International Journal of Advances in Medicine

Fatima SH et al. Int J Adv Med. 2022 Mar;9(3):xxx-xxx

http://www.ijmedicine.com pISSN2349-3925 | eISSN2349-3933

DOI: https://dx.doi.org/10.18203/2349-3933.ijam2022????
Original Research Article

A study of anemia profile in a research hospital in

Telangana, South India
Syeda Hajra Fatima1*, Tasleem Ahmad2, Sree Latha1, Ghazala Javed3, Ahmed Minhajuddin4

1
Department of Pathology, 2Department of Biochemistry, 4National Research Institute of Unani Medicine for Skin
Disorders, Hyderabad, Telangana, India
3
Central Council for Research in Unani Medicine, New Delhi, India

Received: 22 December 2021

Revised: 31 January 2022
Accepted: 01 February 2022

*Correspondence:
Dr. Syeda Hajra Fatima,
E-mail: dr.syeda.hajra04@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Anemia is widespread public health problem with 1.62 billion people affected globally. In India,
Anemia is considered a major health problem. Children, women of child bearing age and pregnant women are more
prone to develop anemia. Anemia affects the physical and mental growth of children, associated with increase
maternal and fetal mortality, leads to reduced work productivity in adults. The present study was undertaken to
determine prevalence and severity of anemia among patients who attended the outpatient clinics of a Unani research
hospital in Telangana.
Methods: This hospital based retrospective observational study was conducted from January 2020 to December 2020
to investigate the prevalence, type, and determinants of anemia. The complete haemogram values of all the patients
who underwent haemogram investigation were noted, information was compiled, tabulated, and analysed. Descriptive
statistics were computed with percentages, mean, standard deviation, and student’s t-test was used find the
significance of study parameters.
Results: Prevalence of anemia was 26.2% (872/3326), high prevalence of anemia was observed in females (44.04%)
compared to males (5.72%) (p<0.0001). The prevalence was more in reproductive age group (58.6%). Moderate
anemia (58.6%) was more prevalent followed by mild anemia (36.6%). Microcytic hypochromic blood picture
predominates with the incidence of 53.6% followed by normocytic blood picture 42.2%.
Conclusions: Results confirmed high prevalence of anemia in females and moderate anemia being more prevalent
followed by mild anemia and majority of anemia cases were microcytic, suggesting iron deficiency as the main cause
of anemia.

Keywords: Hemoglobin, Anemia, Microcytic, Hypochromic

INTRODUCTION Anemia is a widespread public health problem associated

with an increased risk of morbidity and mortality.
Anemia is defined by WHO as a condition in which the According to the world health organization (WHO),
Haemoglobin content of blood is lower than normal as a globally around 1.62 billion people are affected with
result of deficiency of one or more essential nutrients, anemia, which is around 24.8% of the world population .2
regardless of the cause of such deficiencies. Anemia is Anemia is still considered a major health problem in
established if the haemoglobin is below the cut-off points India. In the 2005- 2006 national family health survey
recommended by WHO.1 (NFHS-3), revealed a high prevalence of anemia among
in children (78.9%) aged 6-59 months, 55% in females

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 Fatima SH et al. Int J Adv Med. 2022 Mar;9(3):xxx-xxx

