GENERAL SEMINAR ON

NUTRITIONAL ANEMIA, ITS EFFECT ON WOMEN’S HEALTH AND HOMOEOPATHIC

MANAGEMENT.

PRESENTED BY
DR. PRAGYA JOSHI
22ND BATCH PGT

UNDER THE GUIDANCE OF

DR. USHA GHELANI UCHAT, M.D. (HOM)
PROFESSOR
HEAD OF THE DEPARTMENT
DEPT. OF HOMOEOPATHIC MATERIA MEDICA
AND
DR. PRATIMA PAL, M.D.(HOM)
ASSISTANT PROFESSOR
DEPT. OF HOMOEOPATHIC MATERIA MEDICA
DATE : 07-10-2022
TIME : 3:00 PM
NATIONAL INSTITUITE OF HOMOEOPATHY
BLOCK-GE, SEC-III, SALTLAKE, KOLKATA
 PREVIEW

• PART-I : NUTRITIONAL ANAEMIA

• PART-II : EFFECT ON WOMEN’S HEALTH

• PART-III : HOMOEOPATHIC MANAGEMENT

 NUTRITIONAL ANEMIA AS A PROBLEM1,2
• Major global public health problem affecting about a
quarter of world’s population.
• In India, 33-89% of pregnant females, and more than 60%
adolescent girls suffer from anemia.
• Iron deficiency remains the major cause of anemia.
• Anemia affects health, education, economy and
productivity of entire nation constituting a public health
epidemic.
• It causes ill health, premature death and lost earnings.
• Fortunately, large portion of it is preventable with
appropriate and timely intervention.
 ANEMIA3,4

• Anemia is defined as reduction in the concentration of

circulating Hb or oxygen carrying capacity of blood below the
level that is expected for healthy persons of same age and sex
in the same environment.

• A decrease in circulating RBCs can be related to either

inadequate production of RBCs or increased RBC
destruction or loss.
 Normal levels of Hemoglobin3

Age/ Sex Hemoglobin (Gm/dl)

Adult males 13-17
Adult females (Non pregnant) 12-15
Adult females (pregnant) 11-14
Children (6-12 years) 11.5-15.5
Children (6 months to 6 years) 11-14
Infants (2-6 months) 9.5-14
Newborns 13.6-19.6
 ANEMIA3,5
• Grading of Anemia

Mild Hb from lower limit of normal to 10.0 gm/dl

Moderate 10.0- 7 gm/dl
Severe < 7.0 gm/dl

Grading of pallor
Mild Pallor in conjunctiva and mucous membrane

Moderate Pallor of skin

Severe Pallor of palmar creases

ANEMIA
 ANEMIA 3
• Rule of 3
 Cell count in millions/cmm x 3 = Hb in gm/dl
 Hemoglobin in gm/dl x 3 = PCV in %
 Applies to only normocytic normochromic specimens.
Eg:
 RBC count - 4 million/cmm
Hb - 4x3= 12gm/dl
PCV - 12x3= 36%
 COMMON CAUSES IN INDIA3
• Nutritional Deficiency : Iron, Folate, B12
• Infections : Tuberculosis, Malaria, Kala Azar, HIV/
AIDS, Hookworm
• Inherited Anemias : Thalassemia, Sickle cell
disorders, G6PD dehydrogenase deficiency.
• Blood loss : Obstetrical problems
PART-I : NUTRITIONAL ANAEMIA
 NUTRITIONAL ANEMIA6

