Anemia: Symptoms, Causes, and Treatment

Anemia is defined as a low hemoglobin concentration/ may be due to either low red cell mass/ increased plasma volume. Low Hb is <13.5 g/dL for men and <11.5g/dL for women. It can be due to reduced RBCs production/ loss of RBCs due to several causes. Some forms of anemia include aplastic anemia/ folic acid deficiency anemia/ hemolytic anemia/ sickle cell anemia.

According to the Ayurveda concept, Anemia is generally known as Pandu Roga. It is due to less amount of blood( rakta-alpata). Pandu is considered as Rakta Pradoshaja Vikara. In this case, the patient skin color changes to shveta peet(pandu varna).

Pandu ( Anaemia) according to Acharya Charak is mainly classified into five types:-
1) Vataja
2) Pittaja
3) Kaphaja
4) Sannipataja
5) Mridu Bhakshan Janya

Anemia Causes

• Blood loss/ decreased red blood cell production/ increased red blood cell breakdown
• Trauma/ gastrointestinal bleeding
• Iron deficiency
• Vitamin b12 deficiency
• Thalassemia
• Bone marrow neoplasms
• Genetic conditions ( sicke cell anemia/haemophilia)
• Certain autoimmune diseases
• Blood loss/fluid overload
• Kidney failure
• Some endocrine disorders
• Protein malnutrition
• Hepatic failure
• Aplastic anemia
• Drug-induced anemia
• Scurvy

Anemia Symptoms

• Fatigue/ Weakness
• Decreased energy
• Weakness/ Numbness
• Palpitations
• Lightheadedness
• Looking pale
• Cramps
• Breathlessness
• Dyspnoea
• Tinnitus
• Anorexia
• Coronary Artery Disease
• Dryness of skin
• Excessive salivation
• Indigestion
• The yellowness of urine/stool
• Loss of glow
• Tinnitus/ vertigo
• Fever
• Hair fall
• Excessive sleep/excessive salivation
• Cramps in the calf region

When to See Your Doctor for Anemia Disease?

If signs and symptoms appear for a long-duration / some of the following symptoms appear, then you should consult doctor as soon as possible :

• Tiredness/ vertigo/ excessive fatigue
• Pale skin/ pale eyes
• Rapid heartbeat ( tachycardia)
• Palpitations occur for long
• Blood in urine/ stool
• Heavy menstrual periods
• Hereditary anemia conditions

Diagnosis

• Hb Examination and levels
• CBC ( Complete Blood Count)
• Vit B12 levels
• Homocystene Serum
• Ferritine Serum’
• Peripheral smear microscopic examination
• MCV (Mean Cell Volume) investigation.
• In Ayurveda, differential diagnosis is examined by checking vata/pitta/kapha prakriti.

Prevention of Anemia

• Proper nutrition and diet of Iron.
• Prevent yourself from infectious and parasitic diseases.
• When signs and symptoms appear then consult doctor soon.
• By examining yourself by doctor to check any other disease leading anemia.
• Take iron supplements under the guidance of Doctor.

Risk Factors of Anemia

• Premature birth
• Excessive menstruation
• Being pregnant/ giving birth
• Diet low in vitamins
• Family history
• Chronic illness ( AIDS/Diabetes/ Kidney disease/ Heart failure/ Liver disease)
• Trauma

General Tips

• 3 gm Gooseberry powder three times a day with honey.
• Dry Grapes intake
• 1cup beetroot juice + 1 cup apple juice + mixed with sugar/honey = once a day
• Fresh pomegranate/ fresh bananas
• Intake of jaggery
• Intake of anjeer ( fig)
• Broccoli/ green leafy vegetables/ carrot/ spinach.
• Peanut butter
• Intake of kidney beans/ black- eyed peas
• Avocadoes

What to Avoid?

• Salty/ sour/ spicy /hot diet
• Exposure to sunlight
• Drinking and smoking
• Excessive exercise
• Junk foods

What to Eat?

• Green leafy vegetables such as spinach
• Carrot/carrot dishes
• Dates
• Cherry/ cranberry
• Jaggery
• Anjeer ( fig)
• Pomegranate/ banana
• Grapes/ mango/ apple
• Eggs
• Beetroot juice
• Apple juice

Questions & Answers

Q.1 What are the reference ranges of Hb in adults and children?
Ans- Reference ranges are -

• Men  = 14- 18 g/ dL
• Women = 12-16 g/dL
• Pregnant women > 11g/dL
• Newborn = 14-24 g/dL
• 0-2 weeks = 12-20 g/dL
• 2-6 months = 10-17 g/dL
• 6 months/ 1 year = 9.5-14g/dL
• 1) 6 years = 9.5 - 14 g/dL
• 6-18 years = 10-15.5 g/dL

Q.2 Is it normal to have Hb value high?
Ans- No, it's not to be normal while having high Hb values. High Hb values occur when the body requires an increased Oxygen carrying capacity. It may result in polycythemia/ Heart diseases/ COPD/ emphysema/ heart failure/ kidney Cancer/ liver cancer/ dehydration/ etc.

