hundred consecutive hospitalized patients

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1 ORIGINAL ARTICAL Medical Science Iron deficiency anemia: an experience with one hundred consecutive hospitalized patients Dr.M.Rajesh Kumar* Dr.P.Ramesh Babu** Dr.Manjoor Ilahi***Dr.Amit Agrawal**** *Associate Professor; Dept of General Medicine **Assistant Professor; Dept of General Medicine ***Resident; Dept of General Medicine ***Professor of Neuro Surgery Narayana Medical College & Hospital, Nellore-AP India. Corresponding author :Dr. Amit Agrawal; AFFILIATION Abstract Abstract Objective The objective of the present study is to understand the spectrum and characteristics of admittedd patients for anemia. Objective Materials and Methods The objective present study of the included present study one hundre is to ed nderstand consecutive the spectrum patients and admitted characteristics with the of diagnosis admitted of patients anemia for in anemia. general medicine wards. Data were collected in a pre-designed proforma and analyzed. Details regarding age, gender, clinical presentation, Materials and Methods clinical examination findings, blood investigations, management and outcome were recorded. Severity of anemia was The present study included one hundred consecutive patients admitted with the diagnosis of anemia in general medicine wards. defined based on WHO criteria, for normal with hemoglobin value of equal to or more than 12 gm/d1, mild anemia as Data hemoglobin were collected value of in 10 a up pre-designed to 11.9 gm/1, proforma moderate and anemia analyzed. as 7 Details to 9.9 gm/d1 regarding and age, severe gender, anemia clinical as less presentation, than 7 mg/1 clinical of blood. The Institutional Ethics Committee approved the study. The data analysis was carried out using the Epiinfo 7. examination findings, blood investigations, management and outcome were recorded.severity of anemia was defined based on Results WHO criteria, for normal with hemoglobin value of equal to or more than 12 gm/d1, mild anemia as hemoglobin value of 10 up The mean age was years (minimum 13 years and maximum 85 years, SD ±16.80 years). Most of the time patients to were 11.9 house gm/1, wives moderate or farmers. anemia Microcyti as 7 to ic 10.9 hypochromic gm/d1 and anemia severe was anemia most as common less than followed 7 mg/1 by of normocytic blood. The normochromic Institutional Ethics anemia. The mean hemoglobin was 6.9 gm% (minimum 2.2, maximum 11.9 and SD Committee approved the study.the data analysis was carried out using the Epiinfo ). 47% patients had severe anemia.. All the patients were managed conservatively and improved. There was no mortality in the present series. Results Conclusions The In summary, mean age in was present study years the (minimum majority m 13 of years the patients and maximum who were 85 admitted years, SD had ±16.80 severe year ane rs). emia, Most microcytic of the time hypochromic patients were anemia was the common finding in peripheral smear, and not only the females but males weree involved as well. house wives or farmers. Microcytic hypochromic anemia was most common followed by normocytic normochromic anemia. Th Key words : Anemia, red blood cells, rural, incidence 12

2 Introduction Anaemia a common blood disorder; characterized by abnormal reduction in red blood cell count, hemoglobin and/or hematocrit values below the normal reference values gender, clinical presentation, clinical examination findings, blood investigations, management and outcome were recorded. Severity of anemia was defined based on WHO 10 criteria, for normal with hemoglobin value of equal to or more than 12 gm/d1, mild anemia as hemoglobin value of 10 up and still remains a public health challenge to 11.9 gm/1, moderate anemia as 7 to 9.9 gm/d1 worldwide. 1-4 It is estimated that more than a and severe anemia as less than 7 mg/1 of blood. billion people suffer from iron deficiency 5-7 and majority of them are females and children residing in resource poor developing countries. 8, 9 The objective of the present study is to understand the spectrum and characteristics of admitted patients for anemia. Material and methods The present study was conducted at Department The Institutional Ethics Committee approved the study. The data analysis was carried out using the Epiinfo 7. Results A total 100 patients were included in the study. The mean age was years (minimum 13 years and maximum 85 years, SD ±16.80 years). Age and sex distribution is shown in figure-1. of Medicine, Narayana Medical College and Hospital. One hundred consecutive patients admitted with the diagnosis of anemia in general medicine wards were included in the present study. Data were collected in a pre-designed proforma and analyzed. Details regarding age, 13