 The term “nutritional anemia” encompasses all the

pathological conditions in which the blood Hb concentration
drops to an abnormally low level, due to deficiency in one or
several nutrients.
 The main nutrients involved in the synthesis of Hb are iron,
vit B12 and folate.
The term ‘nutritional anemia’ encompasses all pathological
conditions in which the blood hemoglobin concentration drops to an
abnormally low level, due to a deficiency in one or several nutrients.
The main nutrients involved in the synthesis of hemoglobin are iron,
folic acid, and vitamin B12. I
The term ‘nutritional anemia’ encompasses all pathological
 TYPES OF NUTRITIONAL ANEMIA6
• Iron deficiency anemia
• Megaloblastic anemia
 Deficiency of folic acid
 Deficiency of Vit B12
• Deficiency of other essential elements such as vit A,vit C,
copper, zinc.
 IRON DEFICIENCY ANEMIA(IDA)3
• Iron deficiency is a state of low total body iron content.
• It develops when body iron stores are depleted.
• Level of circulating iron is reduced.
• Insufficient iron available for erythropoiesis.
 CAUSES OF IDA5
• Reduced intake
 Severe diets and vegetarianism, otherwise rare
• Reduced absorption
 Achlorhydria
 Long lasting antacid treatment
 Excessive consumption of tea or coffee
 Gastritis with H. pylori.
 Inflammatory diseases of small intestine.
 CAUSES OF IDA5
• Increased need
 Pregnancy
 Twins
 Developmental periods during puberty.
• Loss of iron
 Blood loss, GI bleeding in men and menstrual bleeding
in women.
 CLINICAL FEATURES 2
Symptoms caused Symptoms caused Symptoms and signs
by tissue hypoxia by heart or lung due to iron deficiency
adaptation to
hypoxia

• Pallor • Tachycardia • Dysphagia

• Fatigue • Tachypnoea • Plummer-vinson
• General • Dyspnoea syndrome
weakness • Angina pectoris • Nail changes,
• Headache koilonychia
• Vertigo • Friable hair
• Tinnitus • Stomatitis
• Intermittent
claudication
• Poor appetite
 DIAGNOSIS OF IDA 3,2
Peripheral Blood Iron Reserves Bone Marrow
• Low serum ferritin • Micro normoblast
• Low Hb levels • Low serum iron • Absence of
• Low RBC level • low transferrin stainable iron on
• Low MCV, MCH, saturation’ Perl's Prussian
MCHC • Increased TIBC blue reaction.
• Reticulocyte count (specific and
is normal or slightly reliable)
elevated
• Anulocytes in
blood smear
 DIAGNOSIS OF IDA 2

In clinical practice, Low Hb%

Low transferrin saturation<15%
Low serum ferritin <30mcg/dl
High total binding
capacity>13.1mcgmol/dl
 EVALUATION OF ANEMIA3
MICROCYTIC
HYPOCHROMIC

Serum ferritin

Low High

Iron Deficiency Hb electrophoresis

anemia

Normal Abnormal

Anemia of chronic disease

Thalassemia
or sideroblastic
 IRON RICH FOOD
• Green Vegetables And Fruits
• Grains-wheat, Jowar, Bajra,
• Sprouted Pulses
• Ground Nut
• Sesame
• Jaggery
• Dried Fruits
• Egg, Fish, Meat
• Citrus Fruits (Oranges, Lemon), Indian Gooseberry
(Amla), Apple, Pear Are Rich In Vitamin C.
IRON RICH FOOD

22
 OTHER ESSENTIAL ELEMENTS6
• Copper
 An essential trace element participate in heme synthesis through the
action of cytochrome oxidase.
• Cobalt
 Essential for the formation of vit b12.
 vit b12 is an organometallic compound with cobalt atom in the centre.
• Vitamin C
 Helps in easy absorption of iron.
 Vit C prevents the formation of insoluble iron salts.
• Zinc
 Plays key role in intestinal iron absorption and tissue iron distribution
23
 ROLE OF COPPER6

Decreased absorption of iron.

Defective mobilization from stores, to protophyrin

ix

Decreased plasma erythropoietin levels

Shortened life span due to increased oxidative

stress.
24
 ROLE OF ZINC6

Decreased erythrocyte precursors.

Decreased plasma erythropoietin levels.

Shortened life span due to oxidative stress and

abnormal membrane function.

