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Anaemia
Anaemia is a condition in which there is a diminished oxygen carrying capacity of the blood because of total circulating haemoglobin and/or reduction in red cell mass.

Nutritional anaemia is a world wide problem. Deficiency of these nutrients results in anaemia. Red blood cells (RBC) or erythrocytes are synthesized in the bone marrow and proceed through a number of stages before they are released into the circulation as non-nucleated fully matured cells. For the synthesis of RBCs many nutrients are required, e.g. Vitamin B12 and folic acid. When either B12 or folic acid or both, are deficient, fewer RBCs are produced resulting in nutritional anaemia.

Haemoglobin synthesis also requires a constant source of iron for the formation of haem and of protein for the formation of globin. The iron is obtained from the blood, which in turn is supplied by the stores in the liver, and by absorption from the intestinal tract. Anaemia is a condition in which there is a reduction in the photocirculating haemoglobin.

Anaemias are differentiated: -

  • On the basis of the appearance of the red blood cells as
    1. Microcytic- small erythrocyte.
    2. Macrocytic- large erythrocyte.
  • On the basis of colour of the RBC's
    1. Hypochromic- pale erythrocyte
    2. Hyperchromic- dark erythrocyte.
  • On the basis of the presence of a nucleus
    1. Nucleated
    2. Non - nucleated

Signs and symptoms

Mild anaemia is not closely associated with clinical symptoms. When the anaemia becomes more severe, the symptoms include skin pallor, weakness, easy fatiguability, headaches, dizziness and loss of appetite.

Concave, spoon shaped fingernails - koilonychia, with longitudinal ridging of the nails.
In very severe anaemia, the heart rate increases, palpitations occur and there is shortness of breath due to the reduced oxygen carrying capacity of the blood.

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Iron Deficiency Anaemia

Iron deficiency anaemia is microcytic as well as hypochromic in nature.

Causes

It is caused due to deficiency of iron, protein and vitamin C. It can also be caused due to malabsorption syndromes, injury, loss of blood due to bleeding ulcers, menstrual losses, blood donation or parasitic infestations.

Prevention and treatment

A diet that is adequate in green leafy vegetables, liver, egg, meat, whole grain cereals and other rich sources of iron are helpful in the prevention of iron deficiency anaemia. In the case of deficiency, iron salts like ferrous sulphate and ferrous gluconate are given orally. The dosage depends on the kind of iron salt and the severity of anaemia. Also giving extracts of liver and diet rich in protein and vitamin C is helpful.

Iron

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Pernicious Anaemia

Pernicious anaemia is megaloblastic (with a large nucleus) in nature. Due to the inability of the bone marrow to produce, mature RBC's, because of Vitamin B12 deficiency, large but fewer erythrocytes are released into the blood.

Causes

Deficiency of vitamin B12 and folic acid causes pernicious anaemia. This deficiency is caused due to a defect in the absorption rather than a dietary lack.

Prevention and treatment

The vitamin B12 dosage for pernicious anaemia is variable. Two factors guide the schedule, (a) a vitamin B12 deficient person can accumulate a store in the liver to last for a long time if a sufficiently large dose is given. (b) Very large doses lead to a considerable loss in the urine. If the anaemia is caused due to an inadequate diet, the condition usually disappears with an improved diet and a short course of folic acid tablets.

Vitamin B12

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Sickle Cell Anaemia

Sickle cell anaemia is of genetic origin, in which an abnormal gene must be inherited from both the parents.

Causes

Sickle cell anaemia is a genetic disorder. Low fluid and high salt intake hasten sickle cell anaemia crisis. Due to this sickling or shrinking of the RBC takes place, because of which they cannot pass through the capillaries and therefore lead to blood clotting. The cells have a short life span and a person becomes anaemic because the RBCs are destroyed faster than they can be replaced.

Prevention and treatment

Reducing serum sodium, which allows the red blood cells to swell, prevents sickle cell anaemia. Sickling may also be inhibited by decreasing the osmolarity of the plasma by the administration of a long acting derivative of arginine, vasopressin, with potent anti diuretic properties.

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