Complete picture of Anemia

 

Introduction

Anemia is a condition in which the body is severely deficient of healthy red blood cells which have the ability to carry oxygen to different parts of body.

Anemia affects almost 1.62 billion people on earth, which means that 24.8% of the Earth's total population is anemic. It is most prevalent in children of pre schooling age and the least prevalent in men. The population group with the highest number of effected individuals is the non-pregnant women (468.4 million).

Types of Anemia and their causes

Anemia is of different types and they may have a number of different causes. The major causes of different types of anemia are explained as follows:

Iron deficiency anemia:

Iron deficiency anemia is the most common type of anemia and as the name suggests, it is cause by the lack of sufficient amount of iron in the body. Iron is important in the synthesis of hemoglobin in the bone marrow. When the amount of iron is insufficient, enough hemoglobin is not synthesized and hence the shortage of red blood cells occurs. This type of anemia is common in pregnant women. It may also occur due to blood loss such as bleeding caused by an ulcer, cancer, heavy menstruation and over use of some medications such as NSAIDs (Non-Steroidal Anti Inflammatory Drugs) which cause inflammation of the lining of stomach causing ulcer.

Vitamin deficiency anemia:

Along with iron, vitamin B-12 and folate are essential for the production of enough amounts of healthy red blood cells. Consumption of a diet in which these nutrients are deficient cases decreased production of RBCs. Some people who take enough vitamin B-12 but aren't able to consume it, also develop Vitamin deficiency anemia. Such type of anemia is known as pernicious anemia.

Anemia caused due to inflammation:

Diseases such as cancer, HIV/AIDS, rheumatoid arthritis, renal diseases, Crohn's diseases and many other acute and chronic diseases, can affect the normal production of red blood cells.

Aplastic Anemia:

This rarely occurring, life threatening anemia occurs when the body is not able to produce enough amounts of red blood cells. Causes of aplastic Anemia could be microbial infections, certain medications, autoimmune diseases and exposure to toxic substances.

 Anemia caused by defects in bone marrow:

Red blood cell production could be effected by a variety of diseases occurring in bone marrow such as leukemia and myelofibrosis, leading to the development of anemia. These cancer and cancer-like conditions could be mild and sometimes, life-threatening.

Sickle cell anemia:

Sickle cell Anemia is a hereditary disease which causes hemolysis of Red blood cells. It is caused by a defect in hemoglobin which causes the red blood cells to acquire an abnormal shape that resembles a sickle or crescent. Due to their abnormal shape, the cells die before getting mature, therefore causing a shortage of RBCs.

Life cycle of RBCs

In the bone marrow, burst forming units-erythroid (BFU-E) and colony forming units-erythroid (CFU-E) are differentiated into reticulocytes. This differentiation is enhanced by erythropoietin.

Reticulocytes stay in the bone marrow for three months to get mature after which they move into peripheral blood.

Mature RBCs then circulate in the peripheral blood for 100 to 120 days (approximately 4 months).

In the state of equilibrium or under steady state concentration, the rate of production of RBCs equals the rate of loss of RBCs.

Lab definition

Hemoglobin (Hgb);

Women: 

<12.0

Men: 

>13.5

Hematocrit (Hct);

Women: 

<36

Men :

< 41

Lab findings

Iron deficiency anemia;

Serum iron

Low (<60 micro grams/dL)

Total iron binding capacity (TIBC)

High (>360 micrograms/dL)

Serum Ferritin

Low (<20 Nano grams/mL)

It could be 'falsely' normal in inflammatory conditions

Symptoms

Different symptoms of Anemia that appear due to decreased oxygenation of body tissues and decreased supply of blood are as follows:

Symptoms that appear due to decreased oxygenation:

Exertional dyspnea

Dyspnea at rest

Fatigue

Bounding pulses

Lethargy

Confusion

Symptoms that appear due to decreased volume of blood:

Fatigue

Muscular cramps

Postural dizziness

Syncope

Special considerations while diagnosing anemia

Acute bleeding:

Drop in hemoglobin (Hgb) or hematocrit (Hct) is not observed until 36 to 48 hours of after acute bleeding has occurred (even though the patient may be hypotensive)

Pregnancy:

In the third trimester of pregnancy, the RBCs and plasma levels are expanded by 25 and 50%, respectively.Lab findings will show a reduction in hgb, hct, and the RBC count often to anemic levels, but according to the RBC mass, they are actually polycythemic

Volume Depletion:

Patients with severe volume Depletion may not show anemia until after they are re-hydrated.

