Examining prevalence and risk factors for anemia in
referred gynecological diseases to Ali Ibn Abi Talib
Hospital of Zahedan city
Farzaneh Khadem Sameni,
Elham Sadat Mortazavi Vaghie,
Parisa Mohammadiyan,
Amir Saremi Ronizi,
Vahid Sabur Momen
and Zahra Asadolahi
MD Pathologist, Assistant Professor, Faculty of Medicine, Zahedan branch, Islamic Azad University
Zahedan Iran
Faculty Member and Head of Midwifery Group, Zahedan branch, Islamic Azad University Zahedan, Iran
Student Midwifery, Zahedan Branch, Islamic Azad University Zahedan, Iran
Clinical laboratory sciences student, Zahedan branch, Islamic Azad University Zahedan, Iran
Anemia is a common blood disorder that is one of the Hygiene & Health problems of today, In which there is not
enough red blood cells or hemoglobin in the blood. Research shows, amount of anemia in women is more than
men; Especially about young girls are entering puberty and begin of menstruation. Iron de ciency in diet is other
underlying factors that cause anemia, Blood loss caused by Continuous bleeding at the time of menstruation, diges-
tive disorders, vaginal infections, cancer and pregnancy are some of the factors that in gynecological diseases can
also cause anemia ,However, in addition to iron ,absence of some required nutrients and vitamins for the body can
also cause anemia. Information and to identify risk factors by the patient, Nowadays can help healthcare system in
the diagnosis and treatment, In addition, the doctor can recognize treatment according to patient involvement with
any of the underlying disease and apply for treatment with detailed knowledge of risk factors , In this article, have
tried also careful study risk factors for anemia in patients referring to gynecology clinic Ali ibn Abi Talib Hospital in
Zahedan, Statistical population is provided for patient involvement with each risk factor. We hope to be able to do
this research, take effective step to improve the public health.
*Corresponding Author: Bizhan.mortazavi@gmail.com
Received 30
Dec, 2016
Accepted after revision 12
March, 2017
BBRC Print ISSN: 0974-6455
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Biosci. Biotech. Res. Comm. Special Issue No 1:335-340 (2017)
Farzaneh Khadem Sameni et al.
Anemia is a common blood disorder that is one of the
hygiene and health problems of today, in which there is
not enough red blood cells or hemoglobin in the blood.
Hemoglobin in red blood cells causes, oxygen to bind
with red blood cells to reach to various tissues of body
by capillaries. Because all human cells depend on oxy-
gen to survive, its de ciency leads to hypoxia and results
in wide range of problems. Physiologically anemia can
be caused by iron de ciency, folic acid, and vitamin
B12. Research shows, amount of anemia in women is
more than men; especially about young girls are enter-
ing puberty and begin of menstruation. More pregnant
women due to physiological changes in the body that is
created during pregnancy and childbirth, strike to ane-
mia, (Baig-Ansari & Badruddin, 2004).
Blood loss caused by continuous bleeding at the time
of menstruation, digestive disorders, vaginal infections
and or cancer can also cause anemia. Iron de ciency in
diet is other underlying factors that is caused anemia,
if the food, which is used daily, have small amount of
iron or in the diet remove meat, occurs Iron de ciency.
Pregnant women, especially those who are breastfeed-
ing due to functional systems of body need iron several
times more than typical person and their diet should be
rich in iron. Frequent consumption of drugs that destroy
vitamin D in the body use of drugs and supplements
that prevent to absorption of iron, Catching chronic
diseases associated with bleeding such as: Tuberculo-
sis, catching the fruit worms and parasites, and lack of
digestive enzymes, especially stomach acid, are factors
that prevent iron absorption. Pregnant women during
pregnancy should regularly visit to their doctor and it
is better examined in terms of catching anemia before
pregnancy, and if they need to use medicines and sup-
plements, after improvement, action to be pregnant.
