Anaemia

Overview of Anaemia

• Anaemia is a condition in which the number of red blood cells or the haemoglobin concentration within them is lower than normal.[2]
• Haemoglobin is needed to carry oxygen besides this, if you have too few or abnormal red blood cells, or not enough haemoglobin, there will be a decreased capacity of the blood to carry oxygen to the body’s tissues.[2]

Causes of Anaemia

Decreased or ineffective marrow production because i.e.,

• Lack of iron, vitamin B12 or folate
• Either Hypoplasia or myelodysplasia
• Invasion especially by malignant cells
• Renal failure
• Anaemia of chronic disease.[2]

Normal marrow production but increased removal of cells i.e.:

• Blood loss
• Haemolysis
• Hypersplenism.[2]

Risk factor of Anaemia

• Pregnancy
• Menorrhagia
• GI tract bleeding
• Dietary vegans
• Hook worm infection.[1]

Pathophysiology of Anaemia

Subnormal level of haemoglobin causes lowered oxygen carrying capacity of the blood.

This, in turn, initiates compensatory physiologic adaptations such as follows i.e.:

• Increased release of oxygen from haemoglobin
• Increased blood flow to the tissues
• Maintenance of the blood volume and
• At last, Redistribution of blood flow to maintain the cerebral blood supply.

Eventually, however, tissue hypoxia develops causing impaired functions of the affected tissues.

The degree of functional impairment of individual tissues is variable depending upon their oxygen requirements.

Tissues with high oxygen requirement such as the heart, CNS also the skeletal muscle during exercise bear the brunt of clinical effects of anaemia.[3]

Classification of Anaemia

Etiological

1. Blood loss – either acute or chronic post-haemorrhagic anaemia.
2. Impaired red cell formation:

a] Genetic disorders of haemoglobin synthesis: i.e. Thalassemia syndromes.

b] Acquired deficiency of substances essential for haemopoiesis

• Iron deficiency anaemia.
• Megaloblastic anaemia due to deficiency of vitamin B12, folic acid, vitamin C.
• Protein malnutrition.

3. Haemolytic anaemia due to red cell destruction.
4. Defect in stem cell/erythroid precursor

• Aplastic anaemia
• Pure red cell aplasia

5. Miscellaneous i.e.

• Anaemia of chronic disorders- Infection/inflammatory disorders, either kidney or hepatic failure.
• Drug-induced disorders of erythropoiesis.
• Infiltrative disorders of bone marrow – e.g. leukaemia, lymphoma, metastatic Ca, myelosclerosis.

According to Size of Red Cells and their Haemoglobin Content (Morphological)

• Microcytic, hypochromic
• Normocytic, normochromic
• Microcytic.[1]

Sign & Symptoms of Anaemia

SYMPTOMS:

In symptomatic cases of anaemia, the presenting features are i.e.:

• Tiredness
• Easy fatigability
• Generalized muscular weakness
• Lethargy and headache.

In older patients, there may be symptoms of i.e.

• Cardiac failure
• Angina pectoris
• Intermittent claudication
• Confusion
• Visual disturbances. [3]

SIGNS

• Pallor i.e.: Pallor is the most common also characteristic sign which may be seen in the mucous membranes, conjunctivae and skin.
• Cardiovascular system i.e.: A hyperdynamic circulation may be present with tachycardia, collapsing pulse, cardiomegaly, mid systolic flow murmur, dyspnoea on exertion, also in the case of older people, congestive heart failure.
• Central nervous system i.e.: The older patients may develop symptoms referable to the CNS such as attacks of faintness, giddiness, headache, tinnitus, drowsiness, numbness and tingling sensations of the hands and feet.
• Ocular manifestations i.e.: Generally, Retinal haemorrhages may occur if there is associated vascular disease or bleeding diathesis.
• Reproductive system i.e.: Menstrual disturbances such as amenorrhoea and menorrhagia and loss of libido are some of the manifestations involving the reproductive system in anaemia subjects.
• Renal system i.e.: Mild proteinuria and impaired concentrating capacity of the kidney may occur in severe anaemia.
• Lastly, Gastrointestinal system i.e.: Anorexia, flatulence, nausea, constipation and weight loss may occur.[3]

Physical Examination

Appearance of the Patient

• Pallor (pale skin, mucosal linings and nail beds) is often a useful diagnostic sign in moderate or severe anemia, but it is not always apparent. Commonly seen in nail bed, palm crease, also conjunctiva.