aged 15-49 years, and 24% in males aged 15-49 years from January 2020 to December 2020, to
years.3The most common cause of anemia globally is investigate the prevalence, type, and determinants of
thought to be Iron deficiency, but other nutritional anemia among patients coming to hospital. The complete
deficiencies (folate, vitamin A and vitamin B12), acute haemogram values for the all the patients who underwent
and chronic nonspecific inflammation, parasitic haemogram investigation were noted and all the patients
infections, and inherited or acquired disorders that affect with haemoglobin percentage less than the normal level
haemoglobin synthesis, red blood cell production or red defined by WHO criteria according to the age and sex
blood cell survival, can all cause anemia.4 were included in the study.4 Exclusion criteria- all the
patients whose haemoglobin percentage is within the
Anemia has serious long term consequences as the normal range as per the WHO criteria were excluded
disease progress. It will not only affect the growth of from the study.4 Further based on the haemoglobin
children and adolescence but also affects their percentage, they were classified into mild moderate and
attentiveness, memory and school performance. 5 It also severe anemia as per WHO criteria (Table 1).4 A total of
causes delay in onset of menarche, affects immune 3326 samples that underwent haemogram investigation
system leading to frequent infections.6 Anemia during during the study period were included in the study. The
pregnancy is associated with maternal mortality, preterm study was conducted after getting the clearance from the
labour, low birth-weight, and infant mortality.7 Anemia institutional ethical committee.
leads to reduced work productivity in adults which can
have further social and economic impacts for the Table 1: Classification of anemia as per WHO
individual and family. Anemia can be classified from criteria.
three points of view: pathogenesis, red cell morphology,
and clinical presentation. In practice, classification based Mild Moderate Severe
Age
on basic parameters of red cell morphology such as mean anemia anemia anemia
corpuscular volume (MCV), allows for a quicker Children:
10-10.9 7-9.9 <7
diagnostic approach.8 Mean corpuscular volume (MCV) 6-59 months
measures the average size and volume of a red blood cell Children:
expressed in femtoliters (fl), while mean corpuscular 11-11.4 8-10.9 <8
5-11 years
hemoglobin (MCH) measures the mean hemoglobin per Children:
erythrocyte expressed in pictograms (pg).9 Mean 11-11.9 8-10.9 <8
12-14 years
corpuscular hemoglobin concentration (MCHC) measures Female:
the concentration of hemoglobin in a given volume of 15 years and 11-11.9 8-10.9 <8
packed red blood cell expressed in g/dl.9 above
Male:
Anemia is classified based on its morphology into 15 years and 11-12.9 8-10.9 <8
Microcytic Hypochromic, Normocytic normochromic above
and macrocytic depending on MCV and MCH.9,10
Microcytic anemia is a type of anemia where the average
Statistical analysis
erythrocyte is smaller than normal (MCV, 80 fl),
Commonly seen in chronic iron-deficient anemia, anemia
Data obtained were compiled, tabulated, and analysed.
of chronic disease, sideroblasticanemia, and thalassemias
Descriptive statistics were computed with percentages,
but can also occur in other conditions. Macrocytic anemia
mean, standard deviation, and student’s t-test was applied
is a type of anemia where the average red blood cell
to test the association of age with occurrence of anemia,
volume is larger than normal (MCV >100 fl) seen in
p<0.05 was considered statistically significant.
folate deficiency, vitamin B12 deficiency, hepatic
insufficiency, chronic alcoholism among other causes.
Normocytic anemia is anemia with a low hemoglobin but RESULTS
MCV in the normal range of 80 to 100 fl, causes include
nutritional deficiency, renal failure and haemolytic- Out of 3326 samples, 872 (26.2%) patients were
anemia.8,10 The present study was conceived and designed diagnosed with anemia (Table 2). Among 872 patients,
with the objective to determine prevalence and severity of 788 (90.3%) were female patients and 84 (9.6%) were
anemia stratified by age and gender among patients who male patients (Table 3). Anemia is most commonly
attended the outpatient clinics of a Unani hospital in observed in 30 -40 years age group (37.5%) followed by
Telangana, India. 21.1% in 21-30 age group (Table 4). Most common being
moderate anemia constituting 58.6% followed by mild
METHODS anemia (36.6%) (Table 5). Peripheral smear examination
showed, out of 872 patients, microcytic hypochromic
blood picture was predominant constituting (53.6%)
This was a hospital based retrospective observational
followed by normocytic normochromic blood picture
study conducted in the department of pathology at
constituting (42.2%) and macrocytic smear being 2.3%.
National research institute of Unani medicine for skin
1.8% cases were dimorphic anemia (Table 6).
disorders, Hyderabad, Telangana for duration of one

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 Fatima SH et al. Int J Adv Med. 2022 Mar;9(3):xxx-xxx

Haematological indices revealed the Mean RBC count for In this observational study using routine clinical data
males was4.37 million cells/mcl and in females it was from a large number of patients attending the outpatient
4.38 million cells/mcl. Mean haematocrit value in males clinics of a Unani research hospital in India, anemia was
was 32.43% and in females 31.24%. Mean MCV value in present in 26.2% of blood sample. The high proportion of
anemic patients in our study is 71.51fl and mean MCH anemia was observed in females (44.04%) compared to
value is 23.67 Pg while Mean MCHC value was observed Males (5.72%) and the difference was statistically
to be 32.94 g/dl (Table 7). significant (p<0.0001). This finding was consistent with
prior studies done by Kandasamy et al, Sanjay et al and
Table 2: Prevalence of anemia Vitull et al.11-13 These findings coincides with NFHS-4
data of Telangana state where 56.6% of women age 15-
Total samples N % 49 were anemic while only 15.3% males aged 15-49 were
3326 872 26.2 reported to be anemic, indicating more prevalence of
anemia among females compared to males.14
Table 3: Gender wise distribution of anemic patients.
The present study revealed that the prevalence of anemia
Gender Anemia Non anemia % P value is more in reproductive age group (20-40 years) which
Female 788 1789 44.04 accounts for 58.6% of total anemic patients. This finding
<0.0001 is similar to studies done Raghuram et al where
Male 84 1537 5.72
prevalence of anemia was more among women aged 26-
40 years (63.2%) and Thankachan et al where prevalence
DISCUSSION
rate of anemia in reproductive age group women was
observed to 39%. Kandasamy et al study also
Anemia is a global health problem with major impact on
demonstrated the higher prevalence of anemia in age
health and wellbeing. Worldwide around 1.62 billion
group 18- 30 (40.4%) and 31-50 (42.4%).11,15,16 It was
people are affected with anemia, which is around 24.8%
found in many studies that anemia is a common problem
of the world population. Despite recent economic growth
in reproductive age group women due to low income
and awareness among people, the prevalence of anemia
leading to low dietary intake of iron rich food,
among various age groups still persist in India and is the
multiparity, lack of awareness, chronic blood loss or
important contributor to extreme health conditions such
disease, mal-absorption, or a combination of all these
as fatigue, malaise, neurological dysfunction, poor focus
factors. Our study depicted that out of 872 patients, 511
and attention. Many studies have reported previously the
(58.6 %) patients had moderate anemia, while 320
possible causes of anemia in the Indian population, such
(36.6%) of patients had mild anemia and only 41 (4.7 %)
as poor intake of iron and other essential nutrients,
were having severe anemia.
reduced intake of vitamin C, repeated child bearing,
lactation, and inadequate access to nutritional
supplements after menarche and during pregnancy.