Due to the increased iron requirements during preg-
nancy. In addition to increasing amount of this material
in their diets, From the fourth month of pregnancy until
three months after giving birth, should use iron supple-
ments (Guralnik et al., 2004) for the detection of anemia,
blood test is the best way, type and severity of anemia
is determined by testing and doctor can diagnose that is
this de ciency can be remedied with diet or is there need
of medication. If is need to medication, doctor prescribes
course of required medication and again test is taken
from individual and if necessary, medicine consumption
would be extended for the new period. Noting this point
is essential that never should not be arbitrarily used tab-
lets and iron supplements. more common Segmentation
of anemia (decreased hemoglobin) is based on MCV or
the volume of red blood cells, So that MCV less than
80 as microcytic anemia, MCV within the normal range
(100-80), Normocytic anemia (normal cell volume) and
high MCV, are called macrocytic anemia (Lindenfeld,
The most important signs and symptoms of anemia
include: Fatigue and feel exhausted, lethargy, hair loss,
restlessness and discomfort, Shortness of breath or dif -
culty in breathing, poor concentration, palpitations, sen-
sitivity to cold air, Chest pain, tinnitus, headaches, affect
the sense of taste, Dry tongue, dif culty in swallowing,
restless leg syndrome, Dry and scaly or spoon-shaped
nails, First of all, should identify presence or absence
of anemia and also its type and then if necessary use of
supplements under medical doctor (Shirvani & Nikfar,
2001). Anemia is recognized in terms of laboratory that
hemoglobin or hematocrit of person concerned is less
than the desired, its probability and severity is diag-
nosed based on amount of patient’s hemoglobin and
hematocrit deviation from the estimated value of age
and sex. The amount of average hematocrit for adult
men 47% (7 ± sd) and for adult women 45% (5 ± sd) as
well as the World Health Organization (WHO) de nes
anemia ,Hemoglobin less than 130 grams per liter
(13 grams per deciliter) for men and 120 grams per
liter (12 grams per deciliter) for women. Iron de ciency
anemia is the most common type of anemia in women.
Research has shown that women’s problems has signi -
cant relationship with anemia, iron de ciency and the
underlying disease (Shirvani & Nikfar, 2001).
It is possible the person who has iron de ciency and
subsequently anemia to reduce or getting reducing or
cut bleeding during menstruation ,con ict depends
on the body’s iron reserves which usually goes away
with prescription pills, but if not natural and does not
respond to treatment, should be closely examined the
cause. Because it may disturb hormonal cycle which if
disrupted can cause gastrointestinal disorders. On the
contrary, this issue can also occur, Excessive menstrual
bleeding causes strike to anemic and muscle cramps
occurs in yourselves and cannot do your daily activi-
ties, If menstrual bleeding is excessive high, it is called
menorrhagia. Excessive bleeding, irregular bleeding, any
bleeding after menopause can be reasons for establish-
ing anemia. Intestinal disorders and Indigestion of food
can also be underlying factors of anemia, No absorp-
tion of nutrients and vital elements are the Chronic or
acute problems that involves patients with intestinal
disorders and digestive disorders and can also be causes
of types of anemia. Celiac disease is chronic disease of
the small intestine, As well indigestion problems cause
utilization of nutrients and vital elements for the human
body (Safavi, 2006). There are many underlying causes
of anemia and risk factors for it are widespread .in the
present study with prepared questionnaire and consider
referred women to Ali ibn Abi Talib hospital in city of
Farzaneh Khadem Sameni et al.
Zahedan in  rst six months of 2015,has been paid to
examining prevalence and causes types of anemia in the
target population.
