Introduction

Anemia is defined as a decrease in the number of red blood cells or the haemoglobin concentration lower than normal limits. Anemia is a serious global public health problem that particularly affects young children, menstruating adolescent girls and women, and pregnant and postpartum women. Indian population has a high prevalence of anemia, especially in rural areas. Anemia in adolescents needs to be studied as it affects the development and health of an individual in adult life. Adolescent anemias refer to a group of anemias that occur between the age of 10- 19 years. Adolescent females are more prone to develop anemia due to menstrual blood loss and poor nutritional status. [1], [2], [3],[9].[10]. The factors responsible for the high prevalence of anemia may be poor iron intake from the diet (vegetarian diet), infection like malaria, parasitic infestation and menorrhagia through menstruation.[1],[12]. Anemias due to chronic diseases and genetic disorders (sickle cell anemias and Thalassemias) are also seen in adolescents. Gastrointestinal Diseases such as varices, polyps, colitis, peptic ulcers, and Inflammatory bowel diseases can lead to anemia by causing bleeding during adolescence.[2] Anemia is a frequent cause of hospital admission for various bone marrow diseases. Morphological examination of anemia is important to find out the cause of anemia.

Material and Methods

Study Design: Retrospective Observational  

Study Duration: September 2022 to September 2023

Sampling technique: Universal sampling

Inclusion Criteria: All indoor patients, between 10-19 years of age, whose CBC blood samples were received in the central clinical laboratory, Department of Pathology, Dr Vasantrao Pawar Medical College Hospital and Research Centre, Adgaon, Nashik

Exclusion Criteria: Patients not falling in the adolescent age group. Adolescent patients whose CBCs were not done.

Methodology: Ethics committee permission is sought before initiation of the study.

On categorising the cases according to age, it was found that 96(29%) were early adolescents, 53(17%) were mid adolescents and 174(54%) were late adolescents. Females in the late adolescent age group were most affected by anemia occupying 36% of total anemic adolescents.

On classifying anemia according to severity, it was observed that 18 cases had Hb less than 7 gm%.117 had moderate anemia and 188 had mild anemia. 49% of patients of all anemic individuals had mild anemia.

On studying RBC Indices and morphology, it was observed that 242 cases had Microcytic Hypochromic anemia, 57 cases had macrocytic anemia and 24 cases showed Normocytic Normochromic anemia.

Many cases showed dimorphic blood pictures, of which the predominant morphologic finding was taken into consideration. 2 cases showed fragmented RBCs, polychromasia, and nucleated RBCs and were diagnosed as Hemolytic anemia.

Table 1: Age-wise prevalence of anemia among adolescents

Table 2: Age and gender-wise prevalence of all patients

Table 3: Age and gender-wise distribution of anemic adolescents

A study has 74% of girls and 26% of boys involved in anemia. Other studies also show similar findings[3]. A study in Bundelkhand shows that 57% of all adolescent girls and 50% of all adolescent boys were involved in anaemia.[4]Similarly, 52.3% of girls and 47.7% of boys were affected by anemia in adolescence in Neal[5]. The higher percentage of anemia in girls is due to low iron intake, menstrual loss, pregnancy, illiteracy etc.[9],[10],[14].

After puberty, anemia was seen constantly in over 50% of females. Males showed a peak of anemia during puberty and a progressive increase of anaemia with age. [15] There are few anemia studies including both male and female adolescents. Although girls are more affected, adolescent boys should also be studied as a significant population of boys is found to be anemia in various studies[11]. Anemia in adolescents affects their cognitive physical growth and development.

Maximum cases were in the late adolescence stage in our study which was similar to a study in Bihar. Neal's study shows a higher incidence in girls more than 18 years old 17.5%. [5]. In girls, early marriage and pregnancy can be a reason for the high number of cases in late adolescence. In Bundelkhand, maximum cases were in early adolescence followed by mid adolescence stage.[4]

The percentage of severe anemia was less(5%) in our study which is comparable to other studies. It was 5.8% and 6.9%in other studies.[4, 5] Nepal study shows more cases of mild anemia which were 69.7%.[5] A study in Belkare shows 32.1% severe anemia in girls which was very high compared to our study. Rekha K et al shows 43.3% mild and 3.3% severe anemia cases in girls.[8]The severe anemia in our study was due to leukaemia, bone marrow infiltration by tumour, haemolytic anemia and iron deficiency anemia.

Most cases of mild anemia showed microcytic hypochronic peripheral smear which points towards Iron deficiency anemia. Many other studies also showed similar results.[4-8]. Dvijendra N et found that the most common type observed was microcytic hypochromic 32.56%, while in the early adolescent period, it was normocytic normochromic.[4]Several other studies show iron deficiency anemia in many females which was 87% in a study. [2] [11].