Abstract: A reduction of hemoglobin concentration in blood is termed as anemia. Especially women’s are suffering from anemia due to loss of blood in menstrual cycle, poor nutrition foods and in postpartum females and different types of diseases in humans which causes anemia. To treat this there is no specific medicine is available except iron tablets though they are not safe and may cause serious health problems. That’s why in this particular review article I will emphasis on the naturally occurring products which may be beneficial in anemia.

1. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
www.ijprsonline.com
A Brief Review on Anemia & Its Clinical Management
Babita Gautam*, Arunbala, Anshubala, Ajay kumar, Chetan kr Dubey , Shalini Tripathi.
*Department of Pharmacy, Rameshwaram Institute of Technology and Management Lucknow, UPTU
Email- babita.gautam26@gmail.com
---------------------------------------------------------------------------------------------------------------------------------have enough RBC or when yours RBC do not
Abstract:
A reduction of hemoglobin concentration in blood
work properly [2]
is termed as anemia. Especially women’s are
Symptoms:
In case of anemia following
suffering from anemia due to loss of blood in
symptoms are appearmenstrual cycle, poor nutrition foods and in
Fatigue, Weakness, Shortness of breath, Light
postpartum females and different types of diseases
headedness, Palpitations, Decrease energy,
in humans which causes anemia. To treat this
Looking pale, Dizziness, Heart attack, Rapid heart
there is no specific medicine is available except
rate, Low blood pressure, Rapid breathing
iron tablets though they are not safe and may
Causes: Following are the causes which may
cause serious health problems. That’s why in this
cause anemiaparticular review article I will emphasis on the
External bleeding, Chronic disease, Pregnancy,
naturally occurring products which may be
Bleeding disorders, Infections, Hereditary
beneficial in anemia.
conditions, Jaundice, Imbalance nutrition.
Types of anemia: Anemia has various types,
Keywords: Hemoglobin, anemia and its types,
some of which are named belowcauses, diagnosis and treatments.
Sickle cell anemia, A plastic anemia, Thalassemia,
Bone marrow related anemia, Hemolytic anemia,
Pernicious anemia, Anemia from active bleeding,
Introduction
Anemia is a medical condition in which the red
Iron deficiency anemia, Anemia of chronic
blood cells or hemoglobin is less than normal. The
disease, Anemia related to kidney disease,
normal level of hemoglobin is generally different
Anemia related to pregnancy.
in males and females. For men, anemia is
Anemia
Treatment
Reference
typically defined as hemoglobin level is less than
approaches
13.5gm/100 ml and in women less than 12
Hemolytic
In case of
this
[3]
[1]
gm/100 ml.
Anemia causes serious problems
anemia
anemia, Special blood
due to loss of blood in the body by various
transfusions
reasons. In the tropics, due to endemicity of
Pernicious
This
[4]
malaria, between 10-20 % of the population
anemia
Treatment involves a
presents less than 10gm/dl of hemoglobin.
shot of vitamin B12
Hemoglobin is a main part of RBC which binds
once a month
oxygen and oxyhemoglobin. If there is less or
Sickle cell Drugs,
like
[5]
abnormal RBCs in your blood, it is the reason that
anemia
Analgesic , opiods
your body will not get enough oxygen. Women
Thalassemia Deferoxamine,
[6]
and people with chronic disease are at increased
deferasirox,
risk of anemia. Anemia occurs when you don’t
deferiprone
37

2. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
Alcoholism
Diazepam,
disulfuram,
[7]
Iron
deficiency
anemia
Iron sulfate
www.ijprsonline.com
[8]
hematopoietic stem
[9]
cell transplantation
Combination
Table.1 (various types of anemia and its treatment
approaches)
Figure.1.normal RBCs [13]
Aplastic
anemia
Sickle cell anemia:
Sickle cell anemia is caused by an autosomal
recessive inherited disorder which results as
hemolysis. The genetic abnormality is due to
substitution of the amino acid valine for glutamic
acid at the sixth position on the beta globulin
chain and was first described over one hundred
yrs ago [10]. Hemoglobin S, the hemoglobin that is
produced as a result of this defeat, is a
hemoglobin tetramer (alpha 2/ beta S2) that is
poorly
soluble
and
polymerizes
when
[11]
deoxygenated.