For a total 350 patients referred to the Ali ibn Abi Talib
hospital in city of Zahedan in terms of personal infor-
mation (Age, weight, height, marital status, education,
occupation, income, hometown) Behavior and relation-
ships of sexual (Age at marriage, age at menarche, age
at  rst sexual intercourse, age at  rst pregnancy, inves-
tigate menstrual abnormality, risky sexual behavior and
having multiple sexual partners), Blood pressure, use of
dietary supplements, dietary information, Underlying
disease, type of consumable drugs and catching to types
of anemia were evaluated and analyzed in this study,
received Information from the questionnaires were ana-
lyzed by using spss software .Researchers in the cur-
rent study have used library resources and international
authoritative articles for clinical reasoning of above
In this study of the total 350 patients admitted to hospital,
279 patients (79.71%) have faced with types of anemia,
symptoms of anemia and iron de ciency or had suffered
to the underlying disease, anemia and poor diet . These
statistics provide a place of re ection in order to further
investigation for researchers. Iron de ciency anemia
has been a public health problem that Developing and
developed countries are caught in that. According to the
de nition provided by the World Health Organization
in 2014, Iron de ciency anemia is called to reduce the
concentration of blood hemoglobin that is less than the
normal range that this amount depending on the age,
sex and physiological conditions (such as pregnancy) is
different. Investigations in above study indicate of the
total statistical population, 241 case (68.85%)of clients
have been involved with iron de ciency anemia that
show the importance of this subject.
Iron de ciency anemia is the most common cause of
anemia in the world; But because of it , signi cant num-
ber of patients remain unknown. Iron de ciency anemia
(IDA) is to reduce red blood cells or insuf cient hemo-
globin in red blood cells, This anemia is created due
to other diseases. So, for proper treatment of anemia,
the cause must be found (Davari, 2005). In the present
research ,have paid to statistical analysis of relationship
between gastrointestinal irritation, menstrual disorders,
reproductive tract infections, nutrition and blood pres-
sure with Iron de ciency anemia. According to the lat-
est medical research, from every  fth Iranian woman,
one person is suffering from anemia and factors listed is
related to one of these silent disease(Shirvani & Nikfar,
2001). The body requires raw materials such as iron and
vitamins especially folic acid, for hematopoiesis. But
most people around the world have little access to food
sources of iron (vitamin B12 such as meat) (Shirvani &
Nikfar, 2001). So anemia, resulted from Iron de ciency
is considered the most common and the most important
anemia of people in the world. The main part of hemat-
opoiesis of body occurs through bone marrow. Because
of this, factors that cause to damage bone marrow, can
be caused anemia.
Research shows that two-thirds of Iranians nutri-
tional problems is caused by shortages and reception
problem of iron. Anemia in children start from period
after 6 months and have negative impact on IQ of peo-
ple. Ability to learn and concentration of girls especially
in adolescence are overwhelmed by the complications of
anemia. disregard health issues often arise due to culture
and economic poverty, and lack of human health, with
there poor eating habits gives hand in hand to people
caught this dangerous disease. From the perspective of
traditional medicine, consumption of a cup of tea after
meals reduces iron absorption more than 95% and con-
sumption of an orange or two tangerines shortly after
eating will increase the iron absorption of foodstuffs
.Unfortunately, in Iran we are seeing mistaken belief
after meals. Anemia, is not only iron de ciency but
many factors are effective involved in this disease that
may be unaware of their existence that is included such
as intestinal disorders, pregnancy, hemorrhage and….
The rest of this article becoming familiar with  ndings
of scienti c research and conclusions.
Prevalence: The prevalence suggests of the total sta-
tistical population 241 case (68.85%) of patients have
involved with Iron de ciency anemia that had exposed
to Iron de ciency anemia.
Table 1 shows the risk of anemia. The impact on ini-
tial indicators in risk factors, and underlying disease of
target population in two danger zone (red) and warning
(orange) and the other (black).
Diet lacking in required vitamins and vital elements
for hematopoiesis is one of very important underlying
causes of Iron de ciency anemia, Diets which is avail-
able small amount iron, vitamin b 12, folic acid and
other vital elements such as zinc, copper, etc. in them,
increases the risk of Anemia. In the present research 170
cases (48.57%), have denied use of vital dietary supple-
ments to prevent anemia and 137 cases (39.14%),have
not informed from suf cient public information about
the proper diet to prevent anemia.
Farzaneh Khadem Sameni et al.
