Anemia is a clinical manifestation with high prevalence in the world, reaching about 30% of the total inhabitants of the planet. It is responsible for a great reduction in quality of life of affected people. The present paper aimed to obtain the frequency of anemia in the blood counts of a sample from the population of registered patients of a Family Health Team in Dourados, MS, Brazil. 462 patients, who had blood counts done from February 2008 to March 2009, were included in this research. The frequency of anemia was 22.7% in the studied population, including all age groups.
Anemia is a common finding in the world population, affecting both developing countries and industrialized nations. It reaches about 2 billion people worldwide, or about 30% of the total inhabitants of the planet, according to data from the World Health Organization-WHO. Because of such magnitude, it is considered a public health problem. It can greatly affect a person's life, especially in its more severe forms. Anemia causes tiredness, weakness, malaise, and making routine tasks more difficult and painful [
A quantitative and descriptive study, with a retrospective component, using secondary data and blood counts from the medical records of patients subjected to research, was conducted in the city of Dourados, MS, Brazil. Patients ascribed to the Family Health Strategy studied totalize 4,244 people and a purposive sample of 462 patients from that population was used. The sample consists of patients who attended the Health Unit and had blood counts done during the period from February 2008 to March 2009. Pregnant patients were excluded. Data were collected through forms made by the author containing information on sex, age, and hematologic condition of the research subjects. Results were organized into charts and tables with descriptive statistical analysis through Software Excel 2007 and Epi-Info 3.3.2. This research was authorized by Committee of Stage, Practical Class, Research and/or Final Course Work from the Municipal Health Department–CEPET, and it was also approved by Ethics Committee on Human Research from Federal University of Mato Grosso do Sul-UFMS, according to Ordinance MS 196/96, protocol number 1497. Rules for use of information from patients’ records are mentioned in items III.3.i and III.3.t of Resolution CNS 196/96 and they were followed. The present research did not entail risks to patients, since the blood samples had already been collected. It benefits population, since, from the determination of frequency of anemia, prevention and treatment actions can be made.
The frequency of anemia obtained in the studied sample was 22,7%, including all age groups.
The frequency of anemia by age in the studied sample is shown in Figure
Frequency of anemia in users of the Family Health Strategy studied, according to age range, from February 2008 to March 2009, Dourados, MS, Brazil.
Tables
Hemoglobin values according to age range, Dourados, MS, Brazil, 2009.
Hemoglobin values (g/dL or g%)* | Younger than 1 year old | From 1 to 15 years old | Older than 15 years old | |||
| % | | % | | % | |
6.5–7.9 | 1 | 7.7 | — | — | 1 | 0.3 |
8.0–9.4 | 2 | 15.4 | 2 | 2.1 | 2 | 0.6 |
9.5–10.9 | 3 | 23.1 | 14 | 14.7 | 12 | 3.4 |
11.0–12.4 | 7 | 53.8 | 36 | 37.9 | 63 | 17.8 |
12.5–13.9 | — | — | 39 | 41.1 | 135 | 38.1 |
14.0–15.4 | — | — | 3 | 3.2 | 115 | 32.5 |
15.5–16.9 | — | — | 1 | 1.1 | 24 | 6.8 |
17.0–18.4 | — | — | — | — | 2 | 0.6 |
Total | 13 | 100 | 95 | 100 | 354 | 100 |
*g/dL: grams per deciliter of blood.
Hematocrit values according to age range, Dourados, MS, Brazil, 2009.
Hematocrit values (%) | Younger than 1 year old | From 1 to 15 years old | Older than 15 years old | |||
| % | | % | | % | |
21–25.9 | 1 | 7.7 | — | — | 3 | 0.8 |
26–30.9 | 3 | 23.1 | 3 | 3.2 | 4 | 1.1 |
31–35.9 | 4 | 30.8 | 24 | 25.3 | 28 | 7.9 |
36–40.9 | 5 | 38.5 | 61 | 64.2 | 145 | 41.0 |
41–45.9 | — | — | 6 | 6.3 | 135 | 38.1 |
46–50.9 | — | — | — | — | 37 | 10.5 |
51–55.9 | — | — | 1 | 1.1 | 2 | 0.6 |
Total | 13 | 100 | 95 | 100 | 354 | 100 |
Mean Corpuscular Volume (MCV) values according to age range, Dourados/MS, Brazil, 2009.
