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| EDITORIAL |
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| Year : 2022 | Volume
: 4
| Issue : 1 | Page : 1-3 |
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Anemia... An unwanted gift to women...
Arati Mahishale1, Santosh Metgud2
1 Department of OBG Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India
2 Department of Orthopaedic Manual Therapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka, India
| Date of Submission | 16-Jun-2022 |
| Date of Decision | 28-Jun-2022 |
| Date of Acceptance | 04-Jul-2022 |
| Date of Web Publication | 30-Jul-2022 |
Correspondence Address:
Dr. Arati Mahishale
Department of OBG Physiotherapy, KAHER Institute of Physiotherapy, Belagavi, Karnataka
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/ijptr.ijptr_101_22
How to cite this article:
Mahishale A, Metgud S. Anemia... An unwanted gift to women... Indian J Phys Ther Res 2022;4:1-3 |
Anemia is a condition when the red blood cell count or hemoglobin concentration is below normal. Gender, age, lifestyle, and pregnancy status all affect the ideal hemoglobin concentration required to meet physiologic requirements. Iron deficiency anemia, which is the most prevalent kind of anemia found in women and a major contributor to morbidity in this population, is brought on by a lack of iron.
The World Health Organization (WHO) calculates anemia prevalence as having a hemoglobin concentration of less than 12 g/dL for nonpregnant and breastfeeding women and less than 11 g/dL for pregnant women, adjusted for smoking and altitude. After Benin, Mali, Yemen, and Nigeria, India has the fifth highest prevalence of anemia among women of reproductive age in the world in 2019, at 53%, according to the WHO's control panel.[1],[2]
| National Family Health Survey Records | |  |
The Union Health Ministry presented the important findings of both stages of the National Family Health Survey (NFHS), which was conducted between 2019 and 2021. The NFHS's fifth edition, known as NFHS-5, had 6.1 lakh samples from all throughout the nation. The prevalence of anemia in women, men, and children was noted in the representative survey. After receiving voluntary consent, blood samples were taken from all men and women (15–49 years). Severe anemia patients were referred to nearby healthcare facilities for additional evaluation and management.[3]
According to the results of the NFHS-5, there is now more anemia among women and children than in the NFHS-4, which was performed in 2015–2016. Anemia rates rise by 1.8% points in expectant women, 3.9% points in women of childbearing age, and 5% points in women in their adolescent years. Overall, the results of NFHS-5 show that the prevalence rates in Kerala and some other northeastern states have increased while having lower prevalence than in NFHS-4. In comparison to NFHS-4, the prevalence of anemia among women and children increased significantly in Gujarat, Assam, and West Bengal.[3]
| Several Reasons Predispose Women to Develop Anemia... | | |
Anemia due to heavy bleeding
Historical definitions of anemia in women have been called into question by data from more recent observational research. Due to blood loss during menstruation, women who have frequent periods run the risk of developing iron deficiency anemia. Women who have longer periods and extremely severe bleeding are more likely to develop anemia. If they have heavy periods, women between the ages of 12 and 49 years may lose blood once a month. In addition, estrogen insufficiency increases the production of hepcidin, which blocks intestinal iron absorption and lowers serum iron levels. Hepcidin also prevents adipocytes from releasing iron, which raises the iron levels in local adipose tissue.
Anemia in pregnancy
Women who are pregnant require 50% more iron than usual (27 mg per day). Checking the iron levels of women who are or are planning to get pregnant is crucial. Iron is present in prenatal vitamins, which can help avoid low iron and anemia associated with pregnancy. The risk of anemia for postpartum women who lose blood during childbirth remains high.
Anemia in postpartum period
Anemia in the antenatal period and severe hemorrhage brought on by blood loss following birth are the two main causes of postpartum anemia. Life quality is impacted by postpartum anemia, which can also interfere with cognitive function and emotional stability. In women of reproductive age, it can result in depression, which is a cause of health issues.[4]
Iron deficiency is identified medically
Hemoglobin, serum ferritin, and serum soluble transferrin receptor are valid indicators of anemia that are used to determine anemia based on total blood count. Cancer, colon polyps, and bleeding from intrauterine devices used for birth control can all induce delayed bleeding in women that result in iron loss. All of these factors increase the likelihood that the women may experience iron deficiency, which can lead to extreme weariness and decreased exercise tolerance. It might have a detrimental effect on quality of life, which would result in decreased work performance.
