Classification of Anaemia

Definition of Anaemia

•   Anaemia is a condition where by haemoglobin level in blood is below the lower extreme of the normal reference range for age and sex of the individuals.
•  Anaemia is a reduction of oxygen carrying capacity of the blood, which may be caused by decrease in red blood cells production or reduction in haemoglobin content of the blood or combination of these.

Causes of Anaemia

1.   Poor absorption of iron from diets,
2.  Low intake of iron
3.  Heavy blood loss as a result of menstruation, or parasite infections such as hookworms, ascaris, and schistosomiasis
4.  Acute and chronic infections, including malaria, cancer, tuberculosis, and HIV can also lower blood Hb concentrations.
5.  The presence of other micronutrient deficiencies, including vitamins A and B12 and folate.
6.  Blood disorders e.g. sickle cell and thallasemias.
7.  Short birth intervals (less than 3 years) and multiple pregnancies

 Classification of Anaemia
Anaemia is classified into:

•  Nutritional anaemia

 - This type of anemia results from inadequate food intake of nutrients necessary for synthesis of red blood cell-Iron, Folic acid (Folate), Vitamin B12.
- It can also result from excessive demand of nutrients as in infant/child (due to rapid growth), pregnancy, breastfeeding, and hemolytic anemia (like sickle cell anemia)
Infection related anaemias
- This may result from infection such as malaria, parasitic infection (hookworms, ascaris), tuberculosis and HIV may cause anemia.

• Blood loss anaemias

- This can occur in bleeding such as pregnancy related bleedings, abortions, gastrointestinal bleeding as in peptic ulcer, cancers, postmenopausal bleeding, tumours such as fibroids, leukemia,and trauma/accidents.
- Normally blood loss leads to iron deficiency anemia

• Haemolyticanaemias

- Haemolytic anaemia results from increased red blood cell breakdown as in sickle cell anemia and hemolytic disease of newborns.

• Sickle Cell Anaemia

-This is a severe hereditary form of anaemia in which a mutated form of haemoglobin distorts the red blood cells into a crescent shape at low oxygen levels.
- It is commonest among those of African origin
- Sickle cell anaemia presents with the following clinical features
        o Low hemoglobin concentration (anaemia)
        o Fatigue (tiredness),
        o Pale skin and nail beds
        o Jaundice, and
        o Pain (Sickle Cell Crisis): Sudden episode of pain throughout the body. Common sites includes:
                   * Bones
                   * Lungs
                   * Abdomen
                   * Joints pain
                   * Lack of blood flow can cause pain and organ damage

 Clinical Presentation of Anaemia

The signs and symptoms of anaemia include:

1.  Pallor seen in conjunctiva, lips, tongue, palms, nails beds, and soles
2.  Body fatigue (feeling tired)
3.  Dizziness, light headedness, fainting, lack of concentration
4.  Tachycardia (increased heart rate)
5.  Difficulty in breathing
6. Swelling of the limbs

 Preventive Measures of Anaemia
 1. De-Worming of children.
 - Children aged 2-5 years should receive tablets for preventing worm infections such as hookworms and ascaris.
- Mebendazole or albendazole are used at least once every 6 months.

2. Diet and food fortification.
 - Mixed daily diet that contains vegetables, fruits and animal products should be promoted in the community basing on the kind of food that is available.

3.Promoting of use of Insect Treated Nets (ITN) by children and mothers.
- This will help to prevent malaria which is common in most Tanzanian communities.

4. Encourage utilization of Mother and Child Health clinic.
 - Apart from nutritional assessment, mothers and children who are at risk of developing anaemia are likely to be identified at an early stage for intervention measures.

5. Attending Antenatal Clinics.
- All Pregnant women should be screened for anaemia at antenatal clinics.
- Supplements of iron and folate should also be given to pregnant women for at least 90 days

6. Family planning.
- Advise women of reproductive age to utilize family planning methods in order to avoid frequent and unplanned pregnancies.
- This will reduce anaemia that is related to complications of pregnancies and child birth

7. Community health education.
- Health education on prevention of anaemia should be given at community health meetings, schools and in various clinics in most hospitals health centers and dispensaries.welling of the limbs

SUMMARY

•  Anaemia is present when the haemoglobin level in blood is below the lower extreme of the normal reference range for age and sex of the individuals
•  Causes of anaemia include poor nutrition, heavy blood loss, infections and blood disorders
•  Preventive measures of anaemia include de-worming of children, modification of diet, prevention of malaria and utilization of the antenatal services by pregnant mothers.