Anaemia is a condition in which the number of red blood cells or the amount of haemoglobin is low.
Hb Men : 14 to 17gms/dL
Women : 12 to 15 gms/ dL
Anaemia may be mild or severe. Mild anaemia causes fatigue, weakness, paleness, irritability and drowsiness. Concentration and learning ability may be impaired. When severe, anaemia may cause headache, ringing in the ears, spots before the eyes, faintness, dizziness, increased thirst, sweating, a weak and rapid pulse and rapid breathing. Females have powerful leg cramps during exercise. More severe forms have shortness of breath and chest pain. Menstrual period may stop.
Major causes of anaemia
||DECREASED RBC PRODUCTION||INCREASED RBC DESTRUCTION|
|A ) SUDDEN||Iron deficiency||Enlarged spleen|
|Accidents||Vit B12 deficiency||Haemolytic anaemia|
|Surgery||Folic acid deficiency||Sickle cell anaemia|
|Childbirth||Vitamin C deficiency||Thalassemia|
|Ruptured blood vessels||Aplastic anaemia||Hereditary causes|
|B ) CHRONIC||Chronic disease|
|Ulcers in stomach and small intestine|
|Cancer or polyps in the digestive tract|
|Heavy menstrual bleeding|
Around 30% of the total world population is anaemic. Of all the major causes of anaemia, half of the patients have iron deficiency. Iron deficiency is the most common mineral deficiency in the world. The body must have iron to make haemoglobin and to help transfer the oxygen to the muscles. If the blood is low in iron, all the body cells particularly muscles in adults and brain cells in children, do not function at par of the requirement. Tests are often performed to differentiate between iron deficiency anaemia and other causes of anaemia, i.e., some chronic disease.
Blood levels of iron and plasma ferritin is the most accurate test. Plasma ferritin is a protein that stores iron. A low level of ferritin indicates iron deficiency. However, sometimes ferritin levels are misleading because they can be falsely elevated by liver damage, inflammation, infection or cancer. In this case, the doctor may measure the amount of iron in transferrin – the protein that carries iron in blood when iron is not inside red blood cells. A low level of S. Transferrin is commonly encountered in malnutrition, liver disease, acute phase response and nephrotic syndrome. A high level of S. Transferrin occurs in iron deficiency anaemia, pregnancy as a compensatory mechanism to meet the iron demand of the body. S. Transferrin and Total iron binding capacity measure iron availability, hence they are affected by many factors besides iron stores. A high level of Total Iron Binding Capacity indicates iron deficiency anaemia and a low level indicates Anaemia of chronic disease.
Qualitative analysis of Anaemia can be done by tests like
· Mean Corpuscular Volume ( MCV )
· Mean Corpuscular Haemoglobin ( MCH )
· Mean Corpuscular Haemoglobin Concentration ( MCHC )
MCV is a measure of the average volume of a red blood cell. This measurement allows classification as either a microcytic anaemia, normocytic anaemia or macrocytic anaemia. MCV is Haematocrit / RBC.
Normocytes are erythrocytes that have normal size or volume. This suggests blood loss or haemolysis.
Microcytes are erythrocytes that have small size or volume. This suggests iron deficiency anaemia, Thalassemia, sideroblastic anaemia or lead poisoning.
Macrocytes are erythrocytes that have large size or volume. This suggests Vit B12 and folic acid deficiency, use of antiviral drugs, liver and spleen disease, chronic alcoholism or Chronic Obstructive Pulmonary Disease.
MCH is Haemoglobin / RBC is the average mass of haemoglobin per red blood cell. This is diminished in hypochromic anaemia due to blood loss over time, too little iron in the body or microcytic anaemia. This is high in macrocytic anaemia due to Vit B12 or folic acid deficiency.
MCHC is MCH / MCV is the measure of concentration of haemoglobin in a given volume of packed red blood cells. This count is used to give a rough guide to what shade of red erythrocytes will be.
MCHC is diminished in hypochromic anaemia, usually seen in microcytic anaemia. MCHC is normal in normochromic, usually seen in macrocytic anaemia. MCHC is elevated in hyperchromic anaemia, usually seen in hereditary spherocytosis, sickle cell anaemia, homozygous haemoglobin C disease.
