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

3,6

Student Midwifery, Zahedan Branch, Islamic Azad University Zahedan, Iran

4,5

Clinical laboratory sciences student, Zahedan branch, Islamic Azad University Zahedan, Iran

ABSTRACT

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.

KEY WORDS: PREVALENCE, RISK FACTORS, ANEMIA, GYNECOLOGICAL DISEASES, ZAHEDAN

335

ARTICLE INFORMATION:

*Corresponding Author: Bizhan.mortazavi@gmail.com

Received 30

Dec, 2016

Accepted after revision 12

March, 2017

BBRC Print ISSN: 0974-6455

Online ISSN: 2321-4007

Thomson Reuters ISI ESC and Crossref Indexed Journal

NAAS Journal Score 2017: 4.31 Cosmos IF : 4.006

reserved.

Online Contents Available at: http//www.bbrc.in/

Biosci. Biotech. Res. Comm. Special Issue No 1:335-340 (2017)

336 EXAMINING PREVALENCE AND RISK FACTORS FOR ANEMIA IN REFERRED GYNECOLOGICAL DISEASES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

Farzaneh Khadem Sameni et al.

INTRODUCTION

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,

2005).

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

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS EXAMINING PREVALENCE AND RISK FACTORS FOR ANEMIA IN REFERRED GYNECOLOGICAL DISEASES 337

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.

METHODS

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

article.

FINDINGS

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 DEFICIENCY ANEMIA

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.

338 EXAMINING PREVALENCE AND RISK FACTORS FOR ANEMIA IN REFERRED GYNECOLOGICAL DISEASES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

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.

Menstruation:

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

poverty

Intestinal

disorders

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

exercise

23.923.320.420.824.6

The average age of  rst

menstruation

13.413.813.114.114.3

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.

BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS EXAMINING PREVALENCE AND RISK FACTORS FOR ANEMIA IN REFERRED GYNECOLOGICAL DISEASES 339

larity to menstrual symptoms during menstruation but

these similarities can also be thought-provoking.

Pregnancy:

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.

CONCLUSION

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

society.

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

doctor.

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.

340 EXAMINING PREVALENCE AND RISK FACTORS FOR ANEMIA IN REFERRED GYNECOLOGICAL DISEASES BIOSCIENCE BIOTECHNOLOGY RESEARCH COMMUNICATIONS

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

study.

REFERENCES

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