ANAEMIA : its prevalence across age and gender group has increased. Aneamia has increased by 2-9% among children , Pregnant women and men according to data shared in the National Family health survey 5 (NFHS-5) released November 24, 2021
Anemia Free India Focuusing on 12 gm Haemoglobin for Children , Girls & Women : Dr Sharda Jain
3. ANAEMIA : its prevalence across age and
gender group has increased.
Aneamia has increased by 2-9% among
children ,
Pregnant women and men
according to data shared in the National
Family health survey 5 (NFHS-5)
released November 24, 2021
4. In rural India , 68.3%
children are Anaemic ,
while the urban India
its stands at 64.2 %
according to NFHS-5
5. The largest spike is seen in children
between the ages of
6months and 59 months,
they are now 67.1 % are Anaemic ,
as compared to
58.6% in NFHS – 4 conducted in
2015-2016.
In rural areas 68.3% children are
anaemic ,
while the urban load stands at 64.2
%
6. The Second highest increase is
recorded in adolescent girls
between the ages of 15 and 19th
,
up from 54% in 2015 -2016 to
59% in 2019-2021.
Here too , more young women
in rural areas (60.1 %) are
Aneamic as compared to urban
areas (56.5%)
7. All womenbetween the ages of
15 and 49 years reported a four % increase
in incidence of Anaemia ,
up from 53.1% in 2015 to 2016
to 57 % in 2019 - 2021
8. PREGNANCY : The % of
pregnant women between
the ages of 15 and 49 years
who are anemic
has increased to 52.2%
2019 – 21
from 50.4%in 2015 -2016
9. MEN , irrespective of age group , have reported the lowest
increase in the incidence anemia at 2.3 % for those
between the ages of 15 and 49 – up to 25% now from
22.7% in 2015 -2016 .
Among them , younger men , between 15 and 19, have
shown a 1.9% increase to 31% now from 29.2%
10. WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization;2015.
Anemia affects around 1 billion children and women globally
INDIA USP
:anaemia/Malnutrition
Level of public health
significance:
Severe
Anemia: A Global Burden
11. Work performance
Child development
School PerformanceIQ
Child mortality
Maternal mortality
Perinatal mortality
Other factors
A new conceptual model of IDA and its effects.
Tissue Iron
Deficiency (mild)
Moderate&
Severe
Anemia
12. DEFINITION OF ANAEMIA W.H.O.2000
Greek word – LACK OF BLOOD
• LEVELS : 12 GM % CHILD OF 2 YEARS ,GIRLS ,WOMEN
• USP : oxygen carrying capacity is by Hb molecule
13. DEFINITION OF ANAEMIA
Greek word – LACK OF BLOOD
• Decrease in no. of RBC’s, or
• Decrease in Hb, or
• Decrease in oxygen carrying capacity of Hb molecule
16. HB –CUT OFFS
• WHO recommendation (2001)
Hb concentration should not fall below 11.0g/dL (Hct < 33%) anytime
during pregnancy
*Mild 10-10.9g/dL * Moderate 7 - 9.9g/dL
*Severe <7g/dL * Very Severe <4g/dL
INDIAN DOCTORSshould aim at 12 gm in pregnancy too,in case to save
Life from PPH
17. Source: India Development and Participation by Jean Dreze and Amartya Sen, OUP 2002
ANAEMIA IN PREGNANCY - 2002
18. National Family Health survey 4 MoHFW 2021
Anemia in Women: Declined in most states from NFHS-3 to
NFHS-4,but still remains high
Anaemia among Children and Adults NFHS 4 (2015-16) NFHS 5(2)
Urban (%) Rural (%) Total (%) Total (%)
Non-pregnant women age 15-49 years
(<12.0 g/dl)
51.0 54.3 53.2 57.2
Pregnant women age 15-49 years
(<11.0 g/dl)
45.7 52.1 50.4 52..2
All women age 15-49 years 50.8 54.2 54.1 59.1
National Family Health Survey - 5 (2021) data
20. MAGNITUDE
• 52% of Indian pregnant women suffer from anemia
20 % maternal deaths contributed by anemia
• Iron deficiency anemia (IDA) commonest cause of anemia in pregnancy
Most Common deficiency state in the world
Preventable and correctable cause of anemia.
DR. SHARDA JAIN – AN ACTIVIST OF ANAEMIA FREE INDIA -
90% pregnant women were Anaemic (2000) 52% (2021)
22. 20% Direct , another 20% Indirect cause of maternal deaths
Nothing is more expensive than a missed opportunity! –TOTREAT
just bcz of our callous Attitude
UNCHANGED FOR 5 DECADES
28. Understanding Investigations
• Complete Blood Count with peripheral smear examination.
• Urine and stool routine examination
• Antenatal investigations as per protocol it is good to do digital
HB & counsel on Rx
before patients leaves
the clinic
30. Information from CBC Parameters
1. HB/PCV : Degree of anaemia. Correlates with patient’s symptoms.
HB : PCV ----- 1 : 3
2. MCV, MCH, Peripheral Smear: allow Morphological Classification of anemia, guide
workup and allow assessment of response to therapy
31. Peripheral smear: Shape, size, degree of pigmentation of cell types,
presence of
abnormal cells and blood parasites aid diagnosis of type of anemia
Reticulocyte count : An appropriate response (after correction) shows
appropriate erythropoietin release, a marrow capable of producing red
cell precursors, and sufficient iron stores.
