Anaemia is a clinical condition characterized by a reduction in the haemoglobin (Hb) concentration of blood below normal for age, sex and physiological status, resulting in reduced oxygen-carrying capacity of the blood.

It is one of the most common public-health problems worldwide and a major contributor to:

• impaired growth

• reduced cognitive development

• poor pregnancy outcomes

• reduced work capacity

• increased susceptibility to infection

In many low- and middle-income countries, anaemia is primarily a nutritional disorder, but infectious and chronic diseases also contribute significantly.

2. Nutritional Disorders and Public Health Context

Nutrition disorders arise from:

• insufficient intake of nutrients

• impaired absorption

• defective utilization

• excessive intake

Major nutrition-related disorders commonly encountered:

Children are especially vulnerable because nutritional deficiency interferes with:

• brain development

• immunity

• growth velocity

3. Definition of Anaemia

Anaemia is defined as:

Clinically suspected when pallor is present:

• conjunctival pallor

• palmar pallor

• nail bed pallor

• mucosal pallor

4. Causes of Anaemia

A. Nutritional Causes (Most Common)

B. Blood Loss

• Intestinal parasites (hookworm)

• Peptic ulcer disease

• Malignancy

• Heavy menstruation

• Trauma

• Chronic haemorrhage

C. Chronic Diseases

• HIV infection

• Tuberculosis

• Chronic kidney disease

• Chronic inflammatory disorders

• Malignancies

D. Bone Marrow Disorders

• Aplastic anaemia

• Leukaemia

• Marrow infiltration

E. Increased Red Cell Destruction (Haemolysis)

• Malaria

• Sickle cell disease

• G6PD deficiency

• Autoimmune haemolysis

F. Abnormal Haemoglobin

• Thalassemia

• Sickle cell disease

5. Risk Factors

Children

• Poor diet after weaning

• Exclusive milk feeding >6 months

• Prematurity

• Worm infestation

• Malaria endemic areas

Women

• Pregnancy

• Heavy menstruation

• Short birth spacing

General

• Poverty

• Chronic infections

• Poor sanitation

• Malabsorption disorders

6. Signs and Symptoms

General Symptoms

• Fatigue

• Weakness

• Dizziness

• Shortness of breath

• Palpitations

• Poor concentration

Physical Signs

Severe Anaemia (Emergency)

• Heart failure

• Altered consciousness

• Shock

• Respiratory distress

7. Diagnostic Criteria

Haemoglobin Thresholds

8. Classification by RBC Size (MCV)

9. Investigations

First-Line Tests

• Full blood count (FBC)

• Peripheral blood smear

• Reticulocyte count

Additional Tests (Based on suspicion)

10. Management

A. Non-Pharmacological Management

• Nutrition counselling

• Deworming

• Malaria prevention

• Treat infections

• Improve sanitation

• Blood transfusion (if severe and unstable)

B. Pharmacological Treatment

i. Iron Deficiency Anaemia

Oral Iron Therapy

Ferrous sulfate providing:

• Children: 3 mg/kg elemental iron/day

• Adults: 120–200 mg elemental iron/day

Duration:

Add:

• Vitamin C improves absorption

Avoid:

• Tea, coffee, milk with iron

ii. Folate Deficiency

Folic acid:

• Children: 2.5–5 mg daily

• Adults: 5 mg daily for 4 months

iii. Vitamin B12 Deficiency

Hydroxocobalamin:

• 1000 mcg IM weekly × 6 weeks

• Then monthly maintenance

iv. Severe Anaemia

Indications for transfusion:

• Hb <4 g/dL

• Hb <6 g/dL with symptoms

• Heart failure

• Shock

v. Treat Underlying Causes

11. Prevention

Nutritional Measures

• Iron-rich diet (meat, liver, legumes, green vegetables)

• Vitamin C intake

• Avoid excessive tea/coffee in children

Public Health Measures

• Iron supplementation in pregnancy

• Deworming programs

• Malaria control

• Food fortification

• Growth monitoring

12. Complications

Untreated anaemia leads to:

• Heart failure

• Developmental delay

• Poor pregnancy outcome

• Increased infections

• Maternal mortality

13. Prognosis

Key Clinical Message