Introduction

What is Anaemia?

Anemia is defined as low blood hemoglobin concentration The main function of hemoglobin is to carry oxygen to the tissues hence anaemia leads to hypoxia (lack of oxygen) in organs and later to a wide range of clinical consequences. The normal haemoglobin level is between 11.5 to 16.5g/dL for adult female and 12.5 to 18.5g/dL for adult male.

Anaemia is not a disease but a symptom of various conditions including extensive blood loss, excessive blood cell destruction or reduced blood cell formation. There are several kinds of anaemia caused by various underlying circumstances and the most common is lack of iron from daily intake. It is a condition when there is not enough healthy red blood cells in the blood circulation to carry oxygen to the tissues.

Causes of anaemia

1. Blood loss (which can be acute or chronic).
   1. Acute blood loss may be seen in a motor vehicle accident or following surgery. Blood loss of more than 500ml usually warrants replacement.
   2. Chronic blood loss occurs during excessive menstruation in females, chronic worm infestation and other conditions.
2. Inadequate production of normal red cells by bone marrow. This may be due to :
   1. Deficiency of essential factors like iron, vitamin B12, folate and erythropoietin.
      1. Marked growth spurt in adolescence, causing an increased iron requirement which outstrips the rate of iron absorption.
      2. Menstruation in females with an average loss of 30 mg of iron each month may lead to an iron deficiency situation.
   2. Toxic factors: inflammatory disease, liver or kidney failure, medications.
   3. Hormone deficiency: low thyroid hormone levels.
   4. Invasion of bone marrow: blood cancers, bone marrow disease.
   5. Disorder of developing red cells: conditions such as thalassemia.
3. Excessive destruction of red blood cells due to infection or certain medications.
4. Anaemia can also be due to generalised or specific nutrient deficiencies. Besides protein, other few micronutrients are needed to form red blood cells and haemoglobin such as iron, vitamin C, vitamin E, vitamin B12, vitamin B6, copper, riboflavin and folic acid. Thus, lack of any of these micronutrients may lead to nutritional anaemia. The commonest type of Anaemia is :
   1. Iron deficiency anaemia.
   2. Thalassaemia.

Signs and symptoms

Many teens suffer from anaemia and do not even know it.

Symptoms include

1. Feeling tired all the time.
2. Dizziness.
3. Shortness of breath when engaging in physical activities.
4. Pale skin.
5. Rapid heartbeat.
6. Poor memory.
7. Weight loss.

Complications

If anaemia is very severe it may lead to

1. Heart failure where the heart function becomes very weak and inadequate.
2. Poor pregnancy outcomes including prematurity and intrauterine growth retardation.

Treatment

A local clinic can check your haemoglobin level to determine whether you have anaemia.

The treatment of anaemia depends on what is the cause is :

1. If it is due to a medical condition e.g. thalassemia and leukaemia, specific treatment is required.
2. If it is due to iron deficiency, then one needs to eat a balanced diet rich in iron and take iron supplements. Refer Table 1 and Table 2 for Iron content in foods.

Other dietary recommendations

1. Eat a well-balanced meal that has a high biological values of protein such as meat, poultry, fish, egg, milk and dairy products.
2. Two servings of fresh fruits and two to three servings of vegetables will provide the required folic acid. Supplement is needed only when intake is very poor. Refer to the Malaysian Food Pyramid for further information.
3. Vitamin C which can be found in abundance in fresh fruits promotes better absorption of folic acid and iron from foods.

Other hints when treating iron deficiency

1. It is advisable to take iron supplement with Vitamin C to enhance iron absorption.
2. Specific causes like worm infestation and inflammatory bowel disease will also need to be treated.

Table 1: Iron contents in the foods

Reference : Nutrition Composition of Malaysian Food, 4th Edition. Institute for Medical Research, 1997.

Table 2: Source of iron

Reference: Recommended Nutrient Intakes for Malaysia, Ministry of Health Malaysia, 2005.

Prevention

1. Eat a balanced diet every day. Refer to the Malaysian Food Pyramid.
2. Eat iron-rich foods.

References

1. Escott-Stump. S (2002) Nutrition and Diagnosis – Related Care. Fifths Edition. Lippincott Williams & Wilkins, USA.
2. Mahan LK, Escott-Stump S (2004) Krause’s Food, Nutrition & Diet Therapy. 11th edition. Elsevier USA.
3. Malaysian Association for the study on Obesity (2005) Strategy for the Prevention of Obesity- Malaysia: Malaysian Association for the Study of Obesity.
4. National Coordinating Committee on Food & Nutrition. MOH. ( 2005). Recommended Nutrient Intakes for Malaysia : Ministry of Health Malaysia.
5. utrition Society Malaysia (2002). Resipi Sihat, Pilihan Bijak : Kementerian Kesihatan Malaysia.