33. CBC PARAMETERS IDA THALASSEMIA
RBC count < 5 million/ml >5 million /ml
RDW >14 <14
Mentzer’s Index >14 <14
MCV
MCH
MCHC NORMAL
34. Diagnosing of Iron Deficiency Anemia
Complete Blood Count:
MCV & RDW :IDA is characterised by Low MCV, Low MCH but up to 40% of pregnant women with
true IDA have normocytic indices
A combination of low MCV accompanied by elevated RDW can be used as a sufficient evidence to
start iron therapy
RDW – decreased in Thalassemia
Serum iron and TIBC : Unreliable markers
Serum iron shows diurnal variation and is affected by dietary influences
Pregnancy itself increases total iron binding capacity (TIBC) even in the absence of IDA
RDW –Red cell distribution width, MCV-Mean corpuscular volume, MCH-Mean Corpuscular Hemoglobin, TIBC – Total Iron Binding Capacity
Indian J Hematol Blood Transfus. 2018:1-2.
35. NOT ROUTINELY RECOMMENDED
• SERUM IRON / B12 / Folate
• TIBC
• % TRANSFERRIN SATURATION
Only when serum Ferritin is normal but clinical and morphological picture
strongly suggestive of Iron Deficiency Anaemia
36. EXPERTS are focusing on
B12 Defiency recently
in so called Refractory cases
37. Serum Ferritin < 15 + Other deficiencies noted
Vit B12 < 200
Folic acid < 4
Consider parenteral Iron therapy and add
Inj vit B12 1000 µg IM and
Tab 1000 µg BD
±
Tab Folic acid 5 mg OD
38. Consider parenteral Iron therapy
If no improvment &
Serum Ferritin > 15 + Other deficiencies is noted
Vit B12 < 200
Folic acid < 4
Hb < 10 g%
Add Inj vit B12 1000 µg IM and Tab 1000 µg BD
± Tab Folic acid 5 mg OD
Continue oral iron therapy for 3 mths
Repeat Hb as per protocol
43. Hb ≥ 11 g%
Hb < 11 g%
CBC *, **
Prophylactic IFA
(60 mg+0.5 mg) 1 tab OD
* MCV< 80 MCH< 27
Mentzer index < 13 (MCV/RBC count)
do HPLC to R/O Thalassemia
** MCV> 100 do serum Vit B12 and
folic acid add supplements accordingly
Start therapeutic IFA
(60 mg+0.5 mg) 1 tab BD with
counselling on how to take iron
and calcium tabs
Dietary counselling
Investigate
CBC with PS
If Hb< 10 g/dl Serum Ferritin, Vit
B12, Folic acid (if available)
Repeat Hb after 1 month
Hb improves by
≥ 1 g/dl
Hb < 1 g/dl or
no increase
Continue oral
iron therapy and
repeat Hb after
1 month
Serum Ferritin < 15
Microcytic
hypochromic
Mentzer index > 13
Hb ≥ 11 g%
Consider parenteral
Iron therapy Iron
sucrose/ FCM
Serum Ferritin < 15
Other deficiencies
Vit B12 < 200
Folic acid < 4
Add Inj vit B12 1000 µg
IM and Tab 1000 µg BD ±
Tab Folic acid 5 mg OD
Serum Ferritin > 15
Other deficiencies
Vit B12 < 200
Folic acid < 4
Consider parenteral Iron
therapy and add Inj vit B12
1000 µg IM and Tab 1000 µg
BD ± Tab Folic acid 5 mg OD
Hb ≥ 11 g%
Continue oral iron
therapy for 3 mths.
Repeat Hb as per
protocol
Repeat Hb after
4 weeks
Continue oral iron
therapy for 3 mths.
Repeat Hb as per
protocol
Hb estimation at registration, 28-30 wks. and 36 wks. of pregnancy
45. DOCTORS in GOVT Sector Must emphasize that
GOI Supply of Iron is NO INFERIOR to market tab.
46. WHICH IRON confuses Doctors
in Private Practice -as market is
flooded with >300 preparations
EXPERTS
Must settle this confusion
too
47. 47
Absorption from Ferrous Ascorbate can be as high
as 67% in Iron deficiency anemia patients
Key:
iron-depleted stores (IDS),
normal Fe status (NIS),
Fe deficiency without anemia (IDWA),
Fe deficiency anemia (IDA)
Biol Trace Elem Res. 2013 Dec;155(3):322-6. doi: 10.1007/s12011-013-9797-2. Epub 2013 Aug 27.
49. 49
Study On Ferrous Ascorbate - PRIDE Study
Significantly more patients became non-anemic by treatment with ferrous ascorbate (93.33%) than with
carbonyl iron (46.66%).
Ferrous ascorbate replenished ferritin stores to a greater extent than carbonyl iron.
Hb increase of 5 g/dl vs. 2.8 g/dl in 60 days
IJOG 2005; 8(4):23-30
50. Study On Ferrous Ascorbate - PRIDE Study
50
Rapid rise in Hb % by 5.03 within 60 days
IJOG 2005; 8(4):23-30
51. 51
Study on Ferrous Ascorbate – HERS Trial
N = 1461
The results show that at a dose of 1 tablet daily was effective in treating anemia, with rapid
increase in hemoglobin (mean: 2.37 g/ dl; 95%C.I.: 2.25 - 2.49) within 45 days, and was well
tolerated. The maximum increase of 3.60g/dl (95%C.I.: 3.07-4.13) was observed in those
with baseline hemoglobin less than 6g/dl.
Max 3.6 g/dl rise in 45 days
HERS study Group. IJGO 2005
53. Right Ratio For More Benefits
Right Ratio Of Iron And Ascorbic Acid Is Necessary To Form Stable Ferrous Ascorbate Complex Yielding
High Efficacy And Favourable Tolerability
61. •Anthelminthic medication in pregnant women with
anaemia after 12 weeks of pregnancy
•Drug of choice is single dose Mebendazole 100mg BD
for 3 days
OR Albendazole 400mg
WHO