Physical Findings Associated with Specific Anemia

Iron deficiency anemia i.e.

• Cheilosis
• Koilonychia
• Glossitis

Secondary to Bleeding Iron Deficiency Anemia i.e.

• Melena
• Hematochezia
• Hematuria
• Hematemesis

Secondary to Malabsorption Iron Deficiency Anemia i.e.

• Dermatitis herpetiformis

Vitamin B12 Deficiency

• Chelitis
• Glossitis
• Decreased proprioception, and vibratory sensation

Hematological Malignancy (Leukemia, Lymphoma)

• Lymphadenopathy
• Splenomegaly
• Purpura
• Ecchymoses [8]

Investigation of Anaemia

• Complete blood counts (CBC) with reticulocyte count are the basic test.
• Haemoglobin estimation
• Peripheral blood film examination
• Red cell indices
• Leucocyte also platelet count
• Reticulocyte count
• Erythrocyte sedimentation rate
• Bon- marrow examination. [1]

Diagnosis of Anaemia

Severity of anaemia can be based on Hb levels i.e.:

Mild: Hb 9.1 -10.5 g/dl

Moderate: Hb 6-9 g/dl

Severe: Hb < 6 g/dl [3]

Differential Diagnosis of Anaemia

• Alpha Thalassemia
• Beta Thalassemia
• Low LDL Cholesterol (in other words, Hypobetalipoproteinemia)
• Megaloblastic Anemia
• Spur Cell Anemia

Treatment of Anaemia

• Correction of dietary deficiency i.e.: Especially, Faulty dietary habits, chronic alcoholism, malnourishment.

• Treatment of underlying cause i.e.: for instance Ankylostomiasis, piles, menorrhagia, infection, chronic kidney failure, leukaemia, liver disease, collagen disease or endocrine deficiency, surgical correction of intestinal abnormalities.

• Removal of toxic chemical agents or drugs: cases of either haemolytic anaemia or aplastic anaemia.
• Blood transfusion: Chief value is its immediate effect
• Administration of substances specifically lacking:

Principles are i.e.

(a) Firstly, Haematinic should be started only after adequate blood examination, since response to a haematinic may obscure the blood picture.

(b) Secondly, The specific haematinic should be given alone.

(c) Thirdly, The haematinic should be given in adequate doses for Prevention.[1]

Homeopathic Treatment of Anaemia

Homeopathy treats the person as a whole. It means that homeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homeopathic medicines selected after a full individualizing examination and case-analysis.

which includes

• The medical history of the patient,
• Physical and mental constitution,
• Family history,
• Presenting symptoms,
• Underlying pathology,
• Possible causative factors etc.

A miasmatic tendency (predisposition/susceptibility) also often taken into account for the treatment of chronic conditions.

What Homoeopathic doctors do?

A homeopathy doctor tries to treat more than just the presenting symptoms. The focus is usually on what caused the disease condition? Why ‘this patient’ is sick ‘this way’?.

The disease diagnosis is important but in homeopathy, the cause of disease not just probed to the level of bacteria and viruses. Other factors like mental, emotional and physical stress that could predispose a person to illness also looked for. No a days, even modern medicine also considers a large number of diseases as psychosomatic. The correct homeopathy remedy tries to correct this disease predisposition.

The focus is not on curing the disease but to cure the person who is sick, to restore the health. If a disease pathology not very advanced, homeopathy remedies do give a hope for cure but even in incurable cases, the quality of life can greatly improved with homeopathic medicines.

Homeopathic Medicines for Anaemia

The homeopathic remedies (medicines) given below indicate the therapeutic affinity but this is not a complete and definite guide to the homeopathy treatment of this condition. The symptoms listed against each homeopathic remedy may not be directly related to this disease because in homeopathy general symptoms and constitutional indications also taken into account for selecting a remedy.

