Anaemia

Overview of Anaemia

• Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal.[2]
• Haemoglobin is needed to carry oxygen besides this, if you have too few or abnormal red blood cells, or not enough haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues.[2]

Causes of Anaemia

Decreased or ineffective marrow production because i.e.,

• Lack of iron, vitamin B12 or folate
• Either Hypoplasia or myelodysplasia
• Invasion especially by malignant cells
• Renal failure
• Anaemia of chronic disease.[2]

Normal marrow production but increased removal of cells i.e.:

• Blood loss
• Haemolysis
• Hypersplenism.[2]

Classification of Anaemia

Etiological

1. Blood loss – either acute or chronic post-haemorrhagic anaemia.
2. Impaired red cell formation:

a] Genetic disorders of haemoglobin synthesis: i.e. Thalassemia syndromes.

b] Acquired deficiency of substances essential for haemopoiesis

• Iron deficiency anaemia.
• Megaloblastic anaemia due to deficiency of vitamin B12, folic acid, vitamin C.
• Protein malnutrition.

3. Haemolytic anaemia due to red cell destruction.
4. Defect in stem cell/erythroid precursor

• Aplastic anaemia
• Pure red cell aplasia

5. Miscellaneous i.e.

• Anaemia of chronic disorders- Infection/inflammatory disorders, either kidney or hepatic failure.
• Drug-induced disorders of erythropoiesis.
• Infiltrative disorders of bone marrow – e.g. leukaemia, lymphoma, metastatic Ca, myelosclerosis.

According to Size of Red Cells and their Haemoglobin Content (Morphological)

• Microcytic, hypochromic
• Normocytic, normochromic
• Microcytic.[1]

Risk factor of Anaemia

• Pregnancy
• Menorrhagia
• GI tract bleeding
• Dietary vegans
• Hook worm infection.[1]

Pathophysiology of Anaemia

Subnormal level of haemoglobin causes lowered oxygen carrying capacity of the blood.

This, in turn, initiates compensatory physiologic adaptations such as follows i.e.:

• Increased release of oxygen from haemoglobin
• Increased blood flow to the tissues
• Maintenance of the blood volume and
• At last, Redistribution of blood flow to maintain the cerebral blood supply.

Eventually, however, tissue hypoxia develops causing impaired functions of the affected tissues.

The degree of functional impairment of individual tissues is variable depending upon their oxygen requirements.

Tissues with high oxygen requirement such as the heart, CNS also the skeletal muscle during exercise bear the brunt of clinical effects of anaemia.[3]

Sign & Symptoms of Anaemia

SYMPTOMS:

In symptomatic cases of anaemia, the presenting features are i.e.:

• Tiredness
• Easy fatigability
• Generalized muscular weakness
• Lethargy and headache.

In older patients, there may be symptoms of i.e.

• Cardiac failure
• Angina pectoris
• Intermittent claudication
• Confusion
• Visual disturbances. [3]

SIGNS

• Pallor i.e.: Pallor is the most common also characteristic sign which may be seen in the mucous membranes, conjunctivae and skin.
• Cardiovascular system i.e.: A hyperdynamic circulation may be present with tachycardia, collapsing pulse, cardiomegaly, mid systolic flow murmur, dyspnoea on exertion, also in the case of older people, congestive heart failure.
• Central nervous system i.e.: The older patients may develop symptoms referable to the CNS such as attacks of faintness, giddiness, headache, tinnitus, drowsiness, numbness and tingling sensations of the hands and feet.
• Ocular manifestations i.e.: Generally, Retinal haemorrhages may occur if there is associated vascular disease or bleeding diathesis.
• Reproductive system i.e.: Menstrual disturbances such as amenorrhoea and menorrhagia and loss of libido are some of the manifestations involving the reproductive system in anaemia subjects.
• Renal system i.e.: Mild proteinuria and impaired concentrating capacity of the kidney may occur in severe anaemia.
• Lastly, Gastrointestinal system i.e.: Anorexia, flatulence, nausea, constipation and weight loss may occur.[3]

Physical Examination

Appearance of the Patient

• Pallor (pale skin, mucosal linings and nail beds) is often a useful diagnostic sign in moderate or severe anemia, but it is not always apparent. Commonly seen in nail bed, palm crease, also conjunctiva.

Physical Findings Associated with Specific Anemia

Iron deficiency anemia i.e.

• Cheilosis
• Koilonychia
• Glossitis

Secondary to Bleeding Iron Deficiency Anemia i.e.

