COUNSELLING A CASE

OF ANAEMIA IN A PHC
 !
"" " # " $
!
%

% &
# "
# "
' ( & #
 ) *

+
) +) ( " !
+ "
+ " ( # "

+ %
+ !
 ) ) ' )
) " , %$& $ &
$ #
" & -
" " & !
./-0 .1-0 & " 2 + "
.3 ./-0 & " 2 +# "
) " & # " & !
,
.4& " 2 + "
.3& " 2 + + & , "
..& " 2 + & , "
.3 & " 2 + 1 $ ./ $
.. & " 2 + 1 ' 0$
 CAUSES OF ANAEMIA
Inadequate production of red blood cells in bone marrow
due to:
Lack of raw materials e.g. nutritional anaemia.
Depression of bone marrow e.g. chronic infections, drugs, radiation
etc.
Infiltration of bone marrow in conditions likes malignancy.
Excessive destruction of red blood cells due to:
Abnormality of haemoglobin like thalassemia,
Deficiency of red cell enzymes like Glucose 6 phosphate
dehydrogenase deficiency,
Abnormality of red cell membrane like hereditary sperocytosis
Auto immune haemolytic anaemias
Blood loss due to any cause
NUTRITIONAL ANAEMIA
Nutritional anaemias - caused by deficiency of
nutrients required for the formation of haemoglobin
or red blood cells.
Nutrients essential for formation of normal blood
cells -Iron, folic acid, vitamin B12, vitamin B6,
vitamin C, vitamin E, protein and copper.
Among nutritional anaemias IRON DEFICIENCY
ANAEMIA(IDA) is the most common anaemia in
India.
Nutritional megaloblastic anaemia is the other
common nutritional anaemia.
 CAUSES OF IDA
Low intake of Iron

Increased losses of Iron

Increased demands of iron

Due to reduced intake or absorption of iron:
Iron poor diet
Malabsorption syndromes
Chronic diarrhoea
Gastrointestinal surgery
Due to increased loss:
Gastrointestinal bleeding due to any cause
Hook worm infestation
Bleeding disorders
Excessive menstruation
Due to increased demands:
Pregnancy
Lactation
Prematurity and low birth weight
Adolescence
Chronic illnes
CLINICAL FEATURES OF ANAEMIA
Pallor,
Anorexia
Pica (eating abnormal things)
Lethargy
Irritability
Easy fatiguability
Insomnia (lack of sleep)
Failure to thrive
Increased heart rate
Difficulty in breathing
Mental disturbances
Oedema
Cardiac failure
 LONG TERM IDA
a burning sensation in the tongue. (GLOSSITIS)
a smooth tongue
dryness in the mouth and throat.
sores at the corners of the mouth. (ANG.STOMATITIS)
an altered sense of touch.
nails can become brittle and spoon shaped with vertical
stripes and a tendency to fray. (KOILONYCHIA)
or a 'pica' can arise - an insatiable craving for a specific
food, eg liquorice.
brittle hair.
difficulty in swallowing
 INVESTIGATIONS
Hb% ESTIMATION

PERIPHERAL SMEAR

STOOL EXAMINATION
 MANAGEMENT
DIET

ORAL IRON PREPARATIONS

PARENTERAL IRON

BLOOD TRANSFUSION
 DIET
Haeme Vs Non haem iron
Cooking of diet in iron pots
Jaggery
Green leafy vegetables
Dried dates
Bajra
Pulses
Gingelly seeds
Meat and fish
Iron absorption - ed by VIT.C rich foods (citrus fruits)
ed by tannin rich foods (tea)
 ORAL IRON
IRON TABLETS
Adults & Adolescents - Mild 60 mg / day
- Moderate 120 mg / day
Infants & children 3mgs / kg / day
Pregnant women - 120 mg / day
Warn about BLACK COLORED STOOLS
Eliminate misconception of having BLACK
BABY
 PARENTERAL IRON
Indications :
Moderate & severe anemia
Non Compliance to oral iron
Undesired effects of oral iron
IM - 100 mg of iron in 2 ml of saline
IV - 500 Mg of iron in 10 ml of saline
 PREVENTION
HIGH RISK STRATEGY
DIET
Good sources of iron include liver, beef, wholemeal
bread, cereals, eggs and dried fruit.
CONSULT
Doctor immediately if there is loss of blood in the stools or
urine or persistently heavy periods.
A woman who is pregnant or planning to become pregnant
PERIODIC DEWORMING
Avoid walking barefoot
FOOD FORTIFICATION
 REFERENCES
Park’s textbook of Preventive and Social medicine
Harrisons principle of internal medicine
http://www.bawarchi.com/health/anaemia.html
http://www.netdoctor.co.uk/diseases/facts/anaemiairo
n.htm
http://hcd2.bupa.co.uk/fact_sheets/html/anaemia_iron
.html
Preventing & Controlling IDA through primary heath
care
Guidelines for use of FE Supplements ot prevent &
treat IDA