25
MEGALOBLASTIC ANEMIA

26
 MEGALOBLASTIC ANEMIA7
 Abnormal maturation of haemopoietic cells due to
impaired DNA synthesis leading to anemia.
 Caused by deficiency of vit B12 or folate (B9).
 Characterized by macro-ovalocytic red cells and bone
marrow showing intense erythroid hyperplasia and
megaloblastic changes.
 Termed ‘Megaloblastic Maturation’, are hallmark of
cobalamin and folate deficiency.
 MEGALOBLASTIC ANEMIA5

Impaired DNA production due to death of

deoxyribonucleotides

Imbalance between nuclear and cytoplasmic maturation in

developing haemopoetic cells

Megaloblastic maturation of late erythroid cells with open

chromatin

Destruction within the bone marrow leading to low

reticulocyte count in peripheral blood.
 CAUSES OF MEGALOBLASTIC ANEMIA5
COBALAMIN FOLATE
Decreased • Dietary intake (rare) • Dietary intake
Intake • Common in infants • Alcohol
Impaired • Deficiency of intrinsic • Tropical sprue
Absorption factor (Pernicious • Coeliac disease
anaemia)
• Structural defects in GI
tracts.
• Inflammatory disease like
Crohn's disease, coeliac
disease.

Increased Pregnancy Twins • Pregnancy

Requirement Developmental periods • Chronic exfoliative
during puberty dermatitis
• Anticonvulsant drugs
 COBALAMIN DEFICIENCY5,7
• Physical examination
 Pallor
 Jaundice
 Mild splenomegaly
 Rapid bounding pulse
 Flow murmur
 Optic atrophy (less common)
 Retinal hemorrhage (less common)
 Glossitis (enlarged smooth shiny tongue, loss of
papillae)
Diffuse hyperpigmented knuckles.
 COBALAMIN DEFICIENCY
Glossitis

31
 COBALAMIN DEFICIENCY5,7
• Neuro-cognitive defects
 Neurological disturbances in conjunction with anemia.
 Distinguishes this from folate deficiency.
• Cognitive
 Defects in memory
 Inability of concentrate
 Irritable
 Emotionally labile
 Loose association between their train of thoughts
 COBALAMIN DEFICIENCY5,7
• Neurological
 Numbness and paresthesia in feet and fingers
 Diminished proprioception
 Loss of vibration in toes
 Can not perform heel to toe walking
 Hyperactive reflexes
 Unsteady gait due to spastic ataxia
 FOLATE DEFICIENCY5
• Clinical Features
 Folate deficiency parallels with Vit B12 deficiency.
 Most striking difference is lack of neurological
symptoms
 Angular stomatitis
 Glossitis (occurs more commonly in folate than
cobalamin)
 DIAGNOSIS5
• Peripheral blood changes in megaloblastic anemia

Macro-ovalocytes
Howell jolly bodies
RBC
Coarse basophilic stiplings
Megaloblastic nucleated

Hyper segmented Neutrophils

6 or more lobes
Neutrophils
Giant Neutrophils

Platelets Giant platelets

 DIAGNOSIS5
• Cobalamin
 Low serum cyanocobalamin (200ng/L -600ng/L)
 Plasma methylmalonic acid (increased)
 Plasma total homocysteine (increased)
• Folate
 Low levels of folate in serum or in red cells.
 Elevated total serum homocysteine levels.(as it converts
homocysteine to methionine)
 Unreliable in renal insufficiency as kidney clears these.
 EVALUATION OF ANEMIA3
MACROCYTIC
(MCV>100FL)