Complications

If left untreated, anemia can develop into severe and complicated health conditions such as:

Severe fatigue:

Anemia at chronic stages causes extreme tiredness and fatigue, making it impossible to perform daily life activities.

Complications in pregnancy:

Folate deficiency anemia in pregnant women can cause complications such as premature birth.

Cardiovascular problems:

When an individual is anemic, his/her heart must pump enough blood to fulfill the oxygen requirement of the body. This can lead to the enlargement of heart or cardiac failure. Anemia can also cause arrhythmia.

Death:

Anemia such as sickle cell anemia could be fatal. Loss of a lot of blood abruptly causes acute or severe anemia or even death

Prevention

Many types of Aneamias such as those inherited from parents, are not preventable. Iron and vitamin deficiency could be prevented by taking a diet that includes a number of vitamins and essential minerals, including:

Iron:

Food rich in iron includes beef and meat, red beans, lentils, cereals fortified with iron, green leafy vegetables and dry fruit.

Folate:

Folate is found in fruits and their juices, leafy vegetables, peas, kidney beans, peanuts, enriched grains, bread, pasta, fortified cereals and rice.

Vitamin B-12:

Foods containing sufficient amount of vitamin B12 include meat, milk, yogurt, butter and other dairy products, fortified and enriched cereals and grains, soy products.

Vitamin C:

Vitamin C is present in citrus fruits and juices, peppers, broccoli, tomatoes, melons and strawberries. They help in the absorption of iron.

(Consult your doctor or nutritionist to guide you about the diet suitable for preventing anemia).

Top seven best dietary supplements

 

Supplements are the best option to fulfill the nutrient requirements in malnourished individuals or those having any illnesses. As with every other synthetic product, the excess usage can cause more damage to health than benefits. It is now justified through research that overuse of dietary supplements could be detrimental to health and general well-being.

Given below is a list of top 7 best supplements that are widely used;

1.       Vitamin A and beta carotene

2.       Vitamin E

3.       Vitamin B6

4.       Multi vitamins

5.       Vitamin D

6.       Calcium

7.       Fish oil supplements

 The details of these supplements, their sources, usage and side effects are as follows:

Vitamin A and beta carotene

Source:

Vitamin A or retinol is present in diet in two forms. Performed vitamin A is found mainly in animal products such as meat, fish, chicken and dairy products. The second form known as the pro vitamin A is found mainly in plant derived foods such as fruits and vegetables. The most well-known pro vitamin is Beta carotene.

Use:

The major functions of vitamin A are as follows:

Maintenance of tooth, bone and skin health.

Maintenance of skeletal tissues, soft tissues and mucous membranes.

Maintenance of good eyesight.

Plays important role in promoting health in pregnant and nursing women.

Side effects:

Excess intake of beta carotene can cause carotenodermia, an orange yellow, displeasing coloration of skin.

At a level of more than 4500 micro-grams per day, vitamin A intake can cause liver toxicity.

Substantial damages could be caused in people with kidney failure.

Excess dietary intake of vitamin A can cause nausea, vomiting, reduced appetite (anorexia), blurred vision, headache, hair loss, fatigue, drowsiness and altered psychological state.

Chronic intake of preformed vitamin A can cause osteoporosis.

 Vitamin E

Source:

vitamin E or Alpha tocopherol is found mainly in plant based products, oils originated from plant and vegetable sources, seeds, and nuts. Following are the sources having the highest amount of Vitamin E;

Sunflower oil

Safflower oil

Soybean oil

Sunflower seeds

Peanut oil

Peanut butter

Beet greens

Collard greens

Wheat germ oil

Spinach

Red and green bell pepper

Asparagus

Mango

Avocado

Use:

It has antioxidant activity. It protects the body tissues from the harmful effects of free radicals. This allows it to prevent aging of body cells.

It helps in boosting the immune system and protects the body from pathogenic infiltration.

It is important for the formation of blood cells particularly RBCs.

It helps in the absorption of vitamin K.

It prevents the clotting of blood and keeps the blood vessels wide.

It helps in the intracellular interaction during body processes.

It allows prevention of cancer, cardio vascular diseases, hepatic diseases and memory loss.