Over all the incidence of sickle
cell disease exceeds that of most other serious
genetic disorder including cystic fibrosis and
hemophilia [12].
Sign and symptoms: Sickle cell anemia has
symptoms likeShortness of breath, Dizziness, Headaches,
Coldness of hand and feet, Paler than normal skin
or mucous membranes (the tissue that lines your
nose, mouth, and other organs and body cavities),
Jaundice (a yellowish color of the skin or whites
of the eyes).
Figure.2 sickle shapedRBCs
Treatment:
Folic acid and penicillin:
Children born with sickle-cell disease will
undergo close observation by the pediatrician and
will require management by a hematologist to
assure they remain healthy. These patients will
take a 1 mg dose of folic acid daily for life. From
birth to five years of age, they will also have to
take penicillin daily due to the immature immune
system that makes them more prone to early
childhood illnesses [14].
Analgesics:
Painful crises are treated symptomatically with
analgesics; pain management requires opioid
administration at regular intervals until the crisis
has settled. For milder crises, subgroups of
patients manage on NSAIDs (such as diclofenac
or naproxen). For more severe crises, most
patients require inpatient management for
intravenous opioids; patient-controlled analgesia
(PCA) devices are commonly used in this setting.
Diphenhydramine is also an effective agent that is
frequently prescribed by doctors in order to help
control any itching associated with the use of
opioids [15].
Blood transfusions: Blood transfusions are often
used in the management of sickle cell disease in
acute cases and to prevent complications by
38

3. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
decreasing the number of red blood cells (RBC)
that can sickle by adding normal red blood cells
[16]
Hemolytic anemia:
Glucose-6-phosphate dehydrogenase (G-6-PD)
deficiency is an X-linked disorder, in this type of
anemia there is rupture blood cells in blood stream
which leads to acute hemolytic anemia.
Although many G-6-PD variants have been
described, susceptibility to some drugs has been
mainly confined to the G-6-PD Mediterranean
variant largely found in Sardinia. Its incidence in
the North is different from that of the South [17]
Many patients who are already anemic, they also
have jaundice. Splenomegaly, reticulocytosis and
increased osmotic fragility of RBCs. [18]
Symptoms: following symptoms are observedFeeling grumpy, Weakness, Headaches, Brittle
nails, Blue color to the whitish of eye, Pale skin
color, Shortness of breath
Important test for hemolytic anemia: [19]
Absolute reticulocyte count- The reticulocyte
count is used to estimate the degree of effective
erythropoiesis, which can be reported as absolute
reticulocyte count or as a reticulocyte percentage.
Coombs testUsed for the autoimmune
hemolytic anemia, and a condition of a low count
RBC immune system lysis or breaking of RBC
membranes causing RBC destruction.
Coombs test, indirect - it's mostly for prenatal
pregnant women, It detects antibodies against
RBCs that are present unbound in the patient's
serum.
Donath-landsteiner
test-The
DonathLandsteiner test is used for detecting harmful
antibodies related to a rare disorder called
paroxysmal cold hemoglobinuria. The antibodies
form and destroy red blood cells when the body is
exposed to cold temperatures [20].
www.ijprsonline.com
Platelet count- This test measures the number of
platelets in blood. It is used to evaluate bleeding
disorders [21] this test may be used when disorders
caused by low blood platelets such as
thrombocytopenia are suspected
Serum LDH- The LDH level is measured in order
to check for tissue damage, especially to the heart,
liver, kidney, skeletal muscle, brain, and lungs —
all of which elevates the normally low LDH level
in the blood.