Table 4: Grading of anemia based on age.

Mild anemia Moderate anemia Severe anemia

Age (years) Total %
(11-11.9) ( 8-10.9) (< 8)
<10 12 13 2 27 3
11-20 43 50 3 96 11
21-30 62 113 9 184 21.1
31-40 117 195 15 327 37.5
41-50 51 91 10 152 17.4
51-60 28 33 0 61 6.9
>60 7 18 0 25 2.8

Table 5: Grading of anemia based on severity.

Anemia severity N % Mean Standard deviation P value

Mild anemia (11-12 g/dl) 320 36.6 11.47 0.28 <0.0001
Moderate anemia (8 -10.9 g/dl) 511 58.6 9.80 0.79 <0.0001
Severe anemia (<8 g/dl) 41 4.7 7.38 0.60 <0.0001

These finding do not coincide with NFHS-4 data of moderate anemia cases in our study could be either poor
Telangana state in which mild anemia was commonest compliance of women in taking iron and folic acid tablets
(37%).8,10,11,14 The reason for higher incidence of

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 Fatima SH et al. Int J Adv Med. 2022 Mar;9(3):xxx-xxx

supplied to them by the government or concurrent severe Anemia cases in females, while 34.3% mild,
nutritional deficiency. 17.7% moderate and 1.2% severe anemia cases in
males.11,17
Table 6: Type of anemia based on peripheral smear
examination. In our study, microcytic hypochromic blood picture
predominates with the incidence of 53.6% followed by
Peripheral smear normocytic blood picture 42.2% while macrocytic and
Total subjects %
examination dimorphic smear accounts to 2.3% and 1.8% respectively.
Normocytic Normochromic 368 42.2 As iron deficiency anemia (IDA) is depicted as
Microcytic Hypochromic 468 53.6 microcytic hypochromic blood picture, finding in our
Macrocytic 20 2.3 study is comparable to the report of NFHS-4 showing
Dimorphic smear 16 1.8 prevalence of 44.8% as the most significant contributor to
the onset of Anemia is iron deficiency. This is also in
The findings of present study coincide with study done concordance with the study by Gerado et al which
by Kandasamy et al where moderate anemia was 45.89% showed microcytic Anemia was more prevalent in
children and women, the proportion of normocytic
and mild anemia was 52.73%. Study done by Verma et al
anemia increased progressively with age in male adults
also showed 48.7% mild, 19.9% moderate and 1.5%
and women after menopause age.18
Table 7: Hematological indices in anemic patients.

Normal reference range, Low value, High value, Standard

Blood indices Mean
N N N deviation
RBC count Male 42 40 2 4.37 0.78
(million cells/mcl) Female 717 54 17 4.38 0.54
Male 21 63 0 32.43 6.35
HCT (%)
Female 151 637 0 31.24 3.97
MCV (fl) 188 669 15 71.51 11.37
MCH (pg) 149 723 0 23.67 3.50
MCHC (g/dl) 776 96 0 32.94 1.07

In present study, the Hematocrit value in anemic patients and female which will help in devising a proper
in our study was 31.24% in females and 32.43% in male prevention and treatment plan for anemia.
which is lower compared to normal value. No statistical
significant difference was observed in Hematocrit value CONCLUSION
in females compare to males. The mean MCV value in
anemic patients in our study is 71.51 fl and Mean MCH The present retrospective observational study confirmed
Value is 23.67 Pg , these values are lower compared to 26.2% prevalence of anemia among the patients attending
normal reference values, suggesting microcytic the study hospital with high prevalence in females and
hypochromic anemia probably due iron deficiency to be moderate anemia being more prevalent and majority of
more common in the present study.19,20 anemia cases were microcytic, suggesting iron deficiency
as the main cause of anemia.
In present study the vast majority of anemia cases were
microcytic, suggesting that iron deficiency was the main ACKNOWLEDGEMENTS
cause of anemia. The present study re-emphasize that
anemia still is an important public health burden Authors are thankful to director general, CCRUM,
especially in women, although the prevalence is less ministry of AYUSH for providing necessary facilities.
when compared to decade ago. The presence of anemia
need to be evaluated in details as the aetiology is Funding: No funding sources
multifactorial and the underlying cause should be treated Conflict of interest: None declared
first. The screening programs to identifying the high risk Ethical approval: The study was approved by the
population and Educational programs to sensitize high Institutional Ethics Committee
risk people about the balanced diet and dietary
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