Q: I am 24 years old, unmarried. I have been working in a call centre for the past 3 years. My problem is that I have irregular periods. The doctors say that I am very anaemic. I feel like eating raw rice and I am addicted to it. I want to know if this is harmful for the body and what are the consequences? I have been having this for the past ten years and I attained puberty at the age of 11. Does this have got anything to do with my irregular periods?

A:Anaemia is a condition in which the number of red blood cells or the amount of haemoglobin is below normal for age and sex of the individual. It is defined as a decrease in red blood cells (RBC) mass and is usually discovered and quantified by measurement of the RBC count, haemoglobin (Hb) concentration, and haematocrit (Hct). Anaemia is suggested in males with Hb levels less than 13.0 g/dl and in females with Hb levels less than 12.0 g/dl (less than 11.5 g/dl in pregnant women). It may be due to decreased production of red blood cells, blood loss (haemorrhage) or red cell breakdown (haemolysis). Anaemia is a symptom of disease that requires investigation to determine the underlying cause. It is twice as common in women than in men, especially during the childbearing years due to menstrual blood loss and pregnancies. Blood loss (haemorrhage) is the commonest cause of excessive iron loss from the body with gastrointestinal bleeding sometimes being so insidious that it may be overlooked. Bleeding during periods in women too may go unrecognised. Menstrual losses vary considerably (10-250 ml) and the loss of iron (elemental) with each normal menses is around 12-15 mg. This may be as high as 100 mg in some women. Each pregnancy costs about 500 mg of iron. These factors double the iron requirement in women. Poor iron absorption is not commonly seen except in patients with diseases of the small intestine like sprue, celiac disease, regional enteritis or previous intestinal surgery, which impact on iron absorption. The amount of iron absorbed by the body is only 10% of the total amount consumed i.e. only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. Your symptom of pica (abnormal craving for a particular item) is very suggestive of iron deficiency. Please get a complete blood count and peripheral smear examination done along with serum iron, serum ferritin and TIBC. You need to consult a gynaecologist as iron deficiency is likely due to blood loss during your periods and that has to be corrected. Treatment of most patients with iron deficiency is with oral iron therapy. The underlying cause too is corrected so that deficiency does not recur. The cheapest and most effective form is ferrous iron. The side effects experienced on taking iron tablet are proportional to the amount of iron available for absorption. The iron preparation you take should contain between 30-100 mg elemental iron. Avoid enteric-coated or prolonged-release preparations. The dose you take should be sufficient to provide between 150-200 mg elemental iron per day and the tablet may be taken 2 to 3 times a day about 1 hour before meals. The treatment should be continued for 3 months after the haemoglobin has returned to normal so that the body iron stores are replenished. Response to treatment is confirmed by doing a reticulocyte count after 10-12 days of treatment and the rate of rise of haemoglobin (with adequate dose of iron) is about 1 g/dl per week.