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Anemia is a blood disorder where the hemoglobin level of a person drops below 12 grams. As hemoglobin is responsible for carrying oxygen to all the cells of the body, anemia can cause lack of oxygen in the cells leading to various health problems.

Decreased red cell production, increased red cell destruction, and blood loss are the causes for anemia.

The commonest cause of anemia in India is iron deficiency. It’s frequently blamed on poor nutrition as Indian diet is generally low on iron. In India, growing children, menstruating women and vegetarians are more susceptible to iron deficiency because there is much less absorbable iron in a vegetarian diet.

 Anybody who has a problem of chronic bleeding, like gastric ulcers, hemorrhoids and so on, is susceptible to iron deficiency. However, deficiency of iron can be seen in anybody.
 An infection called helicobacter pylori is very common in India. It not only leads to gastritis in duodenum which can lead to chronic blood loss and therefore anemia, it also competes with body iron and actually demands iron preferentially.

People generally don’t have any symptom when hemoglobin drops below 12 grams until about 10 grams or so. Early symptoms are generally light headedness, increased fatigue and not being able to do the normal activities that they have been doing in the past.
Typically, when hemoglobin drops to 7 grams or less, people are unable to do activities of their daily living, they may have difficulty going to the bathroom, putting on their clothes, cooking and so on.

At a level less than 7 grams, anemia starts affecting the heart wherein the cardiac out put increases, that is, the heart starts doing more work.

However, symptoms depend not only on the absolute level of hemoglobin but also on the patient’s general condition. If anemia develops more slowly, people adjust and may not have any symptoms. Symptoms also depend on the cause of anemia.

Treatment depends on the etiology or the cause. As far as blood transfusion is concerned, generally, it is not recommended, unless hemoglobin is less than 7. The reason generally 7 is chosen is that a lot of pre-clinical studies have shown that the heart starts getting affected when hemoglobin is less than 7. So by international consensus, 7 is a number after which transfusion is considered, no matter what the etiology is.

Between 7 and 10, a lot depends on the clinical state of the patient and if the patient is symptomatic, then a transfusion will be considered. Apart from transfusion, treatment depends on the specific cause. If a diagnosis of iron deficiency is made based upon smear and measuring iron indices, then the patient is typically treated with oral iron.
There is usually no role for intravenous iron unless the patient is absolutely refusing to take oral iron due to severe complications or cannot absorb oral iron. If the problem is deficiency in B12 then B12 injections are given. If the cause is an inflammatory disorder then the inflammation is treated and the anemia will take care of itself. If the cause is renal failure and the anemia is irreversible then efforts are made to treat renal failure and in case it is not reversible then an injection called erythropoietin is given. If it is immune hemolysis, then it is typically treated with oral or intravenous steroids.

To prevent anemia, one needs to eat a good diet that is rich in iron, B12 and folic acid. For non vegetarians, the richest foods in iron, B12 and folic acid are liver and marrow. For vegetarians, foods that are rich in iron are legumes, beans, nuts, cabbage, cauliflower and green leafy vegetables.

Green leafy vegetables are rich in iron but most of the iron is not available to the body as they have chemicals which bind iron so the body can absorb less than 5% of the iron present. Also, people should make a habit of drinking liquids with a little bit of vitamin C in it like lemonade, tomato juice or orange juice which significantly increase absorption of iron. Milk and fish also have B12 and folic acid.

Moreover, if there is any identifiable cause of chronic blood loss, it should be taken care of. Hemorrhoids which bleed consistently need to be taken care of. If there are symptoms suggestive of gastritis or involvement of duodenum, medical help should be taken. Women who have unusually heavy menstruation should take prophylactic iron pills and investigate causes for heavy menstruation and so on and so forth.


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