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COUNSELLING A CASE COUNSELLING A CASE OF ANAEMIA IN A PHC OF ANAEMIA IN A PHC
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Counselling a Case of Anaemia in a Phc

Apr 10, 2015

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Page 1: Counselling a Case of Anaemia in a Phc

COUNSELLING A CASE COUNSELLING A CASE OF ANAEMIA IN A PHCOF ANAEMIA IN A PHC

Page 2: Counselling a Case of Anaemia in a Phc

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Page 3: Counselling a Case of Anaemia in a Phc

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Page 4: Counselling a Case of Anaemia in a Phc

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Page 5: Counselling a Case of Anaemia in a Phc

CAUSES OF ANAEMIACAUSES OF ANAEMIA�� Inadequate production of red blood cells in bone marrow Inadequate production of red blood cells in bone marrow

due to:due to:�� Lack of raw materials e.g. nutritional anaemia. Lack of raw materials e.g. nutritional anaemia. �� Depression of bone marrow e.g. chronic infections, drugs, radiatDepression of bone marrow e.g. chronic infections, drugs, radiation ion

etc. etc. �� Infiltration of bone marrow in conditions likes malignancy. Infiltration of bone marrow in conditions likes malignancy.

�� Excessive destruction of red blood cells due to:Excessive destruction of red blood cells due to:�� Abnormality of haemoglobin like Abnormality of haemoglobin like thalassemiathalassemia, , �� Deficiency of red cell enzymes like Glucose 6 phosphate Deficiency of red cell enzymes like Glucose 6 phosphate

dehydrogenasedehydrogenase deficiency, deficiency, �� Abnormality of red cell membrane like hereditary Abnormality of red cell membrane like hereditary sperocytosissperocytosis�� Auto immune haemolytic Auto immune haemolytic anaemiasanaemias

�� Blood loss due to any causeBlood loss due to any cause

Page 6: Counselling a Case of Anaemia in a Phc

NUTRITIONAL ANAEMIANUTRITIONAL ANAEMIA�� Nutritional Nutritional anaemiasanaemias -- caused by deficiency of caused by deficiency of

nutrients required for the formation of haemoglobin nutrients required for the formation of haemoglobin or red blood cells.or red blood cells.

�� Nutrients essential for formation of normal blood Nutrients essential for formation of normal blood cells cells --Iron, folic acid, vitamin B12, vitamin B6, Iron, folic acid, vitamin B12, vitamin B6, vitamin C, vitamin E, protein and copper. vitamin C, vitamin E, protein and copper.

�� Among nutritional Among nutritional anaemiasanaemias IRON DEFICIENCY IRON DEFICIENCY ANAEMIA(IDA) is the most common anaemia in ANAEMIA(IDA) is the most common anaemia in India.India.

�� Nutritional Nutritional megaloblasticmegaloblastic anaemia is the other anaemia is the other common nutritional anaemia. common nutritional anaemia.

Page 7: Counselling a Case of Anaemia in a Phc

CAUSES OF IDACAUSES OF IDA

�� Low intake of Iron Low intake of Iron

�� Increased losses of IronIncreased losses of Iron

�� Increased demands of ironIncreased demands of iron

Page 8: Counselling a Case of Anaemia in a Phc

�� Due to reduced intake or absorption of iron: Due to reduced intake or absorption of iron: �� Iron poor diet Iron poor diet �� MalabsorptionMalabsorption syndromes syndromes �� Chronic diarrhoea Chronic diarrhoea �� Gastrointestinal surgery Gastrointestinal surgery

�� Due to increased loss:Due to increased loss:�� Gastrointestinal bleeding due to any cause Gastrointestinal bleeding due to any cause �� Hook worm infestation Hook worm infestation �� Bleeding disorders Bleeding disorders �� Excessive menstruation Excessive menstruation

�� Due to increased demands:Due to increased demands:�� Pregnancy Pregnancy �� Lactation Lactation �� PrematurityPrematurity and low birth weight and low birth weight �� Adolescence Adolescence

�� Chronic Chronic illnesillnes

Page 9: Counselling a Case of Anaemia in a Phc

CLINICAL FEATURES OF ANAEMIACLINICAL FEATURES OF ANAEMIA�� Pallor,Pallor,�� AnorexiaAnorexia�� Pica (eating abnormal things)Pica (eating abnormal things)�� LethargyLethargy�� IrritabilityIrritability�� Easy Easy fatiguabilityfatiguability�� Insomnia (lack of sleep)Insomnia (lack of sleep)�� Failure to thriveFailure to thrive�� Increased heart rateIncreased heart rate�� Difficulty in breathingDifficulty in breathing�� Mental disturbancesMental disturbances�� OedemaOedema�� Cardiac failure Cardiac failure