• Melena
• Hematochezia
• Hematuria
• Hematemesis

Secondary to Malabsorption Iron Deficiency Anemia i.e.

• Dermatitis herpetiformis

Vitamin B12 Deficiency

• Chelitis
• Glossitis
• Decreased proprioception, and vibratory sensation

Hematological Malignancy (Leukemia, Lymphoma)

• Lymphadenopathy
• Splenomegaly
• Purpura
• Ecchymoses [8]

Diagnosis of Anaemia

Severity of anaemia can be based on Hb levels i.e.:

Mild: Hb 9.1 -10.5 g/dl

Moderate: Hb 6-9 g/dl

Severe: Hb < 6 g/dl [3]

Differential Diagnosis of Anaemia

• Iron Deficiency Anemia
• Vitamin B12 Deficiency Anemia
• Folate Deficiency Anemia
• Aplastic Anemia
• Myelodysplastic Syndromes (MDS)
• Anemia of Chronic Disease
• Sickle Cell Anemia
• Thalassemia
• Hereditary Spherocytosis
• Autoimmune Hemolytic Anemia
• Drug-induced Hemolytic Anemia
• Microangiopathic Hemolytic Anemia
• Mechanical Hemolytic Anemia
• Acute Blood Loss Anemia
• Chronic Blood Loss Anemia

Investigation of Anaemia

• Complete blood counts (CBC) with reticulocyte count are the basic test.
• Haemoglobin estimation
• Peripheral blood film examination
• Red cell indices
• Leucocyte also platelet count
• Reticulocyte count
• Erythrocyte sedimentation rate
• Bon- marrow examination. [1]

Treatment of Anaemia

• Correction of dietary deficiency i.e.: Especially, Faulty dietary habits, chronic alcoholism, malnourishment.

• Treatment of underlying cause i.e.: for instance Ankylostomiasis, piles, menorrhagia, infection, chronic kidney failure, leukaemia, liver disease, collagen disease or endocrine deficiency, surgical correction of intestinal abnormalities.

• Removal of toxic chemical agents or drugs: cases of either haemolytic anaemia or aplastic anaemia.
• Blood transfusion: Chief value is its immediate effect
• Administration of substances specifically lacking:

Principles are i.e.

(a) Firstly, Haematinic should be started only after adequate blood examination, since response to a haematinic may obscure the blood picture.

(b) Secondly, The specific haematinic should be given alone.

(c) Thirdly, The haematinic should be given in adequate doses for Prevention.[1]

Homeopathic Treatment of Anaemia

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Anaemia

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Calcarea phos

• This remedy acts by supplying new blood cells.
• Pains and cramps dependent on anaemic conditions.
• Waxy appearance of the skin due to anaemia.
• Chlorosis, complexion waxy, greenish-white, with constant headache also ringing in ears.[4]
• Anemia after acute diseases or chronic wasting diseases.
• Trembling or trembling hands; either with pain or other complaints.
• Coldness or soreness in spots, vertex, eyeballs, tip of nose, fingers etc.
• Sensation of crawling and numbness; after bad news.
• Anaemic children who are peevish, flabby, have cold extremities and weak digestion; additionally, they start convulsively when lying on back whereas better lying on side.[5]

Ferrum Phos

• Follows Calcarea phos. as soon as improvement of the general health sets in.
• Moreover, There is a want of red blood in the system.
• This remedy, by its power of attracting oxygen, colors the new blood-cells red also enriches them after they have been supplied by Calcarea phos.[4]

Natrum mur

• Spinal anaemia, paralytic weakness of the lower extremities, with general prostration, heaviness and sensation of fatigue
• Especially after a short walk or ascending steps; legs give way, so as to be unable to progress further.[4]
• Emaciation; descending, either of neck or abdomen.
• Besides this, Mucus membrane and skin may be dry or may produce thick, white or clear, watery, acrid discharges. Dryness of mouth, throat, rectum, vagina etc.
• Numbness of one side; parts lain on; with paralysis; fingers, parts seem too short.
• Easy exhaustion.[5]

Kali phos

• Cerebral anaemia, anaemic conditions of the brain causing undue, nervousness.
• Poverty of the blood from influences which continually depress the mind also nervous system.[4]

Kali mur

• This remedy may have to be given in anaemia, similarly as a secondary remedy or intercurrent, if such symptoms as eczema or eruptions of the skin coexist.[4]

Sulphur

• Partially recovers after that relapses.
• Frequent flushes of heat.
• Uneasiness in blood.
• Very sensitive to open air: to droughts, worse for washing and bath.
• Takes cold, Oppression, burning, stitches, congestion in chest. Additionally, Heat crown of head with cold feet.
• Soles burn at night, must be put out of bed.
• Hungry-starving especially at 11 a.m.
• Drowsy by day, restless nights.
• Starts from frightful dreams.[5]

Diet & Regimen of Anaemia

Regimen and diet for Anaemia

Diet for Anemia

The key to managing anemia through diet is focusing on foods rich in iron, as well as those that help your body absorb iron more effectively.  