Hemosiderin in the urine- This test detects
hemosiderin in urine. Hemosiderin is a pigment
formed when hemoglobin breaks down. This test
is used to evaluate and manage disorders
involving the destruction of red blood cells [21]
Febrile of cold agglutinins- Agglutinins are
antibodies that cause the red blood cells to clump
together Cold agglutinins are active at cold
temperatures. Febrile (warm) agglutinins are
active at normal body temperatures. This article
discusses the blood test used to measure the level
of these antibodies in the blood.
Treatment: [22]
Blood transfusion may be needed. Hemolytic
anemia caused by an overactive immune system
drugs that suppress the immune system may be
used. When blood is destroyed at a fast pace the
body may need extra folic acid and iron
supplements to replace what is being lost.
Pernicious anemia:
Pernicious anemia is a type of vitamin B12
deficiency anemia. The body needs vitamin B12
to make red blood cells. You get this vitamin from
eating foods such as meat, poultry, shellfish, eggs,
and dairy products. A special protein, called
intrinsic factor, helps your intestines absorb
vitamin B12. This protein is released by cells in
the stomach. When the stomach does not make
enough intrinsic factor, the intestine cannot
properly absorb vitamin B12 [23]
39

4. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
www.ijprsonline.com
Symptoms: There are following symptoms of
pernicious anemiaDiarrhea or constipation.
Fatigue, lack of energy, or light-headedness when
standing up or with exertion , Loss of appetite ,
Pale skin , Problems concentrating , Shortness of
breath, mostly during exercise , Confusion ,
Depression, Loss of balance .
which is or was prevalent in the regions where the
trait is common. This selective survival advantage
on carriers (known as heterozygous advantage)
may be responsible for perpetuating the mutation
in populations. In that respect, the various
thalassemias resemble another genetic disorder
affecting hemoglobin, sickle-cell disease. [28]
Anemia in pregnancy:
According to WHO, anemia in pregnancy is
defined as hemoglobin level is less than 11 g/dl
and hematocrit level is less than 33% at any stage
of pregnancy [26]. Anemia of pregnancy affects
women of low socioeconomic status. According to
WHO 52% of pregnant women from undeveloped
or developed countries area anemic as compared
with 20% from industrialized nation [24].The risk
of anemia in pregnancy increases with progression
of pregnancy by CDC criteria among low income
pregnant women in the US 8% are anemic in the
first trimester ,12% in the second & 34% in the
third [25] . Hydremia of pregnancy was first
proposed by German & French physician in the
1830s formally demonstrated in 1934 by
Dieckmann & Degner [26].Folate deficiency is
historical regarded as the second most common
cause of anemia of pregnancy after iron deficiency
& B12 dificiency is more prevalent. In studies,
from India, Turkey, Africa, Newfoundland, &
Venezuela 10% to 100% of pregnant women have
a folate deficiency where as 30% to 100% have
vit. B12 deficiency. The prevalence of folate or vit
b12 deficiency increased with gestation [27].
Alpha (α) thalassemias
Thalassemia:
Thalassemia can cause significant complications,
including pneumonia, iron overload, bone
deformities and cardiovascular illness. However
this same inherited disease of red blood cells may
confer a degree of protection against malaria,
The α thalassemias involve the genes HBA1 [29].
And HBA2 [30]. inherited in a Mendelian recessive
fashion. There are two gene locii and so four
alleles.
Beta (β) thalassemias
Beta thalassemias are due to mutations in the
HBB gene on chromosome 11[31] also inherited in
an autosomal-recessive fashion.
Aplastic anemia:
Aplastic anemia is a term which defined as
destruction of bone marrow to produce RBC.
Aplastic anemia is rare disease but approx. 2000
patient diagnosed in America in every year [32].
Two mechanisms have been suggested for bone
marrow failure. The first mechanism is direct
hematopoietic injury by chemicals (e.g. benzene).
The second mechanism, supported by clinical
observations and laboratory studies, is immunemediated suppression of marrow cells [33].