All these blood tests give us a broad differential diagnosis of anaemia which is must to prescribe homoeopathic similimum.
Is Anaemia due to Iron Deficiency or is it the tip to the Ice-berg? Let’s understand:
Iron deficiency anaemia does not always mean iron intake is insufficient. It is mostly because of the iron imbalance in the body. So, blind supplementation of iron does not work well. Homoeopathy has solutions of iron imbalance in the blood and body as a whole. Homoeopathy being a science of exactness needs differential diagnosis to choose the correct medicine pertaining to a case of a disease. Pathological tests give us that exactness. But yes, in pregnancy cases with low MCV (iron deficiency) or high MCV (folic acid deficiency) demand of iron and folic acid is high, one may give regulated supplementation of iron. In other cases homoeopathic individualization works wonders. Haemochromomatosis is yet another disorder of iron metabolism with excess deposition of iron in the tissues with bronze skin pigmentation. Iron overload or haemochromomatosis are silent and can result in cirrhosis of the liver, bacterial infections, dementia, arteriosclerosis, diabetes and stroke.
Aetiology and Homoeopathic Management
IRON DEFICIENCY ANAEMIA / IRON IMBALANCE
1. Pulsatilla in lower potencies acts well as a chelating agent. It has great power to expel the undesired iron or an excess of iron from blood as well as from body. Generally it is needed to expel the iron from infants who have gone through iron supplement after birth or before birth through the mother. Pulsatilla 6 or 30 takes care of in a weektime. The baby after the use of Pulsatilla becomes healthy.
2. Kali Phos 6X and Natrum mur 6X combination removes the iron deficiency if the cause is mechanical without any disease.
3. Sulphur 0/1 normalises the blood circulation within 20 to 30 days and in doing so, it removes many disorders like convulsion, epilepsy and burning of soles and palms.
4. The functions of Copper, Manganese, Cobalt and Nickel are complementary as far as haemoglobin synthesis is concerned. These elements act as a fixating and fastening element for iron in the haemoglobin. The deficiencies and bad assimilation of these elements produce different varieties of anaemias. Cuprum met, Manganum, Cobaltum and Nickel in potencies are easy solutions to these anaemia’s. The action of Copper against Molybdenum and sulphate ions is antagonistic. Copper intake remaining normal, low intake of Molybdenum and sulphate produces copper poisoning, whereas excessive intake of the two leads to copper deficiency. However, during treatment of anaemia, it is better to suggest the patient, a diet supplement such as nonacca, khajoor ( date ), banana, taking sugar cane or sugar cane juice instead of chemical iron supplement.
Other remedies are :
· Calcarea Phos – This remedy acts by supplying new blood cells to the body. Patient is chlorotic, has waxy complexion with constant headache and ringing in ears. Helps patient with Vit B12 deficiency, i.e., pernicious anaemia. Nutrition is defective and results in cerebral anaemia. There is vertigo, palpitation with anxiety followed by trembling weakness, particularly the calves, weariness and the greatest weakness. Children are anaemic, peevish, flabby, have cold extremities and feeble digestion.
· Ferrum Phos – Schussler says : “ Iron, which enters into the formation of young blood cells, is never absent in the blood stream of the chlorotics. “ This remedy, by its power of attracting oxygen colors the new blood cells and enrich them after they have been supplied by Calc Phos. Calc Phos 6X and Ferrum Phos 6X is inevitable in severe anaemias as one supplies new blood cells and other colors it red.
· Natrum Mur – Prolonged intake of excessive salt causes profound nutritive changes in the system, resulting in salt retention and alteration in the blood causing a condition of anaemia resulting in dropsies and oedema. Blood is thin and watery. Young girls are chlorotic with coldness feeling of back, dead, dirty skin, easily fatigued and prostrated. Patient is craving for salt.
· Calcarea Ars – Fleshy women at climacteric having palpitation from slightest motion. Chilliness feeling. Haemoglobin and red corpuscles low.