Reticulocyte
Increased Normal or low
count

Hemolytic anemia H/O liver ds, drugs,

Acute blood loss hypothyroidism

No yes

Bone marrow examination

Normoblastic Megalo- Myelo- Hypo

blastic dysplasia cellular
VIT B12 RICH FOOD
FOLATE RICH FOOD
EFFECT ON WOMEN’S HEALTH
 ANAEMIA IN ADOLESCENT GIRLS8
• Risk Factors
 Underweight and malnourished girls.
 Low dietary intake and increased demands due to
growth spurt.
 Heavy menstrual loss (>80ml)
 Poor hand hygiene and worm infestation.
 Culture of early marriage and adolescent pregnancy
further reduces the iron and folic acid in the body.
 ANAEMIA IN ADOLESCENT GIRLS7,8
• Long term effects
 Stunted growth
 Poor school performance, reduced attention span,
memory loss and increased drop out rate from schools.
 Reduced immunity and increased infection rate
 Delay in onset of menarche.
 Menstrual irregularities.
 ANAEMIA IN ADOLESCENT GIRLS8
• Preventive measures
 Dietary education and nutritional counselling
 Screening of all adolescent girls through routine health
check ups
 Screening of high risk groups ( heaving menstrual
bleeding, worm infestation etc)
 Iron and folic acid supplementation
 Biannual deworming
• Adolescent anemia control programme.
 ANAEMIA IN PREGNANCY9
• Anemia during pregnancy is defined as Hb levels less than
11g/dl of blood.
• Due to physiological hemodilution, Hb levels vary on each
trimester which use to diagnose anemia
 <10.5g/dl during 2nd and 3rd trimester
 <10g/dl in post partum
 ANAEMIA IN PREGNANCY9
Causes
• Iron deficiency (commonest) (approx. 50% of the cases)
• Folate deficiency (2nd commonest)
• Acute or chronic infections, malaria, HIV etc
• Malignancies
• Hb synthesis disorders
 OBSTETRIC OUTCOMES : ANEMIA9

Maternal
• Lower immunity
• Tiredness
• Lethargy
• Poor concentration and
work performance
• Post partum depression
• Post partum hemorrhage
• Spinal and peripheral
nerve involvement with vit.
B12 deficiency
Foetal
• Impaired psychomotor and /or
mental development
• Low birth weight
• Preterm birth
• Placental abruption
• Neural tube defects with B12
and Folate deficiency.
 PREVENTION : DURING PREGNANCY9
• Oral
 Every pregnant woman should be screened.
 In high risk areas, daily supplement 60mg elemental
iron+400mg of folic acid.
 In case of deficiency, 100-200 mg daily.
 A Prophylactic dose of 400mcg preconceptual.
 Folate supplements.
• Parenteral
 For women with poor compliance, malabsorption, non
tolerance of oral iron.
• Blood transfusion
 Obstetric hemorrhage
 IRON SUPPLEMENTATION1,5

• Oral
• Side effects like abdominal cramping, bloating and
constipation are very common due to unabsorbed iron in the
gut.
• 3 types of oral iron
 Iron salts: ferrous sulphate< ferrous gluconate <
ferrous fumarate
 Polysacchride iron complex: better tolerated than iron
salts
 Carbonyl iron : well tolerated even in large doses.
 EFFECTS IN ELDERLY WOMEN3,10
• Most common causes of anemia in elderly woman are
• Iron deficiency
 Malabsorption
 Malignancies
 Chronic diseases
 Gastro intestinal loss
 Nutritional deficiencies
• Cobalamin deficiency
 Food cobalamin malabsorption
 Dietary insufficiency
 Pernicious anemia
 Malabsorption
 Hereditary causes
 EFFECTS IN ELDERLY WOMEN5,10
• Anemia in elderly woman has been associated with
 Increased risk of falls as a result fractures
 Cognitive decline which is one of the most important
factor for disability
 Decreased physical function
 Cardiovascular complications
 Neurologic complications
 Dementia
 Depression
 Frequent hospitalization
Often associated with some underlying pathological state.
HOMOEOPATHIC MANAGEMENT
 APHORISM11
Aphorism 77
Those diseases are inappropriately named chronic, which
persons incur who expose themselves continually to avoidable
noxious influences, who are in the habit of indulging in injurious
liquors or aliments, are addicted to dissipation of many kinds
which undermine the health, who undergo prolonged
abstinence from things that are necessary for the support of
life, who reside in unhealthy localities, especially marshy
districts, who are housed in cellars or other confined dwellings,
who are deprived of exercise or of open air, who ruin their health
by overexertion of body or mind, who live in a constant state of
worry, etc. These states of ill-health, which persons bring upon
themselves, disappear spontaneously, provided no chronic
miasm lurks in the body, under an improved mode of living, and
they cannot be called chronic diseases.
 H.A ROBERT’S VIEW12

Psora, and the Deficiency in properly balanced essentials, are one

and the same; or if they are not identical problems, we must admit
that here lies a significant key to the problem of psora, and one
worthy of deeper study.

