Introduction
Anemia is defined as Haemoglobin level in the blood is below the lower extreme of the normal range for the age and sex of the individual.1
The prevalence of anemia is 55.3% among women of reproductive age (non pregnant, non lactating women) and 24% of men, 69.5% in children .
In India, anaemia is the second most common cause of maternal deaths, accounting for 20% of total maternal deaths. Anaemia affects mainly the women in child bearing age group, young children and adolescent girls.
Association of anaemia with adverse maternal outcome such as puerperal sepsis, ante-partum haemorrhage, post-partum haemorrhage and maternal mortality is no longer a debatable subject.
Apart from the risk to the mother, it is also responsible for increased incidence of premature births, low birth weight babies and high perinatal mortality.2
Iron, folic acid, and vitamin B12 deficiency is expected among adolescents with poor nutrition. Their deficiency is of concern in India, as undernutrition was observed among about 60.0% of female and 45.0% male adolescents. Also, surveys have also observed significant prevalence of iron deficiency anemia among adolescents.3,4
Anemia is a common condition in the older population, and the prevalence of anemia rises with advancing age. Although it was previously believed that declines in hemoglobin levels might be a normal consequence of aging, evidence has accumulated that anemia does reflect poor health and increased vulnerability to adverse outcomes in older persons. Even in persons 85 years and older, those meeting the World Health Organization (WHO) definition of anemia were found to have higher subsequent mortality rates than persons who were not anemic.5
Weakness, malaise and easy fatigability are complaints. Decreased oxygen content of circulating blood leads to dyspnea. Hypoxia leads fatty change in liver, myocardium and kidney.6
Anemia is also a common in elderly persons and can have more complications than anemia in younger adults. All the types of anemia are known to occur in this age group. Failure to evaluate anemia in elderly could lead to delayed diagnosis of treatable conditions.7
Objectives
To calculate the prevalence of anemia in children, women of reproductive age group and elderly patients in and around Mandya District.
To study the pattern of anemia in these patients.
Materials and Methods
All the patients for whom investigations were sent to the central lab in Mandya Medical College and Hospital from May 2018 to December 2018 over a period of 6 months.
Their blood samples were drawn and results were obtained through Hematology analyzer and slides for peripheral smear study were prepared by Leishman staining.
These slides were viewed under microscope and observations were noted down.
Inclusion criteria 1.Children in age group (1-15 years, male and female children) 2.Women of reproductive age group(16-40yrs) and Males (20-60 years) 3.Elderly (> 60 years both male and female) 4.Hb < 13gm/dl in males, Hb <11gm/dl in children 1-12 years and pregnant females, Hb < 12gm/dl in children 12-15 years and non pregnant women)
Results
Out of 1000 cases taken for studying the distribution of subjects it has been noted that women of all groups were the highest (51.9%) followed by Males (28%) which was followed by children (20.1%).
Table 1
| Gender | Number of subjects | Percentage |
| Children | 201 | 20.1 |
| Women Reproductive age group, Pregnant and Elderly females | 519 | 51.9 |
| Males including elder patients | 280 | 28 |
| Total | 1000 | 100 |
Distribution of study subjects out of 1 000 cases for prevalence of anemia
Out of 201 children taken for studying the prevalence 57.21% of them were female children and 42.79% were male children.
Table 2
| Gender | Number of subjects | Percentage | |
| Children | Male children | 86 | 42.79 |
| Female children | 115 | 57.21 | |
| Total | 201 | 100 |
Distribution of study subjects according to sex in children for prevalence
Based upon the peripheral smear study the most common pattern of anemia in children was found to of microcytic hypochromic anemia (74.63%) followed by normocytic normochromic anemia (13.93%), normocytic hypochromic anemia (4.98%) and Dimorphic(6.46%).
Table 3
| Pattern of anemia | Total number of subjects | Percentage |
| Microcytic hypochromic | 150 | 74.63 |
| Normocytic normochromic | 28 | 13.93 |
| Normocytic hypochromic | 10 | 4.98 |
| Dimorphic | 13 | 6.46 |
| Total | 201 | 100 |
Pattern of anemia in children on the basis of peripheral smear.
Out of 519 cases taken for studying the pattern of anemia in women of reproductive age group 350 were non pregnant,130 of them were pregnant women and 39 were Elderly females
Table 4
| Number of subjects | Percentage | |
| Non pregnant | 350 | 67.44 |
| pregnant | 130 | 25.05 |
| Elderly | 39 | 7.51 |
| Total | 519 | 100 |
Distribution of number of subjects based upon pregnant, non pregnant women and Elderly females in study subjects.
Microcytic hypochromic anemia was the most common pattern of anemia based upon the peripheral smear followed by Dimorphic and Normocytic Normochromic anemia in pregnant women.
