Counselling A Case Of Anaemia In A Phc

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