Anaemia due to iron deficiency is seen in adolescent (growing children) age group, females during their reproductive age period (due to menstrual losses), pregnancy (increased demand of the body) and elderly (due to occult losses from the Gastro Intestinal Tract). Iron deficiency can also develop as a consequence of chronic diarrhoea but that is usually accompanied with deficiency of other important elements (like Vit B12, folic acid).

Although the most common cause of having anaemia is iron deficiency, we must be aware of a genetic disorder known as thalassemia. This disorder is inherited from parents and presents usually with anaemia. There is a wide range of defects which patients can have, the mildest being thalassemia trait and the most severe thalassemia major. Thalassemia trait usually have mildly low haemoglobin, low RBC indices and a high total RBC count. This disorder usually does not become clinically evident unless patient develops concurrent iron deficiency. Most of the times, this is an incidental finding during routine blood tests but the importance lies if the person is unmarried. If a thalassemia trait person marries another thallasemia trait then there is 25% chance of having a thalassemia major child. Thalassemia major children require regular blood transfusions throughout their lives and its distressing for both the child and the parents. In these patients giving or supplementing oral iron will not help. One should consult the pathologist/haematologist for proper diagnosis.

Other important cause of anaemia is Vitamin B12/Folate deficiency. Vitamin B12 and folic acid are two important ingredients for proper DNA synthesis. Their deficiency will cause improper or defective production of red blood cells which are unable to carry enough haemoglobin. Due to deficiency of these ingredients, the growing cells die inside the bone marrow only, a process known as dyserythropeoisis and thereby resulting in anaemia. This type of nutritional deficiency is more commonly seen in vegeterians, since animal products (meat) is one of the major source of Vitamin B12. It is not implied that all vegeterians will suffer from this deficiency as many of the vegetables also contain enough quantities of these vitamins. This deficiency is propentiated with other underlying disorders like malabsorption, chronic alcohol intake and pernicious anaemia. Pernicious anaemia is disease where the body looses the ability to absorb vitamin B12 due to lack of a molecule which transports this vitamin from intestines to blood.

Other diseases which can lead to anaemia are haemolytic anemias, where the red blood cells break down in the circulation due to either a defect within their structure or presence of antibodies against them. This form of anaemia is usually accompanied with development of jaundice and an enlarged spleen. Lot of genetically acquired conditions can lead to haemolytic anaemia and that is the reason, this group of disorders is commonly seen in children. There are a whole lot of external causes which can lead to hemolysis which most importantly include- Drugs and viral infections. A careful look at the peripheral blood film by the pathologist can certainly diagnose this situation.

Other rare forms of anaemia include Aplastic anaemia in which due to some inherent defect in the bone marrow, the body is incapable of producing any blood cell. A Bone marrow examination is essential to diagnose this condition.

Chronic disease like Chronic Kidney Disease also lead to anaemia due to either non-utilization of iron in the body or by suppressing the bone marrow.

Leukemias (Blood cancer) can also produce rapid anaemia. It is mainly due to the fact that the cancer cells don’t allow other cells to grow in the bone marrow.

If any of the above mentioned features are seen, the patient should visit a nearby quality medical laboratory and ask for Complete Blood Counts (CBC), Peripheral Blood Film and a Reticulocyte count. In the past these tests were performed manually, but in today’s world, these tests are performed on fully automated machines which are much more sensitive and lack human errors. But these machinery oriented results need to be verified and reconfirmed by an experienced pathologist. So, do consult your pathologist before leaving the laboratory so as to confirm the nature and cause of the underlying process which is leading to anaemia.