Low red blood cells or haemoglobin needs to be checked for more than mere iron deficiency as it could be an early sign of another disease
‘You look anaemic,’ is a casually made comment and accepted without demur. A National Family Health Survey 4 (NFHS-4), 2015-16 reports anaemia prevalence of 30-69% across all ages, in India. It adds that since 2005-06, there has been very little reduction in the prevalence of anaemia.
Interestingly, another study published in the Lancet Global Health points out that most studies on anaemia in underdeveloped and developing countries have been conducted on women of reproductive age and their children.
This is because of the due implication of anaemia in these two groups. Anaemia was responsible for higher maternal mortality. However, men too suffer from anaemia, though the percentage is lower and ranges from 1 to 33 percent across India.
Some of the common symptoms of anaemia include lethargy, fatigue, effort intolerance, lack of appetite and difficulty in concentrating, all of which have an impact on economic productivity and quality of life.
In children anaemia can cause developmental retardation and lower scholastic performance.
Dr P Prabu, Senior Consultant, Department of Haematology/Haemato-Oncology, Apollo Hospitals, Chennai, affirms the prevalence of anaemia and says, “One of the commonest illnesses I encounter is anaemia, i.e. low haemoglobin.”
Blood has three different types of cells – the red cells, the white cells and platelets. Anaemia involves the red cell population, when either the red blood cell count or the haemoglobin is low.
Haemoglobin, an iron-rich protein, is responsible for making blood red. It plays the critical role of enabling red blood cells to carry oxygen from the lungs to the rest of the body and the carbon dioxide back from other parts of the body to the lungs.
“Anaemia is not a disease per se but a sign, a sign that something is not right with the body,” the doctor adds.
According to him, anaemia could be caused by very straightforward causes such as blood loss due to heavy menstrual bleeding or bleeding from any other part, low iron levels, deficiency in certain essential vitamins such as B12.
It could also be a sign of some serious condition and therefore needs thorough investigation. “Sometimes it can be an early sign that there is something not right with the system. It can represent an illness that involves haematological system, or it can also represent an illness outside the haematological system,” he stresses. Understanding the cause for anaemia is of utmost importance.
Gastrointestinal blood loss due to ulcer is an important cause of anaemia in men. The ulcer may be benign or a cancer whose early detection can result in cure.
People with kidney disease also tend to have anaemia. Erythropoietin, a hormone released by the kidneys, helps the bone marrow make red blood cells. Chronic kidney disease or end stage renal disease can lower the production of this hormone, thus affecting the production of red blood cells leading to anaemia.
Some other causes include hypothyroidism, rheumatoid arthritis and other auto immune diseases. Poor absorption of vitamin B12 by the intestines is yet another cause for anaemia. “If the haemoglobin is not in the healthy range, then see a doctor,” is his simple advice.
For the proper production of haemoglobin, the body needs iron, vitamin B12 and folic acid, this is primarily provided by the food we consume. While strict vegetarians with low vitamin intake are at risk of vitamin B12 deficiency, Dr Prabu stresses that vegetarian diet alone does not necessarily cause anaemia.
Though animal protein is the best source of iron, vegetarian should be iron-deficient is a commonly held fallacy. Having lot of green, leafy vegetables, pulses such as dal, chana etc., can be enough to prevent anaemia.
But even in case of vegetarians, rather than dismissing anaemia as a result of diet, it is important to look for a cause, he emphasises. “Strict vegans who don’t take any milk products are at risk,” he says.
Worm infestation is yet another important cause for anaemia, more in children though it can happen in adults too.
Given the critical role of haemoglobin in reaching oxygen to all the organs and bringing carbon dioxide back, prolonged neglect of anaemia, even benign, can lead to heart problems such as heart failure, or rapid or irregular heartbeat.
The heart has to pump more blood due to insufficiency of oxygen in the blood, leading to an enlarged heart or heart failure. It can cause pre-term delivery in pregnant women, damage organs, increase the risk of infections and even depression.
Not just lay persons, even the medical fraternity sometimes does not give anaemia its due.
Age and gender are accepted as obvious factors in anaemia. Iron tonic or vitamin supplements prescribed or bought over the counter by the anemic to overcome it.
However, if there are other underlying causes, then that will not be enough.
A thorough examination, prompt investigation and correct reference to the appropriate specialist is essential to catch any condition early and even save lives.