Figure. 3 Abnormal celFigure. 4 Normal cells [34]
(Fig no 3 Showing Abnormal shape of RBCs due
to bone marrow Suppression)
40

5. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
Pathophysiology of aplastic anemia:
Figure 4. Immune destruction of
hematopoiesis [35].
Antigen representing cells (APCs) trigger T-cell
to activate and proliferate. A transcription factor
which binds to the interferon-y promoters’ site
and induce gene expression and reduce gene
transcription [36]. Patient with aplastic anemia
shows constitutive T-bet expression and low SAP
levels, TNF-a and IFN-y up regulate other T-cell
cellular receptor and also the FAS receptor
Increased production of interleukin-2 leads to
polyclonal expansion of T- cell. Activation of fas
ligand leads to apoptosis of target cell which
inhibit the transcription of cellular genes and entry
into the cell cycle [37]. INF-y is a potent inducer of
many cellular genes and NOS (nitric oxide
synthase) and production of toxic gas and NO [38].
The processes ultimately lead to reduced cell
cycling and cell death by apoptosis.
Iron deficiency anemia:
www.ijprsonline.com
Urinary
tract.
Iron
deficiency
causes
approximately half of all anemia cases worldwide,
and affects women more often than men. World
estimates of iron deficiency occurrence are
somewhat vague, but the true number probably
exceeds one billion people [39]. The most
significant cause of iron-deficiency anemia is
parasitic worms: hookworms, whipworms, and
roundworms. Worms cause intestinal bleeding,
which is not always noticeable in faeces, and is
especially damaging to growing children. [40]
Malaria, hookworms and vitamin A deficiency
contribute to anemia during pregnancy in most
underdeveloped countries [40].
Diagnosis, cause and treatment of anemia [41] :
In the below table different types of anemia,
description, causes, and their diagnosis and
treatments are described.
Iron-deficiency anemia (or iron-deficiency
anaemia) is a common anemia (low red blood cell
or hemoglobin levels) caused by insufficient
dietary intake and absorption of iron, or iron loss
from bleeding which can be from a variety of
sources such as intestinal, uterine or from the
41

6. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
Type of
anemia
Aplastic
anemia
Thalassemia
Hemolytic
anemia
Sickle cell
anemia
Description
Bone marrow fails to
produce different
type of blood cells
www.ijprsonline.com
Diagnosis
Bleeding in
mucous
membranes,
gingivitis, and
shortness of
breath.
Irregular production Affect equally
of hemoglobin there males and
are two types of
females, both
thallesemia i.e major types of
and minor
thalassemia are
found in an
area of northern
Africa and
southern
Europe.
Premature
Considered
destruction of RBC’s when there is
marked
increase in red
blood cells
production by
bone marrow.
Inherited type of
anemia, sickleshaped RBC has
impaired ability
tosqueezethrough
vessels. Short
lifespan of RBC (1020 days)
Causes
Treatments
Known causes are
hereditary conditions
(fanconi’s anemia),
HIV virus, hepatitis,
rheumatoid arthritis.
Transfusion, bone
marrow or stem cell
transplantation,
immunosuppressant
drugs
Thalassemia major is
more common in
families who
intermarry
Transfusions to supply
enough red blood cells
to achieve moderate
anemia and avoid iron
overload are standard
approaches for
thalassemia major.
Causes associated with
disorders such as
systemic lupus
erythematosus,
lymphoma, and
paroxysmal nocturnal
hemoglobinuria. Other
causes are high
exposure to certain
metals or chemicals.
Joint and bone Disease and genetic
pain, infections, trait occurs primarily
and heart
in people of African
failure can
descent and people
occur.
from India and
Mediterranean regions.
Corticosteroids for
autoimmune anemia,
immunosuppressive
drugs may be used.
Transfusion is used in
many cases.
Measures to avoid
cycling and control
pain. Including
hydration, hydroxyurea,
NSAIDs and narcotic
analgesics. Bone
marrow transplantation
37

7. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
Sideroblastic
anemia
Group of anemia
caused by impaired
ability of bone
marrow to produce
RBC’S
Symptoms of
anemia are
jaundice,
enlarged liver
and spleen,
fever,
headache, loss
of appetite,
vomiting, and
leg sores.
