregnant females (Ferna´ndez-Gaxiola and De-Regil et. al., 2011). Recently, intravenous iron preparations with improved toxicity profiles have been used for cases where rapid therapy was useful in reducing the need for transfusion (Gozzard et. al., 2011). As per guidelines, the therapy should be carried out only tillthe anemia is resolved and iron stores are replenished. These goals are met with a normal haematocrit and serum ferritin level of 50–100 mg/L (corresponding to 400 –800 mg iron in stores for otherwise healthy adults) (Walters et al. 1973; Magnussen et. al.,2008). Currently, the central parameter for determination of significant iron deficiency as well as therapeutic response is ferritin (Mei et. al.,2005; O’Meara et. al.,2011).
CONCLUSION:
Although prevalence of anaemia is on the decline in industrialized countries, developing countries are not yet experiencing such a trend. An estimated 90% of cases occur in developing countries, significantly effecting morbidity, mortality, and national development.