Calcarea phos

• This remedy acts by supplying new blood cells.
• Pains and cramps dependent on anaemic conditions.
• Waxy appearance of the skin due to anaemia.
• Chlorosis, complexion waxy, greenish-white, with constant headache also ringing in ears.[4]
• Anemia after acute diseases or chronic wasting diseases.
• Trembling or trembling hands; either with pain or other complaints.
• Coldness or soreness in spots, vertex, eyeballs, tip of nose, fingers etc.
• Sensation of crawling and numbness; after bad news.
• Anaemic children who are peevish, flabby, have cold extremities and weak digestion; additionally, they start convulsively when lying on back whereas better lying on side.[5]

Ferrum Phos

• Follows Calcarea phos. as soon as improvement of the general health sets in.
• Moreover, There is a want of red blood in the system.
• This remedy, by its power of attracting oxygen, colors the new blood-cells red also enriches them after they have been supplied by Calcarea phos.[4]

Natrum mur

• Spinal anaemia, paralytic weakness of the lower extremities, with general prostration, heaviness and sensation of fatigue
• Especially after a short walk or ascending steps; legs give way, so as to be unable to progress further.[4]
• Emaciation; descending, either of neck or abdomen.
• Besides this, Mucus membrane and skin may be dry or may produce thick, white or clear, watery, acrid discharges. Dryness of mouth, throat, rectum, vagina etc.
• Numbness of one side; parts lain on; with paralysis; fingers, parts seem too short.
• Easy exhaustion.[5]

Kali phos

• Cerebral anaemia, anaemic conditions of the brain causing undue, nervousness.
• Poverty of the blood from influences which continually depress the mind also nervous system.[4]

Kali mur

• This remedy may have to be given in anaemia, similarly as a secondary remedy or intercurrent, if such symptoms as eczema or eruptions of the skin coexist.[4]

Sulphur

• Partially recovers after that relapses.
• Frequent flushes of heat.
• Uneasiness in blood.
• Very sensitive to open air: to droughts, worse for washing and bath.
• Takes cold, Oppression, burning, stitches, congestion in chest. Additionally, Heat crown of head with cold feet.
• Soles burn at night, must be put out of bed.
• Hungry-starving especially at 11 a.m.
• Drowsy by day, restless nights.
• Starts from frightful dreams.[5]

Diet & Regimen of Anaemia

• Jaggery also Prickly pear cactus juice.
• Furthermore, Cereal and millets products.
• Nuts and seeds – for example, hazelnuts, macadamia nuts, peanuts, walnuts, sesame seeds, sunflower seeds and pine nuts.
• Green leafy vegetables – for example, broccoli, spinach, watercress and kale.
• Beans and pulses – for example, baked beans, peas, lentils, chickpeas, black-eyed beans and kidney beans.
• Dried fruit – for example, raisins, apricots, prunes, currants and figs. [7]

Frequently Asked Questions

What is Anaemia?

Anaemia is a state in which the haemoglobin concentration falls below the accepted normal range depending on age also sex.

Homeopathic Medicines used by Homeopathic Doctors in treatment of Anaemia?

• Calcarea phos
• Ferrum Phos
• Natrum mur
• Kali phos
• Kali mur
• Sulphur

What are the causes of Anaemia?

• Lack of iron, vitamin B12 or folate
• Either Hypoplasia or myelodysplasia
• Invasion by malignant cells
• Renal failure
• Blood loss
• Haemolysis

What are the main symptoms of Anaemia?

• Tiredness
• Easy fatigability
• Generalized muscular weakness
• Lethargy and headache.
• Cardiac failure
• Angina pectoris
• Intermittent claudication
• Confusion

Give the types of Anaemia?

• Acute or chronic post-haemorrhagic anaemia
• Thalassemia syndromes
• Iron deficiency anaemia
• Megaloblastic anaemia
• Protein malnutrition
• Aplastic anaemia
• Pure red cell aplasia