Table. 2
Herbal treatment for anemia [42]: Herbal
medicines are the oldest remedies known to
mankind. The demand for herbal products is
growing exponentially throughout the world
because herbal drugs having no side effects as
compare to other drugs and major pharmaceutical
companies are currently conducting extensive
research on plant materials for their potential
medicinal value some herbal drugs are given
below.
Table. 3
Herbal
drugs
www.ijprsonline.com
Work
Ash gourd Ash gourd can prevent the risk of
anemia by checking the amount of
blood lost from the lungs, nose and
if there are piles
Celery
Celery has a high quantity of iron
and magnesium content. Iron is a
component
of
Heme,
which
necessary for the production of
hemoglobin in the blood
Chicory
Chicory is an effective tonic for the
blood
Fenugreek
Its leaves are helpful in building the
volume of blood in the body
Onion
Onion has rich iron content. Hence
onion is the most effective remedy
for anemia
Caused by excessive
Deferoxamine, and
alcohol use, certain
Folate , pyridoxine are
medications, including used,
chloramphenicol, or
other disorders,
including some cancers
and rheumatoid
arthritis. More
common in the elderly
Homeopathic treatment for anemia [43]:
Homeopathic treatments are used since ancient
time in India and other countries. It is popular
because of its availability, cheap in cost and
mostly due to fewer side effects. Few drugs and
their contribution is mentioned in the below table
.4
Oral iron supplements:
There are two forms of supplemental iron: ferrous
and ferric. Ferrous iron is better absorbed and is
the preferred form of iron tablets. Ferrous iron is
available in three forms: ferrous fumarate, ferrous
sulfate, and ferrous gluconate. A 325 mg iron
supplement contains the following amounts of
elemental iron depending on the type of ironFerrous fumarate. 108 mg of elemental iron,
Ferrous sulfate 65 mg of elemental iron, Ferrous
gluconate ,35 mg of elemental iron.
Dosage: Depending on the severity of your
anemia, as well as your age and weight, your
doctor will recommend a dosage of 60 - 200 mg
of elemental iron per day. This means taking one
iron pill 2 - 3 time during the day.
Side Effects and Safety: Common side effects of
iron supplements include- Constipation and
38

8. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
diarrhea are very common, Nausea and
vomiting, Black stools are normal when taking
iron tablets.
Supplements:
A healthy diet, rich in iron, must be consumed.
Whole grain cereals, legumes and pulses are
good sources of iron. Anemia that is caused
due to deficiency of vitamins can be avoided
by a proper intake of vitamins in the diet.
Consult a diet chart for better guidance.
Pregnant women can take multivitamin pills
and other nutritional supplements at the advice
of the doctor. Beetroot is also very good
source of iron intake.
Conclusion:
This review contains different type of anemiasickle cell anemia, hemolytic anemia,
pernicious anemia, iron deficiency anemia,
aplastic anemia and Thalassemia and the ways
by which they cause, diagnose, and treated.
Acknowledgment:
We would like to thank the University for
providing the resources to carry on our
research and our teachers and friends for their
support.
www.ijprsonline.com
Drugs
Works
Ferrumetallicum
It’s a great homeopathic remedy but it
will not cure every case of anemia
Pulsatilla
it’s the great antidote to iron and hence
is indicated in the anemic condition
produced by large or continued doses
of it
Calcareacarbonica
Use in anemic and debilited condition
Arsenicum
Being a direct poison to the RBC takes
first rank in case of pernicious anemia
or anemia due to a material of toxic
influence
Helonias
An excellent remedy in anemia and
chlorosis it suits especially anemia
from prolonged hemorrhage in women
Secale
This remedy produces a progressive
general anemia it shown by the peculiar
cachexia of anemia, pale, bloodless
jaundiced color
Natrummuriaticum This is one of the best remedies in
anemic conditions there is paleness and
inspite of the fact that the patient eats
well, there is emaciation
Table. 4: Few drugs and their contribution
38

9. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
References
1. Yap GS, Steverson MM, inhibition of in
vitro erythropoesis by solube mediators in
plasmodium chanbaundi as malaria: lack
of a major role of interleukin, tumor
necrosis factor alpha and gamma INF
infect immune 1994:62:357-62.
