What is Anaemia?
Anaemia is a condition when the blood is unable to transport oxygen, in quantities required by the body tissues and this oxygen is transported by haemoglobin present in red blood cells in the blood. According to WHO (world health organization), anaemia is defined as haemoglobin<13 g/dl in males and <12 g/dl in females.
Oxygen is essential for all body cells. It is the function of red blood cells to carry oxygen from the lungs to the farthest cells for them to use oxygen and extract energy from food (in the form of glucose). The red cells do so with the help of an iron-containing pigment (colored substance) called Haemoglobin.
In a setting when red cells are reduced or haemoglobin in the cells gets reduced, the oxygen-carrying capacity of the blood reduces and oxygen fails to reach the cell in the quantities required by them. This leads to reduced functional capacity of all body systems.
Therefore, though anaemia is a condition stemming from one or more causes, it affects all the body tissues and leads to reduced functioning of the body as a whole.
Types of Anaemia
- Blood loss anaemia
- Anaemia due to inadequate production of red blood cells
- Anaemia due to increased destruction of red blood cells
- Dietary deficiency of iron, proteins and vitamin B12
How common is Anaemia?
- WHO statistics: 11% of elderly (over the age of 65) are anaemic.
- Anaemia is more common and more disabling in frail elderly compared to those who are in good physical health.
- Prevalence of anaemia in nursing homes and care facilities is as high as 50%.
What are the symptoms of Anaemia?
The symptoms in elderly are generally very mild and are attributed to aging and infirmity and the underlying anaemia often goes undiagnosed.
- Generalised weakness
- Feeling of tiredness
- Repeated falls
- Giddiness and fainting episodes
- History of blood loss especially in stools repeatedly
- Delayed wound healing
- Worsening of already existing illnesses
- Depression and reduced concentration span
- Pale look
What are the risk factors for Anaemia?
Elderly, especially those with existing illnesses are more likely to develop anaemia. High risk groups are:
- Patients with kidney disease
- Patients with peptic ulcers
- Patients with bleeding piles
- Strict vegans
- Patients with mal-absorption syndromes
- Bedridden patients
What are the causes of Anaemia?
1. Blood loss anaemia
b. Bleeding piles
c. Blood loss in stool and urine
d. Peptic ulcer
2. Anaemia due to inadequate production of red blood cells
e. Nutritional deficiencies
i. Iron deficiency
ii. Vitamin B12 deficiency
iii. Folic acid deficiency
iv. Protein deficiency
v. Combined deficiencies
f. Anaemia in chronic disease
i. Chronic kidney disease
g. Malignancies (Cancer)
h. Bone marrow depression
i. Bone marrow failure
ii. Cytotoxic drugs (anti cancer medication)
3. Anaemia due to increased destruction of red blood cells
i. Haemolytic anaemia
i. Sickle cell anaemia
ii. Thalassaemia trait
j. Vasculitis associated haemolysis
What are the complications with Anaemia?
Anaemia in the elderly population is not an isolated disease. It affects the quality of life in general and increases the dependency of the person who is already seeking some kind of support as a senior citizen. Some features are:
- Worsening of existing illnesses
- Delayed recovery
- Reduced appetite
- Delayed wound healing
- Repeated falls
- Reduced quality of life
How is Anaemia diagnosed?
- Haemoglobin reduced
- Blood smear examination indicating the type of anaemia
- Decreased nutritional parameters
- Thyroid status examination
- Invasive investigations to localise the site of bleed in blood loss anaemias like endoscopies
How is Anaemia treated?
Correcting the cause of anaemia is the centre stone of treatment of anaemia. Most common cause of anaemia in elderly is nutritional deficiency which is corrected by a healthy diet and the required nutritional supplementation.
- In very severe cases such as sudden blood loss, blood transfusions may be required.
- In people who do not tolerate oral medications, or those who are bed ridden, or have mal-absorption problems, injectable forms of supplements should be given
- Mobile elderly who are not bed-ridden can be given oral supplements (haematinics)
Diet and Rehabilitation
It is especially necessary that the elderly are provided with nutritious diets, comprising of green leafy vegetables, dry fruits and red meats (if non vegetarian diets are acceptable).
How can Anaemia be prevented?
Anaemia is to a large extent a preventable disease since the most common cause is nutritional inadequacy. Correct foods with correct supplementation can go a long way in preventing the deficiency of nutrients and therefore anaemia.
Sources of iron: Green leafy vegetables, dry fruits, red meat, cooking in iron vessels
Sources of Vitamin B12: eggs, meats, milk, curds, mushrooms
Sources of Proteins: eggs, legumes, soyabean, meat
*Calcium interferes with the absorption of iron. Therefore foods rich in iron or iron supplements should not be consumed with milk and milk products.
Along with diet, light exercise should be followed daily that will help in improving oxygenation of blood. Light exercises can be yoga, morning walk, etc.
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