- H. A Roberts.
 KENT’S REPERTORY13

•Generalities, Anemia
(1st grade)
• Borax, Ars Alb, calc, calc phos, china, ferrum met, ferrum
ars, graph, Hell, kali Ars, kali c, kali p, mang, medo, merc, nat
mur, nit ac, phos, plb, puls, sqil, staph, sulph, sul ac.
 PHATAK’S REPERTORY14

Anemia
• 1st- ars, calc, china, ferr, nat mur, sulph
• 2nd- calc-p, graph, kali c, nit ac, nux v, phos, puls
• 3rd- fer ar, lac d, lyc, mang, medo, nat c, pic ac, plat, plb,
senec, sep, sul ac
 ROBIN MURPHY’S REPERTORY15
• CLINICAL, anemia, iron deficiency anemia(only 1st)
 1st- ars, bell, calc, calc p, carbn-s, cocc, ferr, ferr ars,
ferr m , ferr p, graph, lyco, mang, nat m, nit ac, phos,
plat, puls, senec, sep, sulph
• CLINICAL, anemia ,Nursing mothers in
 2nd- ferr-p
 3rd- acet ac, alf, calc p, lec
• CLINICAL, anemia, young girls in,-
 3rd- stroph
• CLINICAL, anemia, nutritional imbalance from,
 1st- ferr-p
 2nd- ferr, calc p, thyr
 3rd- acet ac, alf, alet, alum, chin, helon, nux v
 QUICK RECAP : ALLEN’S KEYNOTES16
• Anaemia  Phosphorus
 Helonius dioica  Psorinum
 Aletris farinosa  Natrum carb
 Crotalus horridus  Natrum mur
 Picric acid  Spigelia
 Plumbum met  Calcarea carb
 Pulsatilla  Phytolacca
 Calcarea phos  Thalapsi bursa pastoris
 Cyclamen • Defective nutrition
 Ferrum met  Calcarea carb
 Cinchona  Lac def
 Kali carb  Silicea
 Phosphoric acid  petroselinum
 INDICATIONS : SOME OTHER REMEDIES
• Manganum Aceticum17
 It acts upon the red globules and plasma of the blood,
destroying their vitality and thereby causing anemia,
nervous affections due to impoverishment of the blood.
 Used in chlorosis, if gastric disturbances and loss of
appetite predominate.
 Menses too early and too scanty in anemic females;
much bearing down pain. Flushes of heat at climacteric.
 INDICATIONS : SOME OTHER REMEDIES
• Thyroidinum18
 It produces anemia, emaciation, muscular weakness,
sweating, headache, nervous tremor of face and limbs,
tingling sensations and paralysis.
 Acts better with pale patients, than those of high color.
 Easy fatigue, weak pulse, tendency to fainting, palpitations,
cold hands and feet, low blood pressure, and sensitive to
cold.
 INDICATIONS : SOME OTHER REMEDIES18,19
• Lecithinum
 lecithinum has a favorable influence upon the blood,
hence it is used in anemia, convalescence, neurasthenia
and insomnia.
 It increases the number of red blood corpuscles and
amount of hemoglobin.
 Loss of appetite, thirsty, craves wine and coffee.
• Vanadium
 Increases amount of hemoglobin, also combines its
oxygen with toxins and destroys their virulence.
 An oxidant stimulating organic combustion and restoring
health, appetite, strength and weight.
 Anxious pressure in the whole chest.
 INDICATIONS : SOME OTHER REMEDIES18,19
• Aletris Farinosa
 It is generally indicated in anemic patient, esp. in females
suffering from protracted ailments or defective nutrition.
 Great debility is characteristic of this remedy.
 Patient suffers from prolapsus, leucorrhoea, debility and
rectal discomfort.
 Premature and profuse menses with labor like pains.
• Alfalfa
 Favorably influences nutrition, “toning up’ of appetite and
digestion.
 Highly efficacious in anemia and chlorosis, marasmus,
deficient development and all conditions characterized by tissue
waste.
 INDICATIONS : SOME OTHER REMEDIES18,19
• Strophanthus Hispidus
 Anemia with palpitation and breathlessness
 Menorrhagia; uterine hemorrhage, uterus heavily
congested.
 Pulse quickened, heart’s action weak, rapid irregular
due to muscular debility, and insufficiency.

