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What is the treatment for severe anaemia?

Q: I am anaemic for the last 20 years. My haemoglobin (Hb) count is always below 10 gm. I have taken a lot of iron medicines and other vitamins but they are of no use. My doctor says that the body does not absorb iron and now he has advised me to go for advanced blood tests including bone marrow test. Though I am fine in doing my daily chores, but the colour of my skin is very pale. Sometimes after a hard day, I feel fatigued and dizzy. I am scared of getting a bone marrow test done. Please suggest.

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 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. One of the commonest cause of anaemia in our country is nutritional deficiency - iron deficiency &/or folic acid/vitamin B12 deficiency. Normally, the body concentration of iron is regulated carefully by cells in the proximal part of the small intestine, which change iron absorption to compensate body losses. Iron deficiency is caused by either reduced intake of oral iron or excessive loss of iron from the body. A diet low in iron can lead to it as 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. Gastrointestinal tract abnormalities may too lead to it as iron is absorbed in the upper small intestine and any abnormality in the gastrointestinal tract could alter iron absorption. Finally blood loss from GI bleeding, kidney/bladder tumour, or injury can lead to chronic anaemia. 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. Injectable form of iron is given to patients who are either unable to absorb oral iron or who have increasing anaemia despite adequate doses of oral iron. It is expensive and has greater side effects than oral iron preparations. Packed cell transfusion is reserved for patients who have severe acute bleeding or lung/heart disease. Please get yourself examined by a physician and get a complete blood count done (which includes red cell indices) along with a reticulocyte count and a peripheral smear examination. Also get serum iron, TIBC and serum ferritin levels done to document iron deficiency. This will give an idea of the underlying cause on which the treatment depends. If you have documented refractory anaemia i.e. not responding to adequate doses of iron/folic acid/vitamin B12, you may need an endoscopy to exclude any gastro-intestinal abnormality and a marrow examination to rule out any underlying primary haematologic disease.


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