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Anemia (Pandu Roga)

Weak Agni reducing iron assimilation

Iron + vitamin C pairing, sesame/ragi emphasis, circulation yoga, and rest for marrow recovery.

Hemoglobin rise ~0.8-1.2 g/dL expected over 8-12 weeks

Understanding Anemia

Definition

Anemia is a condition characterized by insufficient red blood cells or hemoglobin to carry adequate oxygen to body tissues, resulting in fatigue and weakness.

Ayurvedic Perspective

Known as Pandu Roga (pallor disease), anemia represents a deficiency in Rakta dhatu (blood tissue) often stemming from weak Agni (digestive fire) that cannot properly transform nutrients into quality blood. It involves Pitta dosha imbalance affecting the quality of Ranjaka Pitta (the sub-dosha responsible for blood formation). The condition reflects poor nutrient assimilation rather than just dietary insufficiency.

Modern Medicine

Anemia results from decreased red blood cell production, increased destruction, or blood loss. Iron deficiency anemia is most common, but other types include vitamin B12 deficiency, folate deficiency, hemolytic anemia, and anemia of chronic disease. Hemoglobin levels below 12 g/dL in women and 13 g/dL in men indicate anemia.

Causes

  • Iron deficiency from inadequate dietary intake or poor absorption
  • Weak digestive fire (Mandagni) reducing nutrient assimilation
  • Chronic blood loss (heavy menstruation, GI bleeding, parasites)
  • Vitamin B12 or folate deficiency
  • Chronic diseases (kidney disease, inflammatory conditions, cancer)
  • Bone marrow disorders affecting RBC production
  • Genetic conditions (sickle cell, thalassemia)
  • Excessive consumption of tea/coffee inhibiting iron absorption
  • Pregnancy and lactation increasing iron demands
  • Malabsorption disorders (celiac disease, Crohn's disease)

Risk Factors

Modifiable

  • Poor dietary intake of iron, B12, or folate
  • Vegetarian/vegan diet without proper supplementation
  • Weak digestive fire reducing nutrient absorption
  • Excessive tea or coffee consumption (inhibits iron absorption)
  • Chronic NSAID use (can cause GI bleeding)
  • Heavy alcohol consumption (affects folate absorption)
  • Parasitic infections (hookworms deplete iron)
  • Calcium supplement overuse blocking iron absorption

Non-Modifiable

  • Female gender (menstruation, pregnancy)
  • Age (infants, toddlers, elderly at higher risk)
  • Chronic diseases (kidney disease, inflammatory bowel disease)
  • Genetic disorders (sickle cell, thalassemia, G6PD deficiency)
  • Autoimmune conditions
  • History of gastric surgery (reduced absorption)

Symptoms & Progression

Early Stage

  • • Mild fatigue and weakness (Daurbalya)
  • • Pale skin, nail beds, and conjunctiva (Panduta)
  • • Slight dizziness upon standing
  • • Mild shortness of breath with exertion
  • • Decreased appetite
  • • Mild headaches

Progressive

  • • Persistent fatigue affecting daily activities
  • • Palpitations and rapid heartbeat (Hridspandana)
  • • Cold hands and feet
  • • Brittle nails, hair loss
  • • Sore or inflamed tongue (glossitis)
  • • Difficulty concentrating and memory issues
  • • Restless leg syndrome
  • • Frequent infections due to weakened immunity

Severe

  • • Extreme weakness and inability to perform normal activities
  • • Severe shortness of breath even at rest
  • • Chest pain and angina
  • • Yellowing of skin (if hemolytic anemia)
  • • Dark or bloody stools (GI bleeding)
  • • Confusion and cognitive impairment
  • • Heart failure symptoms (in chronic severe cases)
  • • Pica (craving non-food items like ice, dirt)

Diagnosis & Testing

Diagnostic Methods

  • Complete Blood Count (CBC) - primary screening test
  • Peripheral blood smear examination
  • Reticulocyte count (measures new RBC production)
  • Physical examination for pallor, tachycardia, splenomegaly
  • Medical history including diet, medications, menstrual history

Laboratory Tests

  • Hemoglobin and hematocrit levels
  • Mean Corpuscular Volume (MCV) - determines anemia type
  • Serum iron, ferritin, transferrin saturation (iron studies)
  • Vitamin B12 and folate levels
  • Serum bilirubin (if hemolytic anemia suspected)
  • Stool occult blood test (screen for GI bleeding)
  • Thyroid function tests
  • Kidney function tests (creatinine, BUN)
  • Bone marrow biopsy (if cause unclear or suspected marrow disorder)

Prevention Strategies

Iron-rich diet: red meat, poultry, fish, lentils, beans, dark leafy greens
Pair iron sources with vitamin C (citrus, tomatoes, peppers) for better absorption
Include B12 sources: dairy, eggs, fortified foods; supplement if vegan
Folate-rich foods: leafy greens, legumes, fortified grains
Cook in cast iron cookware to increase iron content of food
Avoid tea/coffee with meals; wait 2 hours after iron-rich foods
Strengthen digestive fire with ginger, cumin, coriander, black pepper
Address underlying causes: treat heavy menstruation, GI issues
Regular screening for at-risk populations (pregnant women, infants, elderly)
Deworming if in areas with parasitic infections

Related Conditions

Iron Deficiency

Most common cause of anemia worldwide; results from inadequate intake, poor absorption, or blood loss

Chronic Kidney Disease

CKD causes anemia through reduced erythropoietin production; anemia worsens as kidney function declines

Hypothyroidism

Low thyroid hormone reduces bone marrow activity and can cause macrocytic or normocytic anemia

Celiac Disease

Intestinal damage from gluten impairs iron, B12, and folate absorption, leading to anemia

Inflammatory Bowel Disease (IBD)

Crohn's and ulcerative colitis cause anemia through blood loss, inflammation, and malabsorption

Menorrhagia (Heavy Periods)

Leading cause of iron deficiency anemia in premenopausal women; requires gynecological evaluation