2. Eschbach JW,anemia management in
chronic kidney disease: role of factor
affecting epoetin responsiveness, J am soc
Nephrol 2002: 13:1412-4.
3. Power A, Silberstein LE, autoimmune
hemolytic anemia, in: Hoffman R, Benj
EJ, shuttle, et al hematology, 5ed 2008
chap 47.
4. Antony AC, Megaloblastic anemias. In:
Hoffman R, Benj EJ, still SS, et al., Eds.
Hematology: basic principles and practice.
5 Ed Philadelphia, Pa: Elsevier Churchil
Livingstone: 2008: chap 39
5. power a, Silberstein LE, autoimmune
hemolytic anemia, in: Hoffman R, benj EJ,
shattil, et al hematology, 5ed 2008 chap 47
6. Oniyangi,O.andOmari,A.A.(2006)Malaria,
chemoprophylaxis in sickle cell disease.
Cochrane Database Syst. Rev. 2006,
CD003489
7. Tesoriere L, D'Arpa D, Butera D, Allegra
M, Renda D, et al. (2001) Oral
supplements of vitamin E improve
measures of oxidative stress in plasma and
reduce oxidative damage to LDL and
erythrocytes
in
beta-thalassemia
intermedia patients. Free Radic Res 34:
529–540.
8. Mason,
B.J.,Heyser,
C.J
(2010)
Acamprosate: a prototypic neuromodulator
in the treatment of alcohol dependence.
www.ijprsonline.com
CNS & neurological disorder drug targets,
9(1): 23-32
9. Thomason,
Ronald
W.;
Almiski,
Muhamad S. (April 2009). "Evidence That
Stainable Bone Marrow Iron Following
Parenteral Iron Therapy Does Not
Correlate With Serum Iron Studies and
May Not Represent Readily Available
Storage Iron". American Journal of
Clinical Pathology 131 (4): 580–585.
doi:10.1309/AJCPBAY9KRZF8NUC.
PMID 19289594. Retrieved 2009-05-04.
10. Kasper, Dennis L; Braunwald, Eugene;
Fauci, Anthony; et al. (2005). Harrison's
Principles of Internal Medicine, 16th ed.
New York: McGraw-Hill. ISBN 978-0-07140235-4
11. L,Itano HA,et al. Sickle cell anemia, a
molecular disease. Science 1949:109:443.
12. Bunn HF,Pathogenesis and treatment of
sickle cell anemia. New Eng J Med 1997
13. National heart, lung, and blood institute .
the management of sickle cell disease. 4th
edition: 2002.
14. WWW.Wikipedia.org
15. Williams TN, Uyoga S, Macharia A, et al.
Bacteraemia in Kenyan children with
sickle-cell anaemia: a retrospective cohort
and case-control study. Lancet 2009;
374:1364-70.
16. Dunlop
RJ,
Bennett
KC.
Pain
management for sickle cell disease.
Cochrane
Database
Syst
Rev
2006:CD003350.
17. Adams RJ, McKie VC, Hsu L, et al.
Prevention of a first stroke by transfusions
in children With sickle cell anemia and
abnormal results on transcranial Doppler
ultrasonography. N Engl
J Med 1998; 339:5-11.
18. Salvidio, E.; Pannacciulli, I; Tizianello.
A.; Gaetani, G.F.;Paravidino,G.:Glucose39

10. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
6-phosphatedehydrogenase deficiency in
Italy. Acta haemat. 41: 331-340(1969).
19. Packman CH. Hemolytic Anemia
Resulting
from
Immune
Injury.