3 Figure-1 Age and sex distribution Age and Sex Distribution Most of the time patients were house wives or farmers (Figure-2) F M Microcytic hypochromic anemia was most common followed by normocytic normochromic anemia (Figure-3). Severity of Anemia gm% 11% gm% 42% <7 gm% 47% Figure-2 Shop Vendor 2% Labourer 1% Coolie 2% Occupation Occupation House wife 52% Student 10% Employed 2% Farmer 31% Summary of clinical presentation and examination findings is shown in table-1. Table-2 is showing the details of the blood group. The mean hemoglobin was 6.9 gm% (minimum 2.2, maximum 11.9 and SD 2.34). 47% patients had severe anemia (Figure-4). Figure Type of anemia Dimorphic Anemia Normocyti c normochro mic anemia 31% Type of Anemia 6% Macrocytic Anemia 4% Megalobla stic Anemia 2% Microcytic hypochro mic anemia 57% 14

4 All the patients were managed conservatively and improved. There was no mortality in the present series. Discussion anemia among male population as well, as this will prevent illnesses and disability. 14 In a study mild anemia was the most prevalent among the female students followed by moderate and severe Iron deficiency anemia can occur due to anemia. 15 In another study similarly the mild inadequate iron intake, chronic blood loss or anemia was the most prevalent type of anemia diseases, malabsorption, or a combination of all among the studied female adults. 16 In a study these factors and can affects development, growth from Vadodara, India moderate anemia was being and resistance to infections, 11, 12 in infants, more prevalent than mild anemia in young school-age children, female adolescents, pregnant women, nurturing mothers 13 and young males. 14 In present study the anemia was more prevalent in young females; however as the age was increasing the males were commonly affected by anemia (Figure-1). In literature also the young females have high prevalence of anemia particularly in the lower socio-economic strata. 8 Although the factor associated with anemia in females is menstrual blood loss 8 however in present study there were not many cases with menstrual dysfunction. In our series it is evident that there was almost equal number of male patients as females a finding consistent with the series published from Nepal. 14 It is also important to identify prevalence of females. 17 In contrast to these community based studies, in the present hospital based study severe anemia was commoner; probably the patients with severe anemia were frequently admitted. In literature, microcytic hypochromic picture in the peripheral smear suggestive of iron deficiency anemia has been described as the most common findings, 8 a similar finding noted in present series. Dimorphic picture is the next common presentation anemia on peripheral smear, 8 however in present study normocytic normochromic anemia the next common finding was followed by dimorphic picture. The common clinical features in patients with moderate to severe anemia include feeling of tiredness, 15

5 fatigue, or short ness of breath and all these can fruits 24, 25 or inaccessibility to medical or interfere with the person s ability to carry out day nutrition services to prevent or treat these to day activities. Similar findings were noted in conditions. 22 Studies have suggested that majority of the patients in present series. Apart from this there is evidence that iron deficiency anemia can cause impaired growth, developmental delay, decreased physical activity, behavioral abnormalities and impairment of cognitive function and concentration in children 9, leading to poor school performance. However as there were not many children in the present study we don t know the impact of anemia in children. In present series there were not many identifiable risk factors for anemia; probably the dietary habits and socio-economic factors were responsible for the occurrence of severe iron deficiency anemia. As was seen in the present study, in literature also it has been well recognized that rural, less educated individuals can have higher levels of nutritional deficiencies, including iron deficiency and anemia. 22, 23 It can improvement in the socioeconomic status of the family and education to adopt healthy eating habits can reduce the incidence of iron deficiency anemia and it should not only include parents but 23, also children. Conclusion In summary, in present study the majority of the patients who were admitted had severe anemia, microcytic hypochromic anemia was the common finding in peripheral smear, and not only the females but males were involved as well. The major limitations of the study were that it was a hospital based and included only patients with significant anemia who required admission. There is a need to study further to find out the specific risk factors and develop strategies to improve nutritional knowledge and awareness about healthy nutritional habits for the local population which will work for them in an efficient manner. be due to irregular eating habits, 23 nonaffordability to a healthy diet, 22, 23 low consumption of red meat, vegetables, cereals and 16

6 Table-1 Summary of clinical presentation and examination findings Analgesic abuse Jaundice 8 92 Pallor Present Absent Ascites 3 97 Breathlessness Frequent fever episodes Fatigue Weakness Loss of appetite 5 95 Chest pain 3 97 Vomiting 5 95 Burning feet 2 98 Splenomegaly Hepatomegaly 6 94 Education Illiterate 81 Literate 19 Socio-economic status Middle class 44 Poor 56 Oedema Painab domen Palpitation 6 94 Bleeding Melena 4 96 Menstrual history Dysfunctional uterine bleeding 1 Menorhagia 2 Menopause 6 Oligomenorrhoea 1 PID 2 Regular 14 Diet Table-2 Details of blood group (n=45) Blood group Frequency A+ 11 AB+ 4 B- 2 B+ 16 A - 1 O- 2 O+ 9 Mixed 98 Vegetarian 2 Malaria 8 92 Alcohol

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