Anaemia means a reduction in the quality of the red cells. This may include their actual numbers, or the haemoglobin content of the cells. Apart from this, they are often strange-shaped. Instead of looking like two “biconcave discs” when inspected under the microscope, they have weird shapes, referred to as poikilocytosis. Deficiency of either vitamin B12 or folic acid can lead to an important and potentially serious form of anaemia. It has nothing to do with the production of haemoglobin that continues normally. It affects the ability of the bone marrow to produce the red cells themselves. The red cells, instead of being normal in shape, are large. They are called megaloblasts, and this is frequently referred to as megaloblastic anaemia. Examination of the bone marrow shows the typical large red cells, quite different from the usual pattern.
Anaemia has various causes. Vitamin B12 deficiency is extremely rare, for the vitamin is widespread in nature. But it can occur in strict vegetarians who refuse to eat any animal product. Folic acid is also widely dispersed in nature, and the usual source is in vegetables. However, in old people living on a poor diet, there may be a deficiency of folic acid, and it is an important cause in alcoholics.
It is worth remembering that folic acid is rapidly destroyed by heat. For this reason, much is lost during cooking. Eating vegetables raw is a good idea, and salads can serve a very useful nutritional function, especially during warm weather. It is worth grasping the opportunity whenever possible, for quite a few essential vitamins are similarly destroyed by cooking.
In some people, although there is an adequate intake of the vitamins, internal disorders do not allow them to be correctly absorbed by the bloodstream, even though they are eaten in adequate quantities. The most likely condition is pernicious anaemia, in which there is a deficiency that interferes with the absorption of vitamin B12 by the bowel.
Often the only indication is that the child looks pale. Frequently this is the only obvious sign. But the child may tire easily, and instead of wanting to run around playing boisterous games, may want to sit down and simply watch them. There may be frequent complaints of feeling weak and tired, often worse with a small amount of activity. Later the patient becomes more listless, and may seem bad tempered and irritable, even though normally possessed of a happy disposition.
Sometimes in more long-standing cases the nails take on a typical spoon shape. In fact this is often diagnostic of anaemia. The nails may grow slowly, often split and crack easily. General body growth may be retarded, and sometimes if untreated, abnormalities occur with the heart, liver and spleen, causing it to become enlarged.
Another strange habit is sometimes in evidence. It’s called pica, and the child may have an abnormal desire to eat strange items. A common one is ice! But it may include chalk, bits of paper, odd foods, or even dirt and clay. Once the anaemia has been cured, the pica vanishes. It’s a remarkable condition, and its cure is also strange.
Ideally she will seek medical attention. The doctor will listen to her story, and then will arrange for blood tests and maybe other investigations to take place. This invariably gives the answer very quickly. The number of red cells may be deficient and the haemoglobin content may also be below normal.
Iron is often prescribed. This will depend on the age of the child. Infants may be given iron in liquid form; older ones may be able to swallow a tablet.
Iron tablets are often a bright, attractive color, and some youngsters mistake them for sweets. Taking excessive amounts of iron is dangerous, and may be life endangering.
It is wise to keep the bottle securely locked away from prying, investigating juvenile hands. I hope all wise mothers will apply this important rule to medicines of all kinds. It’s a good one to live by. So many accidents have occurred through lack of thought as to what the medicines might do to children when taken in unsupervised large quantities. So, mothers, please take the tip and be careful!
Sometimes vitamin C is given for this seems to assist the body absorb and use the iron. What’s more, many natural foods are rich in iron, and it’s a good idea to include these in the daily menu. Liver is perhaps the richest natural source of iron, but beef and veal are also good sources. Yellow fruits are usually high in content, and dried apricots, peaches, prunes and raisins also contain good supplies. Carrots, spinach, peas, sweet potato, wholegrain cereals, eggs, milk and apples are also well-known storehouses and are worth adding to the daily food intake. Fortunately iron is present in many foods so that a wide range of meals is possible, all of which are beneficial.
Some doctors believe that milk is not a good idea, for some children are allergic to this, and it is claimed it may have an adverse rather than a beneficial effect.
Usually the patient does well, gradually starting to feel more alive and alert. There will be a lively interest in vigorous activity, rosy cheeks will develop again, along with normal vitality and spark. The doctor will probably check progress with further blood tests, but these are almost certain to indicate improvement. Keeping an eye on progress of course is vital, for recurrences are possible.
Although the anaemia just described is the most common – doctors call it microcytic hypochromic anaemia – various other kinds do occur, but they are much less common.