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Iron deficiency and anaemia

WHAT IS ANAEMIA?

Anaemia is a common condition that affects 1 in 3 people worldwide1. It is defined as a decreased number of red blood cells (RBCs) and occurs when there is an insufficient amount of iron in the body to make hemoglobin. When the quantity of hemoglobin is reduced, fewer red blood cells are formed, and the ones that are formed are smaller. Since haemoglobin is the protein that carries oxygen throughout the body, when there is not enough, the body doesn’t get all the oxygen it needs.

CERTAIN GROUPS ARE AT PARTICULAR RISK FOR ANAEMIA2,3,4

Why are children at particular risk?

Toddlers and children of preschool age have the highest prevalence of anemia at 47.4% of their population group according to the World Health Organization (WHO), largely due to nutritional choices.6

Children require more iron for growth and development, yet many children receive less than their recommended daily value. Children in this age group often receive a good supply of dairy, yet this food group is deficient in adequate iron and can ultimately increase the child’s risk of developing iron-deficiency anemia.7

What are the consequences of anaemia in children? 8,9,10

LEARNING LAG

DISTURBANCE OF COGNITIVE PERFORMANCES

GROWTH DISTURBANCE IN CHILDREN

DISTURBANCE OF IMMUNE STATUS

References:
6. Global anaemia prevalence and number of individuals affected. World Health Organization Web site. http://www.who.int/vmnis/anaemia/prevalence/summary/ anaemia_data_status_t2/en/. Accessed April 3, 2017.
7. Thakur N, Chandra J, Pemde H, Singh V. Anemia in severe acute malnutrition. Nutrition. 2014;30(4):440-442
8. Bandhu R et al. Effect of iron on growth in iron deficient anemic school going children. Indian Journal of Physiology and Pharmacology. 2003. 47 (1) : 59-66.
9. Grantham-McGregor S et al. A Review of Studies on the Effect of Iron Deficiency on Cognitive Development in Children. J Nutr. 2001 Feb;131(2S-2):649S-666S.
10. Ekiz C et al. The effect of iron deficiency anemia on the function of the immune system. The Hematology Journal. 2005. 5: 579-583.

Why are women of childbearing age at particular risk?

Due to blood loss experienced through menstruation and the greater demands on the blood supply for the developing fetus during pregnancy, women tend to suffer from a high rate of anemic risk, with a global prevalence of around 42% within their population group.6

Women of childbearing age are the population with the most affected individuals, with an estimated 468 million being non-pregnant women, according to WHO5 and are the highest at-risk population group for iron-deficiency anemia.

What are the consequences of anaemia in women of childbearing age?

Whilst women of child bearing age are vulnerable to iron deficiency anaemia, pregnant women in particular are at risk due to high iron requirements.

Iron deficiency anaemia can, in pregnant women, lead to11, 12:

LOW BIRTH WEIGHT

SPONTANEOUS ABORTION

FETAL GROWTH RETARDATION

PREMATURITY

References:
6. Global anaemia prevalence and number of individuals affected. World Health Organization Web site. http://www.who.int/vmnis/anaemia/prevalence/summary/ anaemia_data_status_t2/en/. Accessed April 3, 2017.
11. Vural T et al. Can anemia predict perinatal outcomes in different stages of pregnancy? Pakistan Journal of Medical Science. 2016. 32(6) : 1354-1359.
12. Huch R et al. Iron Deficiency and Iron Deficiency Anemia. Pocket Atlas Special. Thieme. 2006. Chapter 4 : 34-38

Why are surgical patient at particular risk?

The mean prevalence of pre-operative anaemia is around 35%. The aetiology of pre-operative anaemia may be multifactorial and complex. (Nutritional deficiencies, some drugs, activation of the immune system…). The mean prevalence of post-operative anaemia can reach 90%. It is mainly caused by preoperative anaemia and/or important blood loss during surgery.13

What are the consequences of anaemia in surgical patients?

Preo-operative anemia and post operative anemia are independent risk factor for increased post-operative morbidity and mortality, as well as for prolonged length of hospital stay.13, 14

References:
13. Muñoz , M., Franchini , M., and Liumbruno , G.M. (2018). The post operative management of anaemia: more efforts are needed. Blood Transfus 16 , 324 325.
14. Muñoz, M., Gómez Ramírez , S., Campos, A., Ruiz, J., and Liumbruno , G.M. (2015). Pre operative anaemia: prevalence, consequences and approaches to management. Blood Transfus . Trasfus . Sangue 13, 370 379.,)

Why are the elderly at particular risk?

Anemia is common in the elderly and its prevalence increases with age.

Iron deficiency anemia, the second most common cause of anemia in the elderly, usually results from chronic gastrointestinal blood loss caused by nonsteroidal anti-inflammatory drug–induced gastritis, ulcer, colon cancer, diverticula or angiodysplasia. Older persons may also become iron deficient because of inadequate intake or inadequate absorption of iron.15

What are the consequences of anaemia in elderly patients?

Anaemia in the elderly is associated with a poor prognosis that is in terms of mortality, morbidity and risk of fragility.16

References:
15. Smith DL. Anemia in the Elderly. Am Fam Physician. 2000 Oct 1;62(7):1565-1572
16. Maerevoet, M., Sattar, L., Bron, D., Gulbis, B., and Pepersack, T. (2014). [Anemia in the elderly]. Rev Med Brux 35, 361–367

HOW TO RECOGNIZE IDA SYMPTOMS? 5

  • CHEST PAIN

  • SHORTNESS OF BREATH

  • HEADACHE

  • TACHYCARDIA

  • BRITTLE NAILS

  • WEAKNESS

  • MUCOCUTANEOUS PALLOR

  • FATIGUE

HOW IS ANAEMIA TREATED?

Anaemia is often easily treated. The treatment options you receive depend on how severe the anaemia is and the underlying cause.

IRON SUPPLEMENTATION

Treatment for anaemia due to iron deficiency usually involves taking iron supplements and making changes to your diet. The purpose is to treat your symptoms by increasing levels of iron and therefore haemoglobin in your body. Oral iron supplementation is available in various forms. Don’t hesitate to ask your healthcare professional about the best solution for you.

DIETARY CHANGES
Certain foods are rich in iron and should be encouraged:
  • Animal-source foods;
  • Lean meat and seafood;
  • Nuts, beans, vegetables, and fortified grain products;
  • Cereals and bread with extra iron in them (fortified);
  • Pulses (beans, peas and lentils).
Other foods and drink are low in iron and / or make it harder to absorb iron thus large amounts should be avoided:
  • Black and herbal tea;
  • Coffee;
  • Milk and dairy;
  • Foods with high levels of phytic acid – such as wholegrain cereals.
References:
1. Nicholas JK. et al. A systematic analysis of global anemia burden from 1990 to 2010. Blood. 2014.123: 615–24.
2. Lopez A et al. Iron deficiency anaemia. Lancet. 2016 Feb 27;387(10021):907-16
3. WHO Library Cataloguing-in-Publication Data 2015. The global prevalence of anaemia in 2011.
4. Munoz M et al.‘Fit to fly’: overcoming barriers to preoperative haemoglobin optimization in surgical patients. British Journal of Anaesthesia. 2015; 115 (1): 15–24.
5. Iron Deficiency Anaemia: Assessment, Prevention and Control. A Guide For Programme Managers (Document WHO/NHD/01.3). Geneva: World Health Organization, 2001 https://www.nhlbi.nih.gov/health-topics/iron-deficiency-anemia.