Side effects:

The various side effects of vitamin E are as follows:

It can cause nausea, vomiting, diarrhea, abdominal and intestinal cramps, rashes, blurred vision, increased amount of creatine in urine.

Excessive use of dietary vitamin E can increase the risk of prostate cancer.

It can worsen the condition of patients with the following problems;

Vitamin K deficiency

Retinitis pignemtosa

Bleeding disorders

Diabetic patients

Patients with history of heart attack and stroke

Patients with head and neck cancer

Patients with hepatic diseases.

Vitamin B6 

Source;

Vitamin B6 or pyridoxine is found in a wide variety of foods which include

Pork

Chicken

Turkey

Fish

Meat

Bread

 Oatmeal

Wheat germ

Brown rice

Eggs

Fruits

Vegetables

Soy beans

Peanuts

Milk

Potatoes

Breakfast cereals

Use:

Vitamin B6 is important for the metabolism of fat, protein and carbohydrates.

It helps in the synthesis of RBCs and neurotransmitters.

It plays important role in mood regulation and reduction of symptoms of depression.

It helps in reducing the risk of Alzheimer's disease.

It is used to treat the symptoms of premenstrual syndrome or PMS.

Decreases nausea in pregnant women.

Prevents blocking of arteries and ultimately reduces risk of cardiovascular diseases.

Side effects:

Commonly observed side effects of pyridoxine include decreased folic acid in the body, headache, anorexia, nausea, vomiting, tingling, numbness, loss of sensations and damage to sensory nerves.

Vitamin D

Source:

Vitamin D is found very rarely in nature. The best sources are tuna, salmon and mackerel fish. Minute quantity is present in beef, liver, cheese and other dairy products. Traces are found in carrots, almonds, rice, bread, sunflower seeds and lentils.

Use:

It is important in the absorption of calcium and thus helps in the maintenance of bone density and levels of calcium in the body.

Side effects:

Vitamin D overdose can cause increase in calcium levels in the body. It also causes weakness, drowsiness, headache, anorexia, xerostomia, metallic taste etc.

Calcium

Source:

Calcium is abundantly found in dairy products (milk, cheese, and yogurt), green vegetables, soy beans, tofu, nuts, fortified flour bread and cereals and fish.

Use:

It helps in the formation of bones and teeth.

It helps in preventing osteoporosis.

It allows normal nerve transmission.

It allows release of hormones.

Maintains normal heartbeat.

Side effects:

Excessive use of calcium supplements can cause digestive symptoms such as flatulence, constipation and bloated stomach. 

  Multi vitamins

Source:

Multivitamins are obtained from food combinations of fruits, vegetables, meat, fish, poultry and dairy products.

Use:

Multivitamins are used to supply the body with the vitamins that are not taken in the diet.  Multivitamin supplements also fulfill the deficiency of vitamins caused by illnesses, digestive disorders, pregnancy, malnutrition, kidney disorders etc.

Side effects:

Multivitamins have a variety of adverse effects ranging from rashes to stomach upset. Overdose may also cause allergic reactions. Due to the presence of a number of active ingredients, adverse effects profile could be wide, advice from the doctor or pharmacist is necessary before using the product.

 Fish oil supplements

 Source:

Fish oil supplements are originated from fish like salmon, sardines, herring and cod liver.

Use:

Fish oil supplements are widely used for lowering blood pressure, cholesterol, preventing the development of plaque in the blood vessels, reducing the risk of developing arrhythmias, heart attack and stroke and decrease the chances of death in people with cardiac disorders.

Side effects:

High intake of fish oil supplements can cause bad breath, heart burn, acidity, loose motion, rashes, nausea, vomiting and bleeding from nose.

Health and exercise

Any bodily activity performed to enhance health and well-being, maintaining physical fitness, promoting growth, preventing aging and improving the strength of muscles is known as exercise.

It is also a good way to socialize as individuals congregate in outdoor exercises.

Classification of exercise:

Exercises are broadly classified into three main types on the basis of their overall effect on the system of human body.

These classifications are as follows:

Aerobic exercise: It is any physical activity involving large muscles of the body consuming more oxygen than the resting state. It allows increased cardiac tolerance and vascular endurance. Running, cycling, swimming, brisk walking, rowing and hiking are some examples of aerobic exercises.

Anaerobic exercise: it is any physical activity that increases strength and tone of muscles as well as enhances bone strength, balance and muscular coordination. It includes strength and resistance training activities such as pull ups, push-ups, lunges and bicep curls using dumb-bells.