MCV values ( | Younger than 1 year old | From 1 to 15 years old | Older than 15 years old | |||
| % | | % | | % | |
50–55 | — | — | — | — | 1 | 0.3 |
55–60 | — | — | — | — | — | — |
60–65 | 1 | 7.7 | 1 | 1.1 | 1 | 0.3 |
65–70 | — | — | 1 | 1.1 | 3 | 0.8 |
70–75 | 3 | 23.1 | 4 | 4.2 | 1 | 0.3 |
75–80 | 2 | 15.4 | 11 | 11.6 | 2 | 0.6 |
80–85 | 6 | 46.2 | 17 | 17.9 | 18 | 5.1 |
85–90 | — | — | 50 | 52.6 | 177 | 50.0 |
90–95 | 1 | 7.7 | 11 | 11.6 | 149 | 42.1 |
95–100 | — | — | — | — | 2 | 0.6 |
Total | 13 | 100 | 95 | 100 | 354 | 100 |
In patients aged from 1 to 15 years old and older than 15 years old, the most common hemoglobin values were between 12.5 and 13.9 g/dL, observed in 41.1% and 38.1% of those populations, respectively (Table
Table
The Mean Corpuscular Hemoglobin (MCH) values in 61.6% of patients younger than 1 year old were between 25 and 28.9 ng—30.8% of them with values between 25 and 26.9 ng and other 30.8% with values between 27 and 28.9 ng. It was observed that 45.3% of patients aged from 1 to 15 years old had values of MCH between 27 and 28.9 ng, while 71.8% of patients over age 15 had MCH values between 29 and 30.9 ng (Table
Mean Corpuscular Hemoglobin (MCH) values according to age range, Dourados/MS, Brazil, 2009.
MCH Values (ng) | Younger than 1 year old | From 1 to 15 years old | Older than 15 years old | |||
| % | | % | | % | |
15–16.9 | — | — | 1 | 1.1 | 1 | 0.3 |
17–18.9 | — | — | — | — | — | — |
19–20.9 | 1 | 7.7 | — | — | 1 | 0.3 |
21–22.9 | 1 | 7.7 | 3 | 3.2 | 3 | 0.8 |
23–24.9 | 3 | 23.1 | 3 | 3.2 | 1 | 0.3 |
25–26.9 | 4 | 30.8 | 14 | 14.7 | 5 | 1.4 |
27–28.9 | 4 | 30.8 | 43 | 45.3 | 65 | 18.4 |
29–30.9 | — | — | 30 | 31.6 | 254 | 71.8 |
31–32.9 | — | — | 1 | 1.1 | 21 | 5.9 |
33–34.9 | — | — | — | — | 3 | 0.8 |
Total | 13 | 100 | 95 | 100 | 354 | 100 |
Table
Mean Corpuscular Hemoglobin Concentration (MCHC) values according to age range, Dourados, MS, 2009.
MCHC values (%) | Younger than 1 year old | From 1 to 15 years old | Older than 15 years old | |||
| % | | % | | % | |
26–27.9 | — | — | 1 | 1.1 | 1 | 0.3 |
28–29.9 | — | — | — | — | 2 | 0.6 |
30–31.9 | 3 | 23.1 | 7 | 7.4 | 9 | 2.5 |
32–33.9 | 9 | 69.2 | 79 | 83.2 | 324 | 91.5 |
34–35.9 | 1 | 7.7 | 8 | 8.4 | 17 | 4.8 |
36–37.9 | — | — | — | — | 1 | 0.3 |
Total | 13 | 100 | 95 | 100 | 354 | 100 |
Children under 1 year old have different reference values for hemoglobin, hematocrit, MCV, MCH, and MCHC, according to age. Figure
Table
Reference values for erythrocytes, hemoglobin, hematocrit, MCV, MCH, and MCHC according to age. Source: Clinical Laboratory, University Hospital of Dourados, MS, Brazil. Brazilian Association of Hematology and Hemotherapy—(ABHH).