In:Williams Hematology Lichtman MA,
Beutler E, Kipps TJ, Seligsohn U,
Kaushansky K, Prchal JT, eds. Mc Graw
Hill Professional, Philadelphia, 2005:729–
51.
20. power a, Silberstein LE, autoimmune
hemolytic anemia, in: Hoffman R, benj EJ,
shattil, et al hematology, 5ed 2008 chap
47)
21. Schwartz
RS.
Autoimmune
and
intravascular hemolytic anemias. In:
Goldman L, Ausiello D, eds. Cecil
Medicine. 24th ed. Philadelphia, Pa:
Saunders Elsevier; 2011:chap 163.
22. Henry JB: Clinical Diagnosis and
Management by Laboratory Methods, 20th
ed. Saunders, 2001)
23. Schrier SL, price EA, extrinsic no immune
hemolytic anemias, in: Hoffman r, et al
hematology basic principle and practices 5
Ed, 2008. chp 48)
24. UN children’s fund U, WHO. Iron
deficiency anemia assessment prevention
& control: WHO 2001.
25. Healthy people 2010, US government
2000.
26. Dieckmann WJ, Wegner CR, the blood in
normal pregnancy, blood & plasma
volume arch intern med 1934.
27. Rasmussen K.is there a causal relationship
between iron deficiency or iron deficiency
anemia and weight at birth, length of
gestation abd perinial mortality? J Nutr
2001:131(2S-2): 590S-601S.
28. Ac¸kurt F, Wetherilt H, Lo¨ker M, et al.
Biochemical assessment of nutritional
status in pre- and post-natal Turkish
www.ijprsonline.com
women and outcome of pregnancy. Eur J
Clin Nutr 1995; 49(8):613–22.
29. Online 'Mendelian Inheritance in Man'
(OMIM)
30. Online 'Mendelian Inheritance in Man'
(OMIM) 141850
31. Gajewski JL, Champlin RE: How to
manage
severe
aplastic
anemia
May1994:69–82.
32. Young NS, aplastic anemia in young NS
ed – the bone marrow failure syndrome
Philadelphia PA-W B saunders 1997.
33. www.wikipedia.org
34. Chen J, Young NS. An immune model of
bone marrow failure mediated by disparity
in Minor histocompatibility Blood. 2004
35. Selleri C, Maciejewski JP, Sato T, Young
NS. Interferon-_ constitutively expressed
in the stromal microenviroment of human
marrow
cultures
mediates
potent
hematopoietic inhibition. Blood. 1996;
87:4149-4157
36. Maciejewski JP, Selleri C, Anderson S,
Young NS. Fas antigen expression on
CD34_ human marrow cells is induced by
interferon-gamma andtumor necrosis
factor-alpha and potentiates cytokinemediated hematopoietic suppression in
vitro.Blood. 1995; 85:3183-3190.
37. Chen J, Young NS. A murine model of
bone marrow failure mediated by disparity
in minor histocompatibility antigens
Blood. 2004; 106:12a. Abstract 132.
38. Review of numbers of infections
39. Calis JC, Phiri KS, Faragher EB et al.
(2008). "Severe anemia in Malawian
children". N. Engl. J. Med. 358 (9): 888–
99.
40. Dreyfuss ML, Stoltzfus RJ, Shrestha JB et
al. (2000). "Hookworms, malaria and
vitamin A deficiency contribute to anemia
and iron deficiency among pregnant
40

11. ISSN: 2348 –0882
==========================================================================
Int. J. Pharm. Res. Sci., 2014, 02(1), 37-41.
www.ijprsonline.com
women in the plains of Nepal". J. Nutr.
130 (10): 2527–36.).
41. Zuckerman KS. Approach to the anemias.
In: Goldman L, Ausiello D, eds. Cecil
Medicine. 23rd ed. Philadelphia, Pa:
Saunders Elsevier; 2007:chap 162.
42. www.livestrong.com/article/312110herbal-treatment-for anemia
43. health.hpathy.com/anemia-symptomstreatmentcure.asp
41