Weight training, functional training, eccentric training, sprinting, interval training are also included in anaerobic exercises.

Flexibility exercises: These exercises allow the muscles to stretch and increase their length.  Stretching improves flexibility of joints and muscles, this increasing the range of movements and reduced chance of injury.

 Physical training that focuses on accuracy of movements, agility, speed and power are also included in exercise.

The terms dynamic and static exercises are also widely used. These refer to activities that cause lowering of diastolic pressure (dynamic), and increase in systolic pressure (static).

Benefits of exercise:

Physical exercises help maintenance of health and well-being through a number of ways:

It allows maintaining a healthy body weight.

Allows regulation of digestive health.

Allows build up and maintenance of bone density.

Increases muscle strength and mobility of joints.

Promotes normal physiological functions.

Reduces risks of surgeries.

Boosts immune system.

Reduces potential of inflammation, thus preventing aging.

Improves metabolism.

Improves neurological functions.

Enhances cardiovascular activity.

Exerts antidepressant effect.

Improves quality of sleep.

Increases life expectancy and improves quality of life.

 Importance of diet with exercise:

A well balanced diet is as important as exercise. While exercising, it becomes more important to consume a healthy diet so that the body is provided with ample amount of nutrients in the correct ratio, in order to support the body to recover after strenuous exercise.

CoVID-19 and Personal Hygiene

 What is hygiene? Series of daily life practices, conducive to maintain a healthy lifestyle, promoting well-being by preventing occurrence and spread of disease is known as hygiene.

According to World Health Organization (WHO),

'Hygiene refers to conditions & practices that help to maintain health and prevent the spread of diseases' [i]

Importance of maintaining hygiene;

Good personal hygiene bears great importance in maintaining healthy social interactions. Keeping your body clean not only keeps your own self healthy but it is also important in preventing spread of infections hence protecting those around us too. The incidence of CoVID pandemic has highlighted the importance of personal hygiene and people around the world have adopted personal hygiene routine to stay safe from the spreading virus.

Personal hygiene is also important religiously. Cleanliness is paramount to worship in different religions of the world. These include Islam, Christianity, Buddhism and Sikhism which practice personal hygiene routine for performing their daily religious chores. Washing hands, performing ablution and bathing in holy waters has been taught and practiced in religious activities since many years.

 

How to start personal hygiene routine? [ii]

I've listed few easy and simple steps which you can follow to stay clean and get rid of all the harmful germs that lead to infections, illness and bad odor.

Hand washing;

Hands are one of the primary carriers of germs. This is because hands are constantly being used for greeting each other, touching surfaces, eating, playing or doing any type of work. Washing hands regularly will easily prevent illnesses such as flu, cough, common cold and GIT infections. It is important to wash hands at the following occasions:

·         Before cooking and eating food

·         Before holding a baby

·         After using the toilet

·         After coughing or sneezing

·         After visiting an ill person

·         After touching/handling animals

·         After leaving hospital

 

Dental hygiene;

Keeping your teeth clean and maintaining good dental hygiene helps in protecting the gums and teeth. It also helps in getting rid of bad odor and oral infections.

Always make sure that you brush your teeth at least twice a day and floss then regularly. Don't forget to replace your toothbrush once every three months, especially after having a dental infection.

Bathing;

Bathing daily with a good antibacterial soap will kill the bacteria responsible for producing bad body odor. Skin infections such as athlete’s foot could be prevented by thoroughly washing and drying the affected area.

Itchy scalp, dandruff and head lice can be avoided by washing hair regularly with a good shampoo.

 Clothing hygiene;

The buildup of dirt and germs on clothes could be prevented by using a good antiseptic detergent. Washing clothes of an ill person is important to prevent spread of infection by contact with the clothes.

 

The massive spread of CoVID has made hand washing and other personal hygiene activities compulsory for everyone. It is important to continue the habits we have adopted during the pandemic to contribute in the development of a healthy, infection-free global atmosphere.

References:

[i]  https://en.wikipedia.org/wiki/Hygiene#:~:text=Hygiene%20is%20a%20series%20of,to%20maintaining%20the%20body's%20cleanliness.

[ii] https://www.dettol.com.ng/personal-hygiene/healthy-body/the-importance-of-personal-hygiene/#:~:text=Good%20personal%20hygiene%20is%20very,protect%20those%20around%20you%20too.