A RECENT statement by the WHO (World Health Organization) said that anaemia was the most common evidence of nutritional deficiency throughout the world. Anaemia isn’t a specific disease, but a symptom of a great many conditions that result from a reduction in the quantity of haemoglobin circulating in the blood. Haemoglobin is a pigment that carries the oxygen absorbed from the lungs around the body. It is the haemoglobin that gives blood its rich, red hue, and therefore con-tributes to the ruddy healthy complexion that is an accepted sign of good health in many parts of the world.

Anaemia can be caused by either a failure of the production of the red blood cells that carry the haemoglobin, by an increase in the rate of destruction of the red blood cells (for the red blood cells are constantly being replaced) or by bleeding. Often the bleeding is brisk and obvious, but sometimes it is insidious, as when there is a slowly bleeding gastro-intestinal ulcer or tumour. Even piles, which may bleed slowly, but continuously. can cause severe anaemia. Likewise in women a small increase in their monthly blood loss during a period, such as may be caused by a fibroid or two, may cause significant anaemia over months. Chronic disease or infection, including cancer, conditions such as rheumatoid arthritis or inflammatory bowel diseases, or infections like tuberculosis or HIV all result in anaemia. Kidney failure causes chronic anaemia. This is because a diseased kidney produces less erythropoietin – a hormone which is an essential regulator of the blood cell production system in the bone marrow.

The WHO’s report mainly focuses on anaemia as the result of nutritional deficiency. In no group of people is this more common than in children in the Third World, where protein is scarce. In the western world nutritionally-induced anaemia is not rare: a survey showed that ten to 15 per cent of women of reproductive age in the UK are anaemic. Most of these cases are the result of iron deficiency – and therefore from the lack of meat or other iron-carrying foods, coupled with the insidious iron loss as the result of bleeding during menstruation. An inadequate protein diet is frequently found among ethnic minorities who now live in the inner cities.

The best source of iron is red meat, offal such as liver or kidneys, or eggs. Other types of meat are also as good, if not quite so good, as steaks and chops. Unfortunately the type of iron found in leafy vegetables is not so well absorbed by the body as the iron derived from animal protein, but it is better than nothing. The green leafy vegetables so favoured by school dinner ladies, parents, the government health advisors and vegetarians have to become major sources or iron if meat is in short supply or doesn’t form part of the diet. There is also iron in cereals, lentils, chocolate, soya bean and raisins. Some more exotic foodstuffs such as oysters, avocado pears, peaches and mussels are also rich in iron.

The obvious way to treat iron deficiency-cy anaemia, anaemia resulting from a poor nutritional state or blood loss, is by giving iron supplements. The problems caused by this wholesale scattergun approach to the treatment of iron deficiency anaemia without a full analysis are threefold. If there is no true iron deficiency, the excess iron taken as the result of the supplements may hinder the absorption of calcium and zinc. This may result in excessive iron storage in the cells. In time this may give rise to a condition known as   aemosiderosis. Haemosiderosis may cause a complex form of liver or heart disease. The third problem is a more esoteric one, the importance of which has only recently been understood. Many people in the third world suffer from iron deficiency and as a result are prone to infection. The simple answer would be to hand out iron pills with antibiotics. This is a dangerous solution. In nature there is competition for the available iron – the bacteria or viruses, which are causing the infection, also are as greedy for the iron as are the human tissues of their host. Unfortunately, in the short term, the organisms harboured by the body are better equipped to make immediate use of iron than is the host. Consequently these possibly deadly organisms may be so boosted
by a dose of iron that they proliferate and the host develops an overwhelming infection and succumbs.

Iron is not the only nutritional deficiency that may result in anaemia. A short-age of some vitamins, especially vitamin B12 and folic acid, is essential for the efficient production of red blood cells. B12 is found in meat and dairy products and is stored in the liver once it has been eaten. If people have been eating a regular well- balanced diet, their livers will hold stores of B12 that will last for five years. Poverty in many parts of the world is such that famine, or near famine, has continued for more than five years and B12 deficiency may be a problem. Its absorption may also be affected by heavy alcohol intake or from a wide variety of intestinal diseases. Like-wise the production of the intrinsic factor by the stomach wall, which enables B12 to be absorbed, may be in short supply either from some genetic fault or an autoimmune disease, pernicious anaemia. Folic acid is also found in green vegetables, cereals and offal, particularly liver, but is not stored for long periods in the human body after absorption.

One form of anaemia that is common in many parts of the world, is the iron deficiency anaemia of infancy. Breast milk offers a better supply of iron than cow’s milk or baby formula milk. If babies are fed on the bottle, and are not given other iron-containing foods, many will be anaemic – likewise babies who have been weaned too early onto fruit juices or other sugary concoctions, so that the baby doesn’t have a balanced diet rich in different flavours and textures between the ages of six and ten months. These babies are also liable to suffer from malnutrition. In one-inner city hospital the two predominant groups in the malnutrition clinic are children from the intellectual muesli-eating classes and those of harried and poor immigrants. It is now possible to buy better balanced iron-fortified formulas, but these won’t be universally available due to financial considerations either in this country or in the developing world.

As well as the ten to 15 per cent of women of reproductive age who suffer from anaemia in the UK, four out of 100 non-menstruating women and one in 100 men have low iron levels.
 
In adults, the symptoms of anaemia are often initially so vague as not to be noticed. They may at this stage cause no more than a feeling of listlessness and general malaise. As the anaemia deepens the symptoms may become more obvious and the patient and those around them will notice tiredness, breathlessness, loss of energy, palpitations, and some-times strange cravings for unusual foods. Among these cravings is that for ice. It is remarkable to witness this in African children who have probably had a low protein diet for years and as a result have iron deficiency anaemia. They clamour as vigorously for ice cubes as western children beg for Smarties or jelly babies.

Persistent anaemia causes sores, sparse hair, brittle flattened nails, palour and general debility. There are many causes of haemolytic anaemia, the anaemias in which the blood cells are broken down too quickly. Other conditions may result in a plastic anaemia – a failure of the bone factory in bone marrow to keep its production lines flowing.

Two diseases associated with anaemia and found in many parts of the developing world and in the western world where there has been immigration, are thalassaemia and sickle cell anaemia. Both can have a savage effect on life expectancy, and need skilled treatment.