Q: My daughter has very low haemoglobin levels. She is 28 years old and married. She has not planned a child so far. What can be the affect of it? What foods should she take to improve it? She takes very little non-vegetarian food. Please advise.

A:Please get your daughter examined by a physician and a gynaecologist and get a complete blood count done (which includes red cell indices) along with a reticulocyte count and a peripheral smear examination. This will give an idea of the underlying cause on which the treatment depends. 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 cell (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 like cardiac, hepatic, and renal disease; chronic infection; endocrinopathy; or malignancy. It is twice as common in women than in men, especially during the childbearing years due to menstrual blood loss and pregnancies. Formation of blood cells (haematopoiesis) depends on several factors like - the presence of stem cells in the bone marrow that are capable of differentiating and developing into mature blood cells; a supportive bone marrow environment for stem cell survival and functioning, and the presence of growth factors that control the division, differentiation, and survival of blood cells. Any dysregulation results in anaemia. The red cells arise in the bone marrow under the influence of a hormone called erythropoietin produced by the kidneys. One of the commonest cause of anaemia in our country is nutritional deficiency - iron deficiency &/or folic acid/vitamin B12 deficiency. The loss of iron (elemental) with each normal menses is around 12-15 mg. A normal diet must include 1.5-2 mg/day of elemental iron to compensate for menstrual losses alone. Iron-deficiency anaemia may be caused by consuming diets low in iron (iron is obtained from foods in our diet but only 1 mg of iron is absorbed for every 10 to 20 mg of iron ingested. A person unable to have a balanced iron-rich diet may suffer from some degree of iron-deficiency anaemia); body changes with an increased iron requirement (growth spurts in children or during pregnancy/lactation); gastrointestinal tract abnormalities (as iron is absorbed in the upper small intestine, any abnormalities in the gastrointestinal tract could alter iron absorption and result in iron-deficiency anaemia) and blood loss (GI bleeding, kidney/bladder tumour, or injury). The common symptoms of anaemia include fatigue, weakness, breathlessness, dizziness, fainting, palpitations, headache, ringing in the ears, difficulty sleeping and concentrating etc. Absorption of iron from food is influenced by multiple factors, one important being the form of the iron. Haeme Iron, found in animal sources, is highly available for absorption while non-haeme iron (found in vegetable sources) is less available. Legumes, lentils, soybeans and dark leafy green vegetables are especially good sources of iron. Iron absorption is increased markedly by eating foods containing vitamin C along with foods containing iron.