The tissues of the human body need a regular supply of oxygen to stay healthy. The haemoglobin in the RBCs binds with oxygen and provides oxygen throughout the body. When RBCs die, the iron they contain is returned to the bone marrow and this is again used to create new RBCs. Normally, the body keeps using its iron over and over again. So, what are the conditions which can give rise to anaemia? Blood loss (due to any reason) leads to excessive destruction of RBCs, which in turn leads to inadequate production of RBCs in the bone marrow, thereby causing anaemia.
 Symptoms of Anaemia
Weakness, fatigue and lethargy may be signs of mild anaemia. A pale skin, lack of colour in the creases of the palm, gums, nail beds, or lining of the eyelids are other signs of anaemia. Someone who is weak, tires easily and is often out of breath, and feels faint or dizzy may be severely anaemic. Some other symptoms of anaemia are:
- Angina Pectoris (chest pain)
- Pica (craving for abnormal things, such as ice)
- Inability to concentrate, memory loss
- Inflammation of the mouth or tongue
- Irregular heartbeat
- Loss of appetite
- Nails that are dry, brittle or ridged
- Rapid breathing
- Swelling of the hands and feet
- Tinnitus (ringing in the ears)
- Unexplained bleeding or bruising
 Types of Anaemia
There are numerous types of anaemia, ranging from nutritional, congenital, anaemia of chronic disease and haemolytic, to the rare ones. Following is a list of the various types of anaemia:
- Iron deficiency anaemia.
- Folic acid deficiency anaemia.
- Vitamin B12 deficiency anaemia
- Vitamin C deficiency anaemia
- Haemolytic anaemia
- Sickle cell anaemia
- Thalassemias anaemia
- Aplastic anaemia
- Anaemia of chronic disease
The first four types are nutritional anaemia and we will restrict ourselves to nutritional anaemia for greater discussion in this article.
Nutritional anaemia is caused by deficiency of nutrients required for the formation of RBCs. Nutrients that are essential for formation of normal blood cells are iron, folic acid, vitamin B12, vitamin B6 and vitamin C. Among nutritional anaemia, iron deficiency anaemia is the most common anaemia in India. Nutritional megaloblastic anaemia (caused by deficiency of vitamin B12 and folic acid) is the other common nutritional anaemia. These anaemia are due to reduced intake, impaired absorption and increased losses, or may be because of the body's increased demand of nutrients.
 Iron Deficiency Anaemia
Iron deficiency anaemia is the most common form of anaemia in the world. Young children and women of child-bearing age are the most affected by it. This condition is less common in older children and in adults over 50, and rarely occurs in teenage boys and young men.
The onset of iron deficiency anaemia is gradual. At first, there may not be any symptoms. The deficiency begins when the body loses more iron than it derives from food and other sources. As a result, fewer RBCs develop. In the early stage of this anaemia, RBCs look normal but are reduced in number. Then the body tries to compensate for the iron deficiency by producing more RBCs, which are characteristically small in size. Symptoms develop at this stage.
Causes and preventions:
- Iron deficiency anaemia occurs because of reduced intake or absorption of iron; adequate iron-containing foods must be included to form a part of the diet.
- Increased loss of iron as seen in bleeding disorders or in hookworm infestation can cause this anaemia; treatment for worms should be done regularly and good personal hygiene must be followed.
- Due to increased demand as seen during pregnancy or adolescence; iron supplements should be given if found necessary.
Iron in the diet: Iron deficiency anaemia can occur at any age group. The recommended daily allowance of iron by the Indian Council of Medical Research is 28mg and 30mg for adult males and females, respectively. Dietary iron comes from two sources; animal products containing haem iron and plant sources containing non-haem iron. Cooking of food in iron pots also contributes to iron in the diet. Even though breast milk contains less iron content, it has better absorption and bio-availability of iron as compared to other milks.
Good sources of dietary iron are jaggery, dried dates, bajra, pulses, gingelly seeds and fish. Other good food sources of iron include almonds, broccoli, dried beans, raisins, dried apricots, whole-grain breads and cereals, brown rice, lean red meat, liver, potatoes and poultry.
Iron absorption is increased in presence of vitamin C. Therefore, inclusion of vitamin C rich foods in meals will enhance iron absorption. Tannin in tea can inhibit iron absorption. Therefore, drinking tea with meals should be avoided.
 Folic Acid Deficiency Anaemia
This sort of nutritional anaemia is the most common type of megaloblastic anaemia (in which RBCs are bigger than normal). It is caused by the deficiency of folic acid, a vitamin that the body needs to produce normal cells.
Folic acid anaemia is especially common in infants and teenagers. Although this condition usually results from a dietary deficiency, it is sometimes due to the body's inability to absorb enough folic acid from foods such as cheese, eggs, fish, milk, meat, mushrooms and green vegetables.
 Vitamin B12 Deficiency Anaemia
Another megaloblastic anaemia, vitamin B12 deficiency anaemia is less common than folic acid anaemia. It develops when the body does not absorb enough of this nutrient. Vitamin B12 is necessary for the creation of RBCs and is found in meat and vegetables. Large amounts of B12 are stored in the body, so this condition may not become apparent until as much as four years after B12 absorption stops or slows down. The most common form of B12 deficiency is pernicious anaemia, which usually strikes between the ages of 50 and 60. Eating disorders or an unbalanced diet increase the risk of developing this type of anaemia.
 Vitamin C Deficiency Anaemia
This is a rare disorder that causes the bone marrow to manufacture abnormally small RBCs. Vitamin C deficiency anaemia results from a severe, long-standing dietary deficiency.
 Treatment of Nutritional Anaemia
Anaemia due to nutritional deficiencies can usually be treated at home with iron supplements or injections of vitamin B12. People with folic acid anaemia should take oral folic acid replacements. Vitamin C deficiency anaemia can be cured by taking one vitamin C tablet a day.
Dealing with nutritional anaemia lies not so much in its treatment, but in its prevention. A diet rich in iron and other nutrients, proper cooking of food, good personal hygiene and fortification of foods with iron goes a long way in combating nutritional anaemia.