Anemia and stress
In comparison to men, women are more prone to experience physical & mental signs of stress, such as- Headache is reported to be 41% in females as compared to men which is 30% & emotional breakdown is also reported to be high in females with 44% than men having 15%. According to a study, married women have higher levels of stress than single women. One-third of the sample (33%) of married women reported having a lot of stress in the past month, compared to one in five (22%) of single women.[5]
Anemia and depression
To determine the levels of stress, anxiety, and sadness in females with iron deficiency anemia and how these affect their ability to think clearly, a study was conducted. After obtaining voluntary, written informed consent, 30 girls with iron deficiency anemia and 30 age-matched controls were enrolled. To measure stress, anxiety, and depression, the Depression, Anxiety and Stress Scale- 42 (DASS-42) was used. There were also tests of verbal and spatial memory. In women with iron deficiency anemia, the study found increased levels of stress, anxiety, and sadness, as well as lower scores for spatial memory.[5]
In a case–control study, the relationship between serum ferritin levels and depression was observed. A questionnaire to diagnose depression was given to 192 female medical students in Tehran with a mean age of 24.5 ± 1.6 years. Hemoglobin (Hgb) level, folic acid, Vitamin B12, erythrocyte sedimentation rate, serum ferritin, and C-reactive protein levels were assessed in the subjects. 34.7% of reported cases were depressed. In comparison to healthy students, students with depression had significantly lower mean ferritin levels (P = 0.001). The study suggests a possible link between depression and a drop in ferritin levels before an episode of anemia.[6]
Certain kinds of anemia are becoming more prevalent in Uttarakhand, Haryana, and Jharkhand. The Jharkhand Health Department launched an action plan for pregnant women, nursing moms, and kids to tackle anemia. Anemia Mukt Bharath, a 2018 National Health Mission initiative, was given priority as a part of the Intensified National Iron Plus Initiative Program. The plan's objective was to offer medications for micronutrients such as calcium, Vitamin A, Iron & Folic acid (IFA), and albendazole. Similar to the Center's Anaemia Mukt Bharat programme, Haryana introduced the Anaemia Mukt Haryana programme under the “Atal Abhiyaan” (Assuring Total Anemia Limit Abhiyaan) initiative in 2019. This program aims to reduce anemia in all age groups.
| More Comprehensive Data on Anemia is Need of the Hour | | |
Despite all programs and attempts, women of all ages are still at risk for anemia. To further reduce anemia, a variety of actions including increased awareness and education, improved food choices and nutrition, and IFA supplementation during pregnancy and lactation are essential. Although iron deficiency is the most frequent cause of anemia, other disorders also need to be diagnosed and treated. To comprehend the severity of the ailment and guarantee that the essential medical interventions are implemented, it is crucial that data on epidemiology be made accessible.
| Conclusion | | |
Thus, it can be said that women are anemic at any stage of their lives: whether it be from menstrual bleeding disorders, prepregnancy iron deficiency, pregnancy anemia, postpartum anemia, stress and depression in the premenopausal stage, or anemia caused by hormonal imbalance in the postmenopausal stage. There is a need for well-designed clinical studies with strong and reliable epidemiological data because, according to the national guidelines, the recommendations for treating iron deficiency anemia are not backed by high-quality evidence.
| References | | |
| 1. | World Health Organization: Iron Deficiency Anaemia: Assessment, Prevention and Control: A Guide for Programme Managers. Geneva: World Health Organization; 2001.  |
| 2. | Yang, Qing & Jian, Jinlong & Katz, Stuart & Abramson, Steven & Huang, Xi. 17β-estradiol inhibits iron hormone hepcidin through an estrogen responsive element half-site. Endocrinology 2012;153:3170-8. |
| 3. | |
| 4. | Milman N. Postpartum anemia I: Definition, prevalence, causes, and consequences. Ann Hematol 2011;90:1247-53. |
| 5. | Ashok V, Kumar A, Kiran Singh RS. Depression, anxiety, stress and cognition in females with iron deficiency anemia. Trop J Pathol Microbiol 2017;3:201-5. |
| 6. | Vahdat Shariatpanaahi M, Vahdat Shariatpanaahi Z, Moshtaaghi M, Shahbaazi SH, Abadi A. The relationship between depression and serum ferritin level. Eur J Clin Nutr 2007;61:532-5. |
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