THREE COMMON CAUSES OF IRON DEFICIENCY ANAEMIA IN INDIAN MALES

THREE COMMON CAUSES OF IRON DEFICIENCY ANAEMIA IN INDIAN MALES

OP Kapoor
Hon. Visiting Physician, Jaslok Hospital and Bombay Hospital, Mumbai, Ex. Hon. Prof. of Medicine, Grant Medical College and JJ Hospital, Mumbai 400 008.

There was a time when I used to teach three common causes of anaemia in males:
1. Hookworms, 2. Bleeding piles, 3. Thalassaemia minor

Bleeding piles as a cause of anaemia has more or less disappeared. People have become more health conscious and early treatment of piles no longer leads to anaemia

Hookworms have more or less disappeared and I have not seen these worms as the cause of anaemia even in villagers. This has happened because of very frequent use of cheap drugs like Albendazole which is partially effective for hookworms even in a single dose. It is likely that even if one sees occasional hookworm ova in stool examination, the worm load will not be enough to lead, to anaemia. Since the total worm load by stool examination is not being done in most laboratories, even in presence of a positive stool report it will be worthwhile to look for another cause of anaemia

Thalassaemia minor is one of the causes of iron deficiency anaemia in males depending on certain ,communities. The more you ask for Hb. electrophoresis test, the more you are going to pick up patients of thalassaemia minor.

In modem days, following three causes should be thought of in a male patient who presents with iron deficiency anaemia These are:

1. Frequent attacks of malaria specially falciparum type. A palpable spleen and history of fever will favour the diagnosis. Such patients will need long term prophylactic anti-malarial drugs.

2. Aspirin - Now that every cardiologist prescribes aspirin in all patients of ischaernic heart disease before and after bypass surgery (and often for life time) we are seeing more and more patients of anaemia due to occult blood loss caused by aspirin. Very often, I see patients who have recurrence of angina or dyspnoea on exertion where the cardiologists have advised large doses of nitrates and betablockers and yet the patient has not improved. On examination, I find that these patients are anaemic and need iron therapy. Such patients have to be told to stop aspirin. In very high risk patients we might continue 50 mg of enteric coated aspirin with antacids.

3. Hiatus hernia is being detected more commonly nowadays because of frequent use of endoscopy. Very often, I see these patients having anaemia which improves rapidly with iron intake but it relapses. Often these patients are on NSAID group of drugs.

Finally it should be noted that a normal haemoglobin in an adult male should be more than 14 gm.