Intestinal disorders:
Intestinal disorders which affects
on absorption of nutrients by your body, Can increase
risk of catching your to anemia. causes and symptoms
of Coronel disease, irritable bowel syndrome, celiac dis-
ease, ulcerative colitis and diverticulosis and any gas-
trointestinal discomfort have been questioned in terms
of catching the disease and history of catching and
symptoms.A total of 128 cases (36.57%), have con rmed
intestinal disorders and gastrointestinal disorders which
in conjunction with the intestinal disorder celiac disease
with 12 case (3.42%)of reported having involvement are
included highest rate of intestinal disorders and It should
be noted that all 12 cases of celiac disease (100%) have
con rmed anemia, 101 (28.85%) cases have con rmed
digestive disorders such as indigestion, abdominal pain,
bloating, diarrhea, rectal bleeding and loss of appetite.
Generally, women in menstrual age
become anemic than men and postmenopausal women.
48 case (13.71%) have con rmed menstrual disorders, 9
case (2.57%), irregular cycles, 21 case (6%) major bleed-
ing during menstruation, 8 case (2.28%) other cases and
also 12 case (3.42%) have con rmed low bleeding dur-
ing menstrual. Which can be a sign of anemia. 93 case
(26.57%) have con rmed existence of the symptoms of
anemia such as paleness, general weakness, dizziness,
shortness of breath and lack of focus. However, compar-
ing the symptoms of anemia is not logical due to simi-
Table 1. Evaluation of Initial indicators of patients and their relationship with risk factors for anemia in women
referred to Ali ibn Abi Talib hospital in city of Zahedan
Index / Risk FactorsFood
MenstruationPregnancyChronic Diseases
Average of age28.829.523.927.237.4
Average of weight53.456.360.262.863.5
Average of Height155.6155.9158.2165.1166.3
The average age of  rst sexual
The average age of  rst
FIGURE 1. Evaluation of underlying factorsof Iron de ciency anemiain patients referred toAli bin Abi Talib hospital
gynecology clinic in Zahedan
Farzaneh Khadem Sameni et al.
larity to menstrual symptoms during menstruation but
these similarities can also be thought-provoking.
increased the risk of anemia during preg-
nancy and 119 case (34%) have con rmed anemia dur-
ing pregnancy and of those, 74 case (21.14%) have con-
rmed use of dietary supplements and proper diet to
prevent anemia during pregnancy.
Chronic Diseases:
Diseases such as cancer, liver or kid-
ney failure or other chronic diseases increase the risk of
anemia. 12 case (42.3%) have con rmed anemia during
involvement with Chronic Diseases.
Genital tract infections:
Although genital tract infec-
tions doesn’t have direct relationship with anemia and
the present study does not have able to prove it but from
among the 12 patients with pelvic in ammatory disease
7 case (2%) have con rmed anemia and from 68 patients
with genital infection contains Vaginal yeast infections,
dermatitis, etc. 13 case (71.3%) have con rmed anemia.
Health Literacy:
The ability of individuals to acquire,
analyze, and understand basic health information and
services that they need to them to be able to take the
right decisions about issues related to their health that
is called health literacy. in the present study amount of
General Information of all clients have been measured
by asking questions which have  lled the questionnaire
which unfortunately 213 case (85.60%) have poor pub-
lic information in relation to anemia, treatment strate-
gies, prevention and symptoms of anemia and only 29
(28.8%) case enjoy excellent public information in the
eld of anemia.
In terms of physiologic, Anemia can be caused by de -
ciency of iron, folic acid, also be created lack of vita-
min B12. anemia associated with Iron de ciency and
vitamin de ciency, can be prevented with one diet
high in vitamins, This vitamins are available in organ-
ized food and in Nature that Unfortunately, bad eating
habits, dependence on poor diet and poverty in Sistan
and Baluchestan Province is cases and underlying fac-
tors to cause iron de ciency anemia with examine cred-
ible sources of nutrition and traditional medicine, we
nd iron-rich foods such as dark green leafy vegetables,
artichokes, apricots, beans, lentils, peas, soybeans, meat,
nuts, prune and raisin for having adequate iron stores
should be included in the diet. Folate and his family
folic acid are available in citrus, banana, dark and leafy
vegetables, legumes, and forti ed foods. Vitamin B12
is also available naturally in meat and dairy products.