· Ferrum Met – False plethora with abnormal paleness of all mucous membranes, pale face flushing up red on emotion. Anaemic murmur in the veins of the neck, chilly with hectic flush in the evening and oedema of the extremities. Pulsating headache, throbbing all over the body. The patient has mild anaemia.
ACCIDENTS / SURGERY
· Arnica – bad effects resulting from mechanical injuries. Conjunctival or retinal haemorrhage. Extravasation from injuries causing anaemia. This remedy facilitate absorption of exudated blood in brain after mechanical or traumatic injuries.
· Millefolium – Anaemia after haemorrhages. Haemorrhages are painless, without fever, bright red, fluid blood; from lungs, bronchi, larynx, mouth, nose, stomach, bladder, rectum, uterus of mechanical origin. Wounds bleed profusely, especially after a fall. Haemoptysis after injury.
· China – Anaemia from loss of blood.
· Hamamelis – Checks haemorrhages from incised, lacerated, contused injuries. Removes pain and soreness. Traumatic nosebleed where flow is passive, long lasting, blood non-coaguable.
· Other remedies are Lachesis, Sulphur, Phos, Phos acid, Nat mur.
CHILDBIRTH / MISCARRIAGE
· Sabina – haemorrhage from uterus following abortion or premature labor. Flow partly pale red, partly clotted. Pain from sacrum to pubes. Worse from least motion.
· Cinnamon – controls profuse and dangerous flooding. Fingers swollen, no desire for anything. Safer for women compared to Secale cor.
· Secale Cor – Adapted to women of thin, scrawny, feeble cachectic appearance; irritable, nervous temperament; pale sunken countenance. Women with lax muscular fibre; everything seems loose and open, no action ; vessels flabby; passive haemorrhages, copious flow of thin, black, watery blood, the corpuscles are destroyed.
· Hamamelis – Milk leg, haemorrhoids and sore nipples after childbirth. Haemorrhage active or passive from jolting while riding over rough roads, bearing down pain in back.
· Ustilago – profuse menses after miscarriage, discharge of blood from the slightest provocation ; bright red, partly clotted. Haemorrhage due to flabby condition of the uterus.
· Erigeron- haemorrhage from the uterus with dysuria ( burning micturition ). Profuse bright red blood. Bloody lochia returns after least motion, comes in flushes between periods in women with weak uterus.
· Nux Mosch – constant bleeding after labor. Drowsiness and sleepiness. Stupor and insensibility; unconquerable sleep. Great dryness of the mouth, but no thirst.
NOSEBLEEDS: Aconite, Belladonna, Hammamelis , Phos, Millefolium ,Bovista, Crocus, Pulsatilla, Sabina, Ferr-pic.
HAEMORRHOIDS: Aesculus, Aloe, Collinsonia, Hammamelis, Blumea, Paeon, Ratania, Mur-ac, Nit-ac, Phos.
ULCERS IN STOMACH OR SMALL INTESTINE: Hydrastis, Kali-bi, Lyco, Nux-v, Phos, Psor, Sep, Ornithogalum.
CANCER AND POLYPS IN DIGESTIVE TRACT: Hydrastis, Kali- carb, Nit-ac, Cundurango, Ars, Alumina.
HEAVY MENSTRUAL BLEEDING
· Aletris – The China of uterine organs. Menorrhagia and dysmenorrhoea. Anaemic, relaxed condition. Patient is tired all the time and suffers from prolapsus.
· Phosphorus – Menses too early, too copious, bright red. Anaemia in deep seated chronic diseases in tall, slender, narrow-chested phthisical patients, easily catching cold.
· China – Anaemia from loss of vital fluids. Women who do not make blood after haemorrhages and develop a gradually increasing anaemia with feeble circulation and dropsy.
· Nat mur – Anaemic and cachectic from profuse menses.
· Helonias – Anaemia from prolonged haemorrhages in those enervated by luxury or worn out with hard work. Sleepless and melancholic. Tired, weak with backache. Better when doing something.
· Cyclamen – Menses profuse, black, membranous, clotted, too early with labor like pains from back to pubes. Menstrual irregularities with migraine. Sleepiness, moroseness and lassitude.
