"...all doctors should be able to diagnose and treat nutritional deficiencies."

Royal College of Physicians. Nutrition and Patients: A Doctor's Responsibility. London 2002

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Anaemia

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Anaemia is one of the commonest health problems worldwide and is often, but not always, due to deficiency of one or more essential nutrients.  The World Health Organisation defines anaemia as a haemoglobin level below 12.0 g/dl in women and below 13.0 g/dl in men.  Haemoglobin is the red oxygen-carrying pigment which is found in the red blood cells that are produced in the bone marrow.  A lack of haemoglobin can be due to a lack of some essential nutrients, excessive blood loss (heavy periods, loss of blood from the bowel and as a result of trauma, childbirth and operation), chronic illness (infection and inflammation) and due to a variety of blood disorders.

Nutrients Required for Haemoglobin Production

Anaemia is a feature of deficiency of several nutrients:

  • Iron
  • Folate
  • Vitamin B12
  • Very occasionally other nutrients: vitamin C, vitamin A, vitamin B2 – riboflavin and copper

Anaemia is particularly common in infants, menstruating women and the elderly.  Regardless of the type and cause of the anaemia, it usually presents with fatigue, reduced capacity for physical work, poor concentration and reduced academic performance in children.  The many other possible features depend upon the type of anaemia.

According to the National Diet and Nutrition Surveys deficiency of one or more of the above nutrients is not uncommon in some of the subgroups of the adult and elderly population.

Prevalence of Anaemia and Related Nutrient Deficiencies in British Adults and the Elderly
Data derived from NDNS.

 
Men
Woman
 
19-64 years
65-84 years
85 years and over
19-64 years
65-84 years
85 years and over
Anaemia
3%
9%
37%
8%
8%
16%
Haemoglobin <12.0/13.0 g/dl
Iron Deficiency
7%
5%
15%
16%
13%
16%
Iron saturation <15%
Folate Deficiency
5%
27%
30%
5%
30%
34%
Red cell folate <350 nmol/l
Vitamin B12 Deficiency
2%
7%
10%
4%
4%
10%
Plasma B12 <118 pmol/l
Vitamin C deficiency
5%
12%
20%
3%
12%
18%
Plasma Vitamin C <11.0 umol/l

 

At present in the UK there is no financial incentive for GPs to screen for, investigate and treat anaemia in the general population in the way that there is for high blood pressure or elevated blood cholesterol.

Once discovered the cause of the anaemia should be investigated so that effective treatment and prevention of recurrence can be achieved. See Nutritional emergencies - Anemia.   Persistent use of iron supplements should only be undertaken with medical supervision and appropriate and regular assessment of need.

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Copyright Dr. Alan Stewart M.B.B.S.M.R.C.P. (UK)M.F. Hom.
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