• Kali Hyppophosphoricum
 Debility with wasting of muscular tissue.
 Phosphaturia with general anemia and leucocythemia.
 Effects of excessive tea drinking
 FERRUM17

“The treatment of anemia by Iron is one of the few

satisfactory and certain things in modern medicine. From
whatever cause this condition may arise, whether it be the
chlorosis of defective menstruation, or the simple poverty
of blood induced by hemorrhages. Deficiency of air, light,
and suitable food, or by exhausting diseases,- Iron is the
one great remedy.”

- R. Hughes
 FERRUM18,19
Ferrum metallicum
 Pallor of skin, mucous membranes, face alternating with
flushes.
 Pseudo plethora; fiery red and flushed from the least pain,
emotion, or exertion.
 Red parts become white, bloodless and puffy.
 Women who are weak, delicate, chlorotic, yet have a fiery
red face.
 FERRUM18,19
Ferrum phosphoricum
 Hemorrhagic diathesis; pale anemic subjects, who, in spite
of want of blood and exhaustion, are subject to sudden
gushes of bleeding.
 Night sweats of anemia
Ferrum arsenicosum
 Simple and pernicious anaemia; chlorosis
 Enlarged liver and spleen with fever; leinteria; albuminuria.

65
ARTICLE20
ARTICLE1
 NNACP21
National nutritional anemia control programme
(NNACP)
• Aim
 Decreasing the prevalence and incidence of anemia in
women of reproductive age.
• 3 vital strategies
 Promotion of regular consumption of foods rich in Iron.
 Iron and folate supplements to high risk groups
 Identification and treatment of severely anemic cases.
 RECOMMENDED DOSE : NNACP21

one tab- 100mg one tab – 20mg In cases of severe

iron +500mg folic iron + 100mg folic anemia, women of
acid acid reproductive age

pregnant woman Ages 1-5 should should take 3 tabs per

1 tab/day for 100 take one tablet for day for a minimum of
days after 1st 100 days per year 100 days.
trimester
Similar dose for
lactating and IUD
acceptors
ANEMIA MUKT BHARAT22
 WIFS
Weekly iron and folic acid supplementation
• Under national health mission (NHM)
• Target population
 adolescent girls and boys
• Intervention
Weekly iron and FA supplementation
Biannual deworming
Screening of target groups
Information and counselling.

71
The want of proper proportion of iron in the blood can not be
rectified by the addition of extra iron in the shape of food or
medicine. The source of the trouble lies in the defective
assimilation- in other words, to the incompatibility of the vital
force in adopting itself to the changing environments.
Homoeopathy takes the fuller view of the situation and aims at
putting things right at the source, rather than interfere or
meddle, in a process known only to the force within the
individual concerned.
This is done by strict adherence to the principle of “similia
similibus curantar”.
-Dr N. M Chaudhary
 CONCLUSION
• Anemia not only affects an individual’s health but health,
education and economy of entire Nation. Fortunately major
part of it is easily preventable through proper diet and food
fortification. If it fails to yield even with proper food and
supplementation, then any underlying pathology should be
ruled out. If it is only due to dietary insufficiencies, it can be
treated with proper nutrition but in cases where there is lack of
absorption, Homoeopathy has a critical role to play, medicine
selected based on totality of symptoms not only corrects the
anemia but also removes the underlying disease.
 References
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management of Iron Deficiency anemia in the reproductive age women. Journal of medical
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 References
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Jain publishers. 2007.
 References
20) Mittal R, Khurana A, Rath P, Moorthy K, Taneja D, Singh U et al. Ferrum phosphoricum
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2020;14(3):171-178
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