SCANTY MENSES YET ANAEMIC
· Pulsatilla – Late, scanty, dark and painful protracted menstruation. Patient is sad, easily crying, seeks consolation. Pain under clavicles, absence of thirst and weak digestion.
· Sepia – Similar to Puls, but differs in mental symptoms. Sepia is irritable, often vehement, averse to household duties.
· Zincum met – Too anaemic to develop menses. Progressive general emaciation, burning along spine, twitching of muscles, jerking of body during sleep.
· Graphites – Although obese, anaemic. Menses are late, scanty, pale, watery. Patient is low spirited and chilly. Skin cracked and fissured. Generally constipated.
· Manganum- Suitable for chlorotic girls, waxy, anaemic, pallid, sickly. Long period of scanty menstruation, or the menses have been delayed until the patient was eighteen or twenty years of age.
ANAEMIA WITH CHRONIC DISEASES e.g. RHEUMATOID ARTHRITIS
· Calc Phos – Anaemias after acute and chronic wasting diseases. Patient is dark complexioned, dark hair and eyes and thin spare subjects.
· Ferrum Met – Anaemia associated with chronic RA, rheumatism of the shoulder and hip joints. Marked symptoms such as stiffness and pain subside when the anaemia is treated. Palpitations on least exertion and an unusual aversion to work on account of weakness and pain.
· Ferrum Phos – Anaemia with rheumatism of the neck joints, shoulders, hands and fingers. The fingers are swollen and in long standing cases, there may be contractures and deformities. The palms may be usually hot to touch. All symptoms of anaemia such as lethargy, easy fatigue, shortness of breath, paleness, weakness with swollen joints, stiffness and pain.
· China – Anaemia with Rheumatoid arthritis.
· Alfalfa – Improves stamina, improves appetite and helps in the proper digestion and absorption of nutrients. Due to chronic RA, there is very possibility that there may be loss of appetite and a generalized weakness.
Kali Phos – Leukaemia induced by long continued disorder such as diphtheria, reflex paraplegia. Cerebral anaemia causing undue nervousness.
Carcinosin, Calc Phos, Ceanothus, Nat – sulph, Nat – Ars, Phytolacca, Ars, Benzolum.
INCREASED RED BLOOD CELL DESTRUCTION – ENLARGED SPLEEN
· Ceanothus – Pain on left side of abdomen, unable to lie on the left side. Enormous enlargement of spleen leading to anaemia.
· Iodum – Spleen sore and enlarged. Hepatospleenomegaly. Rapid metabolism : Loss of flesh with great appetite. Lymphatic glands are also enlarged.
· Manganum aceticum – Anaemia with destruction of the red corpuscles. This remedy can be used as a palliative in hereditary anaemias.
· China – Spleen swollen and enlarged with marked debility.
INCREASED RED BLOOD CELL DESTRUCTION- HAEMOLYTIC ANAEMIA
· Phosphorus – Phosphorus corresponds to yellow fever in many particulars. Liver and blood is disorganized with jaundice. Haemorrhages. It can cause fatty degeneration of the liver; and corresponds also to fatty degeneration of pancreas with gastric symptoms. Sweat profuse, exhausting on slightest exertion; profuse at night; cold and clammy, smelling of Sulphur or of garlic.
· Argentum Nitricum – Destroys red blood corpuscles, producing anaemia with intolerance of heat.
· T.N.T ( 3- Trinitrotoluenum ) – The destructive action of T.N.T on the RBCs is responsible for the anaemia and the jaundice with their secondary symptoms. The haemoglobin is changed so it cannot act satisfactorily as an oxygen carrier and as a result we have breathlessness, dizziness, headache, faintness, palpitation, undue fatigue, muscle cramps and cyanosis; also drowsiness, depression and insomnia.
· Crotalus – specific for haemolytic jaundice.
RED BLOOD CELL COUNT IS HIGH – POLYCYTHEMIA
When the number of RBC is too high, blood can become thick, which may cause the blood to clot more easily and increase the risk of heart attacks and strokes. This disease is rare and often diagnosed after the age of 60. Men are diagnosed more with this disease than females. To prevent the situation Phosphorus is given. Phosphorus averts sudden prostration, fainting and sweat.