Also this vitamin is also available in some soy milk.
Research has shown that foods rich in vitamin C such as
citrus will help iron absorption. Unfortunately, the lack
of adequate information and having public information
has been caused cultural poverty and has become iron
de ciency to health threat.
Results of this study show increasing Factors the
risk of developing Iron de ciency anemia Include Inap-
propriate and inadequate feeding, age over 60 years,
Recent illness, such as Ulcers or duodenal, diverticuli-
tis, colitis, hemorrhoids, Celiac disease or digestive tract
tumors, pregnancy, menstrual disorders and Chronic
diseases including cancer, Liver or kidney disease are
most important underlying factors that create risk of
developing anemia. Anemia covers a wide range of dis-
eases and in above study are also available Symptoms
of anemia in patients with fungal infections and bacte-
rial vaginal and sometimes anemia has been con rmed
by the patient that can not decisive comment and is
required to do practical research but should be named
anemia as today’s threatening the health of patients and
The results of above study with considered study
population ,shoud to say immune performance systems
of women is weaker compared to men and many dis-
eases are caused bad performance of immune system
which include blood diseases Such as aplastic anemia,
leukemia, sickle cell anemia, and myelo brosis and
this means intensifying the anemia and involvement
of women compared to men, women Considering that
are involved to pregnant have likely to more involves
Iron de ciency and anemia, and all pregnant women
should be use iron tablets at the end of fourth month
to three months after delivery and then also measured
their iron stores by doing experiments and share with
Ministry of Health in Iran provide iron pills and gives
free to these mothers through health homes and health
centers care. In addition in these centers, is performed
Learning the importance of iron supplementation, Pre-
ventive ways of iron de ciency anemia and nutrition
advice and food sources of ironby Staff and nutrition
expert. But it seems do not relevant measures in areas
in Sistan and Baluchestan Province or demands required
to further work by the of cials and personnel therapeu-
tic of Province. Menstrual disorders as Women’s chronic
distress can cause severe anemia in women and require
more attention of doctors and health care workers and
health of country and demand more detailed and clini-
cal research, amount of anemia in women is more than
men; Especially about young girls are entering age of
puberty and begin of menstruation.
More pregnant women due to physiological changes
in their body that is ceated during pregnancy and child-
birth, are suffering from anemia, bringsneed to Notices
Farzaneh Khadem Sameni et al.
and Sounding the alarm bell for This stratum of society,
Celiac disease is faced patients with these problems as
a disease of malabsorption of nutrients, the absorption
of iron and vitamin B12 .Iron de ciency and anemia in
this study have been con rmed in all patients and has
required to rigorous scienti c research in these patients
in the province. At the end declare gratitude and thanks
from all Ali bin Abi Talib hospital personnel in city of
Zahedan in order to accompany the researchers of above
Baig-Ansari N, Badruddin SH (2004). Anemia prevalence and
risk factors in pregnant women in an urban area of Pakistan,
Food and nutrition, 15, 4: 75-89.
Davari Tanha Fatemeh (2005). The prevalence of anemia in
pregnant women and its association with maternal factors and
pregnancy outcome, 11, 24: 31-23
Guralnik JM, RS Eisenstaedt, L Ferrucci, HG Klein (2004), Prev-
alence of anemia in persons 65 years and older in the United
States: evidence for a high rate of unexplained anemia. Am
Soc Hematology, 10, 6: 25-31.
Lindenfeld JA (2005). Prevalence of anemia and effects on
mortality in patients with heart failure : American heart jour-
nal, Elsevier, 31, 2: 45-52.
Safavi Sayyed Mortaza (2006). Check the status of Iron and
some related factors in pregnant women in Iran, Iranian Jour-
nal of Epidemiology, 1, 4: 1-10
Shirvani Fariba, Nikfar Roya (2001). The relationship between
mothers anemia with Index anemia of their infants, 6, 1: 99-95