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What is anaemia and what causes it?  What are its symptoms, complications and how can we prevent it? Anaemia is defined by the WHO a...

The Lankan love affair with Anaemia


What is anaemia and what causes it? What are its symptoms, complications and how can we prevent it?


Anaemia is defined by the WHO as "a condition in which the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking, and pregnancy status". It is basically a deficiency in the number or oxygen carrying ability of the red blood cells (RBCs) - which are the most vital component of blood. The primary function of RBCs is in fact the transport of oxygen from the lungs to the tissues of the human body. RBCs contain haemoglobin which is essential for their function. Any decrease in the number or oxygen carrying ability (haemoglobin structure or concentration/volume) causes anaemia. 

Anaemia isn’t a disease in itself but it indicates that something is wrong in the body away from the physiological normal for the individual based on age and sex. Anaemia can have many causes, including certain diseases or conditions and medications. Malabsorption, inherited disorders, autoimmune diisorders,chronic disorders,hormone disorders, bone marrow disorders,blood loss.certain drugs and infections can all cause or lead to anaemia - but by far the most common reason is nutritional - the lack of iron, vitamin B12 and folic acid in the diet. Iron is necessary for the healthy formation of haemoglobin.

The symptoms of anaemia are many and varied from mild anaemia to very severe anaemia. In mild anaemia the patient has no complaints specific to anaemia. Diagnosis is made on routine blood examination. Moderately anaemic patients may complain of excessive tiredness, palpitation, occasional breathlessness, especially during exertion such as on climbing stairs, pallor of the sclera, lips and nailbed etc and severely anaemic patients may have certain severe signs and symptoms.


Certain people are at increased risk of anaemia, including: menstruating women, pregnant and breastfeeding women, children going through puberty, people following a vegetarian or vegan diet, people with cancer, stomach ulcers and some chronic diseases. If left untreated in the long term. anaemia can lead to severe complications. Severe fatigue drastically reducing your quality of life, pregnancy complications, arrhythmia and other heart problems and even death.

Iron deficiency and vitamic deficiency anaemia, the most common forms of anaemia, can be prevented  by taking vitamin supplements and/or eating a diet that includes a variety of vitamins and minerals especially Iron, Folate. Vitamic B-12 and Vitamic C. These micro-nutrients can be obtained via these kinds of food;

Iron: beef and other meats, beans, lentils, iron-fortified cereals, dark green leafy vegetables, and dried fruit.
Folate: fruits and fruit juices, dark green leafy vegetables, green peas, kidney beans, peanuts, and enriched grain products, such as bread, cereal, pasta and rice.
Vitamin B-12: meat, dairy products, and fortified cereal and soy products.
Vitamin C: citrus fruits and juices, peppers, broccoli, tomatoes, melons and strawberries. 


How is anaemia diagnosed?




If you feel like you have some of the symptoms of anaemia, visit your doctor. The doctor is likely to ask you about your medical and family history, perform a physical exam, and run the following tests: a complete blood count (CBC) and/or a blood picture. Your doctor will be interested in the levels of the red blood cells contained in your blood (hematocrit) and the hemoglobin in your blood. If these are ascertained to be lower than the normal depending on your age and sex etc - you may be diagnosed with anaemia. To confirm iron deficiency anaemia, your doctor will have to look at the results of the blood picture study (red blood cell size and color as with iron deficiency anemia, red blood cells are smaller and paler in colour than normal) and also run iron studies. In practice when the probability of nutritional iron deficiency is strong - doctors right away assume iron deficiency and proceed. Otherwise finding the cause of iron deficiency is mandatory in order to proceed with the treatment If treatment for iron deficiency proves refractory or not working - you may be subjected to further tests to ascertain the real cause of your iron deficiency as it might be causes by factors that have nothing to do with your  intake of iron. Patients suspected to have chronic GI bleeding will be advised to undergo image studies like endoscopy, colonoscopy  to exclude colonic cancers and and rarely, a sample of bone marrow may be taken to see if red blood cells are forming in the normal way.

How is iron deficiency anaemia treated?