• Iron-rich foods:

  • Heme iron (from animal sources): Red meat, poultry, fish, and seafood are excellent sources of iron that your body absorbs easily.  
     
  • Non-heme iron (from plant sources): Leafy green vegetables (spinach, kale), beans, lentils, tofu, fortified cereals, and dried fruits (raisins, apricots) contain iron, but it’s not as readily absorbed.
     

• Foods that enhance iron absorption:

  • Vitamin C: Include vitamin C-rich foods like citrus fruits, berries, tomatoes, and peppers in your meals to boost iron absorption. 
     
  • Beta carotene: Foods like carrots, sweet potatoes, and apricots contain beta carotene, which also aids iron absorption. 
     

• Foods to limit:

  • Calcium-rich foods: Dairy products, calcium-fortified foods, and beverages can interfere with iron absorption when consumed at the same time as iron-rich foods. Try to consume them separately.
     
  • Tannins: Coffee, tea, and some red wines contain tannins that can hinder iron absorption. Enjoy these beverages between meals. 
     
  • Phytates: Whole grains, legumes, and nuts contain phytates that can reduce iron absorption. Soaking, sprouting, or fermenting these foods can help improve iron availability.  
     

Regimen for Anemia

• Identify and address the underlying cause: Anemia can have various causes, such as iron deficiency, vitamin B12 deficiency, folate deficiency, chronic diseases, or blood loss. It’s essential to consult a doctor to determine the underlying cause and receive appropriate treatment.
• Supplements: Your doctor may recommend iron supplements, vitamin B12 injections, or folate supplements depending on the type of anemia you have.   
   
• Lifestyle factors:
  • Manage stress: Stress can worsen anemia symptoms. Incorporate stress management techniques into your routine.   
     
  • Regular exercise: Moderate exercise can improve circulation and overall health, which can be beneficial for managing anemia. However, avoid overexertion if you feel fatigued.
     
  • Adequate rest: Ensure you get enough sleep to support your body’s recovery.

References

1. Golwala’s medicine for students 25^th edition 2017
2. Davidson’s principles and practice of medicine 22^nd
3. Textbook of pathology by Harsh Mohan 6^th
4. Twelve Tissue Remedies Comprising of Theory, Therapeutics, Applications, Materia Medica and Complete Repertory of Tissue Remedies [Therapy Part] By Boericke & Dewey.
5. Pointers To Common Remedies by Dr.M.L. Tyler.
6. Concise Materia Medica of Hom. Remedies By S.R. Phatak
7. http://poshukach.com/redir?user_type=2e&type=sr&redir=eJzLKCkpKLbS1y8vL9crT03KTdFLzs_VT8lMLdHPLMrP0y3KTM7QTcvPTylmYDA0MzUxMzA1M7Fk-L3Cb8G51LWb904rmcHQc1AYAJj-GqM&src=94d356&via_page=1
8. https://www.wikidoc.org/index.php/Anemia_physical_examination
9. https://my.clevelandclinic.org/health/diseases/3929-anemia
10. Hoffman, R., Benz, E. J., Silberstein, L. E., Heslop, H. E., Weitz, J. I., & Anastasi, J. (2018). Hematology: Basic Principles and Practice (7th ed.). Elsevier.
11. Kaushansky, K., Lichtman, M. A., Prchal, J. T., Levi, M. M., Burns, L. J., & Caligiuri, M. A. (2016). Williams Hematology (9th ed.). McGraw Hill Professional.
12. Fauci, A. S., Braunwald, E., Kasper, D. L., Hauser, S. L., Longo, D. L., Jameson, J. L., & Loscalzo, J. (2019). Harrison’s Principles of Internal Medicine (20th ed.). McGraw Hill Professional.
13. Longo, D. L., Fauci, A. S., Kasper, D. L., Hauser, S. L., Jameson, J. L., & Loscalzo, J. (2012). Harrison’s Principles of Internal Medicine (18th ed.). McGraw Hill Professional.