Q.3 What are the causes of High Hb values?
Ans- Many factors and various causes are associated with high Hb values like -

• Smoking
• Increase count of RBCs
• Bone marrow produces many RBCs
• Drugs that increase your erythropoietin that further will stimulate RBCs production.
• Chronic kidney disease, etc.

Q.4 What sign does eyelid color shows when anemia occur?
Ans- ‘Conjunctival pallor’ is the classic sign of anemia. The pallor refers to the vasculature on the inner surface of the lid lacking Hb conc. It is usually caused by a reduction in blood flow and oxygen / by decreased no. Of RBCs.

Q.5 What are the classifications of Anemia?
Ans- Anemia is generally classified by two methods:-
1) Morphological
2) Etiological

1) Morphological - It mainly depends upon the size and color RBC. It includes:-

• Normocytic Normochromic Anemia
• Macrocytic Normochromic Anemia
• Macrocytic Hypochromic Anemia
• Microcytic Hypochromic Anemia

2) Etiological - Depends on cause/ origin, it includes -

• Hemorrhagic Anemia
• Hemolytic Anemia
• Nutrition deficiency Anemia
• Aplastic Anemia
• Anemia of chronic disease

Q.6 What happens when Hb value gets lower in Pregnant women? How can it overcome?
Ans- Hb value gets lower due to insufficiency of RBCs to carry oxygen to tissues. During pregnancy, as a growing fetus also requires oxygen and blood supply, so, it is important to increase iron supplements and dietary intake. Hb low value in pregnancy leads to weakness/ fatigue/ pale/yellowish skin/ breathing shortness/ chest pain/ cold hands and feet/ headaches.

Q.7 What are the various dietary intake to come over the deficiency of Anemia?
Ans- Various dietary intake includes:-
- consumption of fortified foods.
- vitamin A-rich foods/folic acid/ vitamin B-12/ Iron-rich supplements and food in the diet
- Foods that rich in vitamin-c ( fruits/tuber/ green leafy vegetables) should be consumed at mealtimes.
- Vitamin B-12 rich animal products
- Folic acid rich legumes.
- beta-carotene/ vitamin A-rich foods
- restrict consumption of tea/coffee/ cocoa between meals/ 1 hr after meals, since it inhibits iron absorption.
- avoid intake of milk/ milk-related products at meals as calcium in milk inhibits iron absorption.

Q.8 How the deficiency of Iron affect the Nervous and Endocrine system?
Ans- It alters the production of Triiodothyronine ( T3) and thyroid function in general,  production of catecholamines and other neurotransmitters, it results in impaired temperature response to a cold environment.

Q.9 Where Folate is found and what are the causes of its deficiency?
Ans- It is found in green vegetables, nuts, yeast & liver/ synthesized by gut bacteria. Causes of its deficiency include poor diet e.g. poverty, alcoholics, elderly/ increased demand, e.g. pregnancy/ increase cell turnover/
Malabsorption/ drugs/alcohol/ antiepileptics etc.

Q.10 What kind of treatment is available in Ayurveda for Anemia?
Ans- In Ayurveda medicine, treatment generally includes Nidaan Parivarjan, Samshodhana chikitsa( nidan parivarjan, aabhyantar snehana, tikshana samshodhan with vamana or virechana,raktabasti, Samshamana chikitsa includes rasa, virya ayurveda drug formulations according to vata/pitta/kaphaja/sannipataja prakritis.

REFERENCES:-

1. Longmore, Wilkinson, Davidson, Foulkes, Mafi, Oxford Handbook of Clinical Medicine 8th Edition.
2. Kayachikitsa Volume-2 by Prof. Ajay Kumar Sharma (2017)
3. Charak Samhita, Chikitsa Sthana - ch-16
4. Madhava Nidana, Ch-8
5. J.Alastair Innes, Davidson’s Essential of Medicine 2nd edition
6. K Sembulingam, P Sembulingam, Essentials of Medical Physiology 6th Edition.