Anemia Overview
Anemia is a significant public health issue in Thailand. The Department of Health, Ministry of Public Health, reported that 31.2% of pregnant women suffer from anemia, and among women of reproductive age (15 to 49 years) who were screened while not pregnant, 37.0% were found to have anemia.
Causes of Anemia
The most common cause is iron deficiency, a vital component for the body’s production of red blood cells.
Insufficient Iron Intake
This occurs when the diet lacks enough iron to meet the body’s needs.
Low consumption of iron-rich foods such as meat, offal (internal organs), milk, and eggs. The iron in these animal sources is more easily absorbed by the intestines than iron found in plants.
Poor appetite due to chronic illness (e.g., pulmonary tuberculosis, cancer, AIDS) or in the elderly who eat little or an unbalanced diet.
Strict vegetarian, raw food (chew-jit), or macrobiotic diets that are not nutritionally balanced. Although vegetables contain iron, it is poorly absorbed, especially when consumed with rice, which contains phytates that inhibit iron absorption.
Increased demand for iron: Infants during their first two years, adolescents during their growth spurt, and pregnant women (who need increased iron for fetal development) are prone to anemia if their iron intake is insufficient.
Loss of Iron Through Blood Loss
Iron is lost from the body when there is significant or chronic bleeding:
Heavy menstrual bleeding (common in adolescent and reproductive-age women).
Blood loss due to miscarriage or childbirth.
Gastrointestinal bleeding (resulting in black stools), often from the use of pain relievers for arthritis or other causes.
Chronic bleeding from conditions like hemorrhoids (fresh blood in stool) or hookworm infection.
Symptoms
Mild Anemia: Often, there are no distinct symptoms, or if the anemia develops gradually, the patient may not notice any abnormality.
Severe or Acute Anemia (e.g., from hemorrhage): Symptoms often include fatigue, easy exhaustion, dizziness, lightheadedness, loss of appetite. If severe, it may be accompanied by palpitations (heart fluttering or pounding).
Obvious Anemia: Characterized by pale complexion, pale palms, pale nails, and pallor of the conjunctiva (inner eyelid lining), lips, and tongue.
Other Causes of Anemia (Beyond Iron Deficiency)
Anemia is a symptom of an underlying disease and can have various causes:
Nutritional or Protein Deficiency: Protein is essential, along with iron, for red blood cell formation. Patients may also show signs of malnutrition, such as emaciation, swollen feet (edema), or reddish hair.
Thalassemia: A hereditary blood disorder that causes the body to produce abnormal red blood cells that break down easily, leading to chronic pallor and jaundice from childhood, facial changes, and an enlarged spleen (a palpable mass under the left rib cage). It is prevalent in people from the Northeastern and Northern regions of Thailand.
Aplastic Anemia or Leukemia (Blood Cancer): Patients typically show pallor, often with fever, small red spots (petechiae) or bruises on the skin, and bleeding in various areas (e.g., nosebleeds, bleeding gums).
Chronic Kidney Failure: Patients are often pale and fatigued, accompanied by nausea and swollen feet. They usually have a prior history of diabetes, high blood pressure, or kidney disease.
Diagnosis
Clinical Diagnosis: Doctors often diagnose based on the patient’s history and the detection of pallor (pale skin and mucous membranes throughout the body), in the absence of other abnormalities like fever, jaundice, petechiae, bruising, enlarged liver/spleen, edema, high blood pressure, or diabetes.
Lab Tests: In uncertain cases or when other diseases are suspected, a doctor may order blood tests, which typically show a hemoglobin level below 12 g/dL. Other specialized tests may include stool and urine analysis, X-rays, bone marrow biopsy, or endoscopy of the stomach or large intestine.
Self-Care
If you feel fatigued, easily exhausted, and notice pallor (pale face, eyelids, and lips) without fever, jaundice, petechiae, bruising, swelling, chronic diseases, or a history of chronic pallor since childhood (Thalassemia), you may begin initial treatment by taking iron supplements (e.g., Ferrous Fumarate), 1-2 tablets after meals, 2-3 times a day.
(Note: This medication may cause black stool due to the iron content, which is normal. However, if you had black stool before taking the medicine and did not consume pork blood or liver, suspect potential stomach bleeding, especially if you have a history of taking pain relievers for arthritis. If in doubt, see a doctor immediately.)
If you feel stronger and your complexion improves after 7-10 days of taking the medicine, it indicates the treatment is working. You should continue taking 1-2 tablets daily for another 3-6 months.
Treatment
Once anemia caused by iron deficiency is confirmed, the doctor will prescribe iron supplements (such as Ferrous Fumarate). If an underlying cause or condition is found, it will be treated simultaneously, such as deworming medication for hookworms, medication for stomach ulcers, treatment for hemorrhoids, tuberculosis, or AIDS.
Prevention
Anemia can be prevented by consuming foods rich in iron, such as meat, pork liver, beef liver, pork blood, kidney, milk, and eggs. This is especially important for pregnant women, infants, and adolescents.
Individuals on vegetarian, raw food, or macrobiotic diets, or the elderly who consume little meat and milk, should have their blood checked for anemia. If found, they should take regular iron supplements.
Women of reproductive age (15-45 years) who experience pallor due to iron loss from menstrual bleeding should take 2-3 iron supplement tablets daily during their menstrual period for about one week each month.
Anemia is found in people of all ages, particularly young children, adolescents, women of reproductive age, pregnant women, and the elderly. It is most common in rural, low-income populations, those with malnutrition, and those following nutritionally unbalanced vegetarian or macrobiotic diets.
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