Table 5
| Pattern of anemia | Total number of subjects | Percentage |
| Microcytic hypochromic | 110 | 84.62 |
| Dimorphic | 10 | 7.69 |
| Normocytic Normochromic | 10 | 7.69 |
| Total | 130 | 100 |
Pattern of anemia in women in pregnancy on the basis of peripheral smear.
It has been noted that Microcytic hypochromic anemia was the most common type of anemia in women of reproductive age group followed by Normocytic normochromic anemia, Dimorphic anemia and Macrocytic anemia.
Table 6
| Pattern of anemia | Number of subjects | Percentage |
| Microcytic hypochromic | 280 | 80 |
| Normocytic normochromic | 40 | 11.43 |
| Macrocytic | 20 | 5.71 |
| Dimorphic | 10 | 2.86 |
| Total | 350 | 100 |
Pattern of anemia in women of reproductive age on the basis of peripheral smear.
It has been noted that Microcytic hypochromic anemia was the most common type of anemia in women of Elderly age group followed by Normocytic normochromic anemia, Dimorphic anemia.
Table 7
| Pattern of anemia | Number of subjects | Percentage |
| Microcytic hypochromic | 28 | 71.79 |
| Normocytic normochromic | 6 | 15.38 |
| Dimorphic | 5 | 12.83 |
| Total | 39 | 100 |
Pattern of anemia in women of elder age on the basis of peripheral smear.
Table 8
| Number of subjects | Percentage | |
| Males (15-60) | 215 | 76.79 |
| Elderly(>60) | 65 | 23.21 |
| Total | 280 | 100 |
Distribution of number of males including elderly males.
It has been noted that Microcytic hypochromic anemia was the most common type of anemia followed by Normocytic normochromic anemia, Dimorphic anemia in males.
Table 9
| Pattern of anemia | Number of subjects | Percentage |
| Microcytic hypochromic | 110 | 51.16 |
| Normocytic normochromic | 80 | 37.21 |
| Dimorphic | 25 | 11.63 |
| Total | 215 | 100 |
Pattern of anemia in males(15-60) on the basis of peripheral smear
It has been noted that Microcytic hypochromic anemia was the most common type of anemia followed by Normocytic normochromic anemia, Dimorphic anemia in males.
Table 10
| Pattern of anemia | Number of subjects | Percentage |
| Microcytic hypochromic | 40 | 61.54 |
| Normocytic normochromic | 15 | 23.08 |
| Dimorphic | 10 | 15.38 |
| Total | 65 | 100 |
Pattern of anemia in Elderly males(>60) on the basis of peripheral smear
Most common cases of anemia in all age groups were Iron deficiency, Vitamin B12 deficiency, Helminthic infections, Vitamin B12 + Iron deficiency, Anemia of chronic disorders.
Discussion
Neeraj Jain and Vibha Mangal Jain done study in 2010 regarding prevalence of anemia in school children aged 5-16 years from government school of Rishikesh, Uttaranchal, India and found anemia in 51.5% of cases. Most common blood pic ture was microcytic hypochromic. In our study in children microcytic hypochromic anemia was found to be predominant type accounting for 74.63% with iron deficiency anemia being noted in 80% of cases.8
In the present study, in children both males and females microcytic hypochromic anemia (74.63%)was common followed by, normocytic normochromic anemia (13.93%), normocytic hypochromic anemia (4.98%) and dimorphic anemia (6.46%) which is somewhat similar to study done by Kapur et al , where microcytic hypochromic anemia was the commonest type (43.2%) followed by normocytic normochromic anemia (27%), normocytic hypochromic anemia (17%), macrocytic anemia (10%) and dimorphic anemia (2.7%).9
According to WHO in India 88% of pregnant and 74% of non pregnant women are affected . In our study it has been noted that anemia in pregnant women accounts for 25.04% and non pregnant women accounts for 67.44% which corroborates with WHO findings as study subjects were less.10
In our study in elderly, microcytic hypochromic anemia was the most prevalent anemia accounting for 71% of all the cases closely followed by normocytic normochromic anemia accounting for 25%. Elis et al. have shown that most common anemia in elderly is microcytic hypochromic anemia.11
Conclusion
Identifying anemia is an important aspect and absolutely essential for the further clinical detection. Confirming the type of anemia is critical to direct the investigation for profiling the etiology.
Iron deficiency anemia is a serious problem worldwide and a major concern in developing countries. In our study we found to have higher prevalence of iron deficiency in all the study subjects. The main reason behind this nutritional anemia could be due to low socio economic status, increased demands, low dietary intake and excessive loss of blood.
Proper diagnosis of anemic cases prevent morbidity and mortality further in life and patients get adequate treatment.
