Q: My wife's haemoglobin is 9. We are trying for a baby. How to increase her haemoglobin count? What medicines and diet does she need?

A:Anaemia is a condition in which the number of red blood cells or the amount of hemoglobin 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, hemoglobin (Hb) concentration, and hematocrit (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 (hemolysis). It is twice as common in women than in men, especially during the childbearing years due to menstrual blood loss and pregnancies. 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). In pregnancy, 500 mg of additional iron is needed by the mother (to expand her red cell mass) while another 500 mg is needed for the baby and placental tissues. Thus, on an average, an additional 3 mg/day of elemental iron must be absorbed from dietary sources. The amount of iron absorbed by the body is only 10% of the total amount consumed, thus 30 mg/day needs to be consumed to meet the requirement. Absorption of iron from food is influenced by multiple factors, one important being the form of the iron. Heme Iron, found in animal sources, is highly available for absorption while non-heme 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. Though ferrous sulphate is recommended to treat iron deficiency, often patients complain of gastrointestinal discomfort, bloating and other distress. Ferrous gluconate, which is roughly equivalent in cost, produces fewer problems, and is preferable as the initial treatment of iron deficiency. Ascorbic acid supplementation enhances iron absorption. Polysaccharide-iron complex is a more recent option.