Page 10: Counselling a Case of Anaemia in a Phc

LONG TERM IDALONG TERM IDA�� a burning sensation in the tongue. (GLOSSITIS)a burning sensation in the tongue. (GLOSSITIS)�� a smooth tonguea smooth tongue�� dryness in the mouth and throat.dryness in the mouth and throat.�� sores at the corners of the mouth. (ANG.STOMATITIS)sores at the corners of the mouth. (ANG.STOMATITIS)�� an altered sense of touch.an altered sense of touch.�� nails can become brittle and spoon shaped with vertical nails can become brittle and spoon shaped with vertical

stripes and a tendency to fray. (KOILONYCHIA)stripes and a tendency to fray. (KOILONYCHIA)�� or a 'pica' can arise or a 'pica' can arise -- an insatiable craving for a specific an insatiable craving for a specific

food, food, egeg liquorice.liquorice.�� brittle hair.brittle hair.�� difficulty in swallowingdifficulty in swallowing

Page 11: Counselling a Case of Anaemia in a Phc

INVESTIGATIONSINVESTIGATIONS

�� HbHb% ESTIMATION% ESTIMATION

�� PERIPHERAL SMEARPERIPHERAL SMEAR

�� STOOL EXAMINATIONSTOOL EXAMINATION

Page 12: Counselling a Case of Anaemia in a Phc

MANAGEMENTMANAGEMENT

�� DIETDIET

�� ORAL IRON PREPARATIONSORAL IRON PREPARATIONS

�� PARENTERAL IRONPARENTERAL IRON

�� BLOOD TRANSFUSIONBLOOD TRANSFUSION

Page 13: Counselling a Case of Anaemia in a Phc

DIETDIET�� HaemeHaeme Vs Non Vs Non haemhaem iron iron �� Cooking of diet in iron potsCooking of diet in iron pots�� JaggeryJaggery�� Green leafy vegetablesGreen leafy vegetables�� Dried datesDried dates�� BajraBajra�� PulsesPulses�� GingellyGingelly seedsseeds�� Meat and fishMeat and fish�� Iron absorption Iron absorption -- ed by VIT.C rich foods (citrus fruits)ed by VIT.C rich foods (citrus fruits)

ed by tannin rich foods (tea) ed by tannin rich foods (tea)

Page 14: Counselling a Case of Anaemia in a Phc

ORAL IRONORAL IRON

�� IRON TABLETSIRON TABLETSAdults & Adolescents Adults & Adolescents -- Mild 60 mg / dayMild 60 mg / day

-- Moderate 120 mg / day Moderate 120 mg / day Infants & children 3mgs / kg / dayInfants & children 3mgs / kg / dayPregnant women Pregnant women -- 120 mg / day120 mg / day

�� Warn about BLACK COLORED STOOLSWarn about BLACK COLORED STOOLS�� Eliminate misconception of having BLACK Eliminate misconception of having BLACK

BABYBABY

Page 15: Counselling a Case of Anaemia in a Phc

PARENTERAL IRONPARENTERAL IRON

Indications : Indications : Moderate & severe anemia Moderate & severe anemia Non Compliance to oral iron Non Compliance to oral iron Undesired effects of oral iron Undesired effects of oral iron IM IM -- 100 mg of iron in 2 ml of saline 100 mg of iron in 2 ml of saline IV IV -- 500 Mg of iron in 10 ml of saline 500 Mg of iron in 10 ml of saline

Page 16: Counselling a Case of Anaemia in a Phc

PREVENTIONPREVENTION�� HIGH RISK STRATEGY HIGH RISK STRATEGY

�� DIETDIETGood sources of iron include liver, beef, wholemeal Good sources of iron include liver, beef, wholemeal bread, cereals, eggs and dried fruit.bread, cereals, eggs and dried fruit.

�� CONSULTCONSULTDoctor immediately if there is loss of blood in the stoolsDoctor immediately if there is loss of blood in the stools or or urine or persistently urine or persistently heavy periodsheavy periods. .

�� A woman who is pregnant or planning to become pregnant A woman who is pregnant or planning to become pregnant

�� PERIODIC DEWORMINGPERIODIC DEWORMINGAvoid walking barefootAvoid walking barefoot

�� FOOD FORTIFICATION FOOD FORTIFICATION

Page 17: Counselling a Case of Anaemia in a Phc

REFERENCESREFERENCES�� Park’s textbook of Preventive and Social medicinePark’s textbook of Preventive and Social medicine�� HarrisonsHarrisons principle of internal medicineprinciple of internal medicine�� http://www.bawarchi.com/health/anaemia.htmlhttp://www.bawarchi.com/health/anaemia.html�� http://www.netdoctor.co.uk/diseases/facts/anaemiairohttp://www.netdoctor.co.uk/diseases/facts/anaemiairo

n.htmn.htm�� http://hcd2.bupa.co.uk/fact_sheets/html/anaemia_ironhttp://hcd2.bupa.co.uk/fact_sheets/html/anaemia_iron

.html.html�� Preventing & Controlling IDA through primary heath Preventing & Controlling IDA through primary heath

care care �� Guidelines for use of FE Supplements Guidelines for use of FE Supplements otot prevent & prevent &

treat IDAtreat IDA

Page 18: Counselling a Case of Anaemia in a Phc