ANAEMIA

• Pallor generally indicates anaemia. Anaemia is defined as a decrease in the quantity of circulating red blood cells (RBC), represented by a reduction in hemoglobin concentration (Hb), hematocrit (Hct), or RBC count
• The 2005/06 National Family Health Survey (NFHS) in India revealed that at least 80% of children between 12 and 23 months were anaemic in India. And in children aged <5 years, 69.5% were anaemic. Unfortunately, recent economic development and the national anaemia-control programme have not translated to major reduction in the occurrence of anaemia in India as shown in the 2015 figures. The 2015 demographic health survey show only 11 percentage point decrease from 69.5% to 58.5% childhood anaemia in India, still making it endemic. The elimination of iron deficiency anaemia in children is a public-health priority, given the association of anaemia with impaired cognitive and psychomotor development

Nutritional 

• Deficiency of iron folate, vitamin B12, protein

Hemolytic

• Congenital -Haemoglobinopathies- thalassemia, sickle cell anaemia
• Enzyme deficiency- glucose-6-phosphate dehydrogenase (G6PD) deficiency, pyruvate kinase deficiency
• Membrane defects- spherocytosis, elliptocytosis

Acquired

• Autoimmune haemolytic anaemia, hypersplenism, malaria, haemolytic uremic syndrome

Hemorrhagic

• Purpura, coagulopathies, trauma

• Increased heart rate 
• Breathlessness 
• Fatigue
• Dizziness 
• Irritability
• Headache 
• Irregular menstruation
• Absent or delayed menstruation
• Swollen tongue
• Jaundice 
• Hepatosplenomegaly
• Poor wound healing
• Delayed growth and development 

• Routine Investigation: Haemoglobin estimation
• Blood counts: Selective rise in WBC (leucocytosis) seen in all infections and leukemias
• Low platelet count is seen in hypoplastic anaemia, leukemias.
• Thrombocytosis (increase in platelet count) is a feature of iron deficiency anaemia
• ESR: raised in case of anaemia except in sickle cell anaemia
• Peripheral Smear: Normocytic normochromic RBC is a feature of anaemia due to infections
• Macrocytic anaemia- vitamin B12 deficiency, folate deficiency, malabsorption

Special Investigations

Serum Iron and Iron Binding Capacity

• Used in differentiating pure iron deficiency from thalassemia. In iron deficiency anaemia, serum iron is decreased and iron-binding capacity is increased
• In thalassemia serum iron is raised and iron-binding capacity is decreased

 Serum Ferritin Estimation

• It is decreased in iron deficiency and increased in anaemia of chronic inflammation

 Urine urobilinogen

• Increased in haemolytic anaemia

 Bone Marrow Examination

• In aplastic anaemia, leukemia

Radiology

• Chest X-ray- cardiomegaly in chronic anaemia

• Skull X-ray- hair on end appearance- congenital haemolytic anaemia

Karyotyping

• Fanconi’s anaemia- chromosomal breaks

Ayurvedic Treatment

• Deepana pachana srothosodhana and Krimihara oushadhas

 Kashsyas

• Drakshadi Kashaya, Punarvadi Kashaya, Vasa guduchyadi kashaya
  • Up to 1 year: for mother: 2tsp sookshma choorna is boiled in 2 glass water, strained and given to mother. If agni bala permits give 1 tsp thrice to the child
  • 1 year to 5 years: ½ tsp powder boiled in 1 glass water and given as divided doses mixed with sugar or jaggery.
  • 5 to 10 years: 1 tsp powder boiled in 1 glass water and given as divided doses mixed with sugar or jaggery.
  • 10-15 years: 1 ½ tsp powder boiled in 1 glass of water and given twice daily mixed with sugar or jaggery.

•  Vyoshadi Kashayam - given in takra (by immersing in takra overnight)

 Arishtas

• Draksharishta + Lohasava
  • Up to 2yrs- ½ tsp arista diluted with 1 tsp water
  • 2-5 years- 2.5ml-5ml diluted with 5 ml boiled water
  • 5-10 years- 10ml
  • 10-15 years- 15ml

 Choornas and Vatakas

• Navayasa choorna : ½ to 1 tsp
• Mandoora vataka: ½ tab to 1 tab with takra

 Lehyas

• Chinchadi lehya, Gandeera rasayana
• 2 to 6 years: ½ tsp
• 6-12 years: 1 tsp

 For long term use

• Gritha yogas like Dadimadi, Vyoshadi, Patadi -½ to 1 tsp based on appetite