Age | Hemoglobin (g/dL) | Hematocrit (%) | MCV (u3) | MCH (ng) | MCHC (%) |
---|---|---|---|---|---|
5 days | 19-20 | 60–65 | 92–99 | 30–40 | 32–36 |
14 days | 12.5–15.7 | 42–48 | 60–70 | 25–30 | 27–34 |
2 months | 14–19 | 40–50 | 90–97 | 28–33 | 31–34 |
6 months | 9.5–13.5 | 29–41 | 74–99 | 25–35 | 30–36 |
12 months | 11.8–12.6 | 35–40 | 75–80 | 25–30 | 33–37 |
4 years | 12.3–13.8 | 35–40 | 75–80 | 28–30 | 33–37 |
8 years | 12.3–14 | 38–42 | 75–85 | 28–30 | 33–37 |
14 years | 13.5–14.5 | 40–50 | 82–92 | 28–30 | 32–36 |
Adult men | 14–16 | 40–54 | 82–92 | 27–32 | 32–36 |
Adult women | 11–14 | 37–47 | 82–92 | 27–32 | 32–36 |
The anemia frequency found in nearly 23% in population is high and it approaches those values found in the world: about 30% of its population were affected by anemia [
The presence of infectious processes in children and adolescents when blood counts were collected may have lead to a bias in the results, possibly overestimating frequency of real anemia, since a transient anemia can be found during an infectious process.
Anemias do not spare more affluent social classes. And the high number of anemia cases found in the study population proves what is observed throughout the country: anemias are the most prominent endemic deficiency, overcoming the lack of iodine (which is currently under control), vitamin A, and even protein-calorie malnutrition [
After treatment in the population of our study, based on ferrous sulfate, it was possible to reverse most cases of anemia found. So iron deficiency anemia is supposed to be the most prevalent type of this clinical manifestation in those people. The values of Mean Corpuscular Volume, Mean Corpuscular Hemoglobin, and Mean Corpuscular Hemoglobin Concentration are needed if analyzed individually correlated with the values of hemoglobin (Hb) and hematocrit (Ht) for each patient studied and combined with additional laboratory tests, not available in records analyzed. Such analysis may be the object of further researches.
It can be seen in this study that the sample has prevalence of women: 62.6% of patients (95% CI 58.0 to 67.0). This is due to historical characterization that women are the majority of people who attend health services.
The values of hemoglobin and hematocrit found in patients with anemia in the study population characterize that clinical manifestation as mild in most cases and in all ages. There were few cases of moderate to severe anemia, which responded promptly to therapy with oral or parenteral replacement of iron, being characterized, although the lack of additional laboratory tests available, as iron deficiency anemia, because of its rapid response to treatment. The WHO defines mild, moderate, and severe anemia according to hemoglobin values. Mild anemia is characterized by hemoglobin values between 11.0 and 11.9 mg/dL in children and adult women and between 12 and 12.9 mg/dL in adult men. Moderate anemia occurs when hemoglobin values vary from 8.0 to 10.9 in children and adult women, and from 9.0 to 11.9 in adult men, and severe anemia has hemoglobin values from 5.0 to 7.9 in children and adult women and from 6.0 to 8.9 in adult men.
The findings of the present research are similar to those observed throughout Brazil, where anemia reaches about 50% of children between 6 months and 2 years old [
The iron fortification in widely consumed foods in each population was sustained as a measure of greater scope to try reducing such a high prevalence of anemia. Several studies show that food fortification can reduce nutritional deficiencies [
The high frequency of anemia in the study population follows what can be seen worldwide. This clinical manifestation does not discriminate between rich or poor countries and affects a great number of people in several nations. A person’s life can be greatly disturbed by its symptoms, such as tiredness, lower immunity, impairment in the growth of children, in cognitive functions, and libido [