Iron deficiency is treated by dietary advice which may be sufficient in by itself. Foods rich in iron are liver, meat, egg, fish and milk, and for a vegetarian diet - green, leafy vegetables, beans, peas, whole wheat, legumes, and raisins are advisable. Sprouting grams are a very rich source of Vit B12. Food containing Vitamin C like lemon, lime and oranges should be also taken as Vit C helps in absorption of iron. Where adequate diet cannot be ensured, prophylactic iron should be prescribed. Daily iron supplementation between 60-120 mg of elemental iron in the form of Ferrous sulphate, ferrous fumarate, or ferrous gluconate would be prescribed along with Vitamin C 500mg tablets. Folic Acid and Vitamin B Complex can be given daily to treat anaemia due to deficiency of Vitamin B or Folic Acid.

If the anemia is severe, it cannot be treated by oral supplementation alone.
The patient has to be admitted in a hospital and investigated thoroughly for other causes of anemia. She should be kept at complete bed rest with adequate high protein diet, supplementary injections of Vit B12, Folic Acid and Vit C if necessary should be given. Injections of iron preparations are rarely used nowadays as severe local reactions at the site of the injection can occur. Blood transfusion using only the red blood cells (packed cell transfusion) is a better form of replacing the deficient iron.

Iron supplements should be taken only when advised by your doctor. The human body isn’t very good at excreting iron and you could poison yourself if you have certain intestinal problems and you take more than the recommended dose.  Reversal of the haemoglobin levels takes time so its advised to stick to the prescribe dosage until the next blood report comes normal and 3 months more-to replenish the stores

So what about Lankans?


The incidence of iron deficiency anaemia in Sri Lanka is high. Iron, Vitamin A and Iodine are the three main micro-nutrient deficiencies rampant in the Island. The Sri Lanka Demographic and Health survey in 2007 found an estimated overall prevalence of anaemia of 34%, with 20.7% mild anaemia and 13.3% moderate to severe anaemia. Prevalence of anaemia among
non pregnant women aged 15‐49 years is 39 percent. The estimated prevalence of anaemia during pregnancy is approximately 17%. The overall prevalence of anaemia among children age 6‐59 months is 33 percent

But as this graph shows there has been a continual drop in prevalence of anaemia among under five children in Sri Lankain the recent past

Trends in the prevalence of anaemia among under fives


Surprisingly the  prevalence of anaemia seem to not vary among wealth quintiles. Iron deficiency seem to be prevalent regardless of how wealthy the family is. It cannot be well explained by routinely assessed socioeconomic characteristics which mainly provide clues to access for food. In fact prevalence of mild anaemia is highest among women in the highest wealth quintile (37 percent) while the corresponding figure is lowest for women in the lowest wealth quintile (32 percent)



But there is a clear increased prevalence among the estate workers of the tea industry. This could be explained by their increased consumption of tea. Studies have shown that tea—notably black tea, but also green—decreases the absorption of iron, especially nonheme iron, the kind found in plant foods (heme iron comes from animal-derived foods). Compounds in tea called tannins can combine with nonheme iron and make it less available for absorption

Women’s education has some influence in determining the women’s anaemic levels. Low educated women show high prevalence of anaemia compared to women with higher levels of education.


For each dollar spent on iron supplementation program for pregnant women, there is a 24 dollar return in increased lifelong wages and decreased disability. For each dollar spent on iron fortification of food there is a 84 dollar return in increased productivity and decreased disability of the consumer. Work output in many occupations can increase 10 to 30% when workers are given iron supplementation. Prevention and treatment of iron deficiency and anaemia can raise national prodictivity by 20%


Some forms of anaemia can’t be prevented because they are caused by a breakdown in the cell-making process. Anaemia caused by dietary deficiency can be prevented by making sure that you eat food from certain food groups on a regular basis, including dairy foods, lean meats, nuts and legumes, fresh fruits and vegetables. 

If you follow a vegan diet (one that does not include any animal products) talk to your health professional about recommended vitamin and mineral supplements.

Feel free to ask me if you have any question regarding anaemia

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