Q: My 14 years old grand daughter got her periods started last year. There is no any problem in her menses. Now she has been affected by severe iron deficiency anaemia. Haemoglobin is only 4% and iron is only 40 ug/dl. As Advised by the doctor, 2 units of blood have been transfused to her body. After transfused 2 units of blood, haemoglobin has been raised to 7.7%. Doctor has advised us to provide nutrition/healthy food and prescribed some vitamin syrup. He has also advised to give an injection every week to increase blood level. Can you tell me a diet plan containing rich nutrition/iron?

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 cell (RBC) mass and is usually discovered and quantified by measurement of the RBC count, haemoglobin (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 (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. One of the commonest cause of anaemia in our country is nutritional deficiency - iron deficiency &/or folic acid/vitamin B12 deficiency. The commonest cause in children is iron deficiency which is due to recurrent or chronic infections, malnutrition, reduced immunity and because this is a period of rapid growth and dietary adjustments. Fussy eaters may be at risk due to poor intake or lack of variety in the foods they eat. Absorption of iron from food is influenced by multiple factors. One important factor is the form of the iron. Haeme iron, found in animal sources, is highly available for absorption in contrast to non-haeme iron found in vegetable sources. Vegetarians need more iron in their diets than non-vegetarians because the iron from plant foods is not as well absorbed as it is from animal foods. Vegetarians should choose several iron-rich plant foods daily. Grains, beans and lentils, vegetables (green-leafy ones, tomato, potato, green & red chillies etc), fruits, nuts and seeds are rich sources of non-haeme iron. The absorption of non-haeme iron can be improved when a source of haeme iron meat/fish/poultry is consumed in the same meal or iron absorption enhancing foods like fruits/fruit juices are consumed. But coffee/tea and calcium if consumed along with a meal impair iron absorption. Treatment of most patients with iron deficiency is with oral iron therapy. There is a very limited role of blood transfusion (packed cells) in the treatment of iron deficiency as the risks of giving blood far outweigh the advantage of doing so and it is strongly discouraged. 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 give should contain between 30-100 mg elemental iron. Avoid enteric-coated or prolonged-release preparations. The dose 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. 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 as most patients tolerate this form of iron better than the iron salts, even though the 150 mg of elemental iron per tablet is substantially greater than that provided by iron salts (50 to 70 mg per tablet).