Anemia in children Gloria Monsalve M.D.

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Anemia in children.
Gloria Monsalve M.D

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» Anemia is defined as hematocrit (Hct),
hemoglobin (Hb), red blood cells (RBC)
concentration >2 SD below mean for age.

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CLINICAL FINDINGS IN ANEMIA
•Pallor
•Tachycardia, tachypnea
•Apnea
•↑ O2 requirements
•Lethargy
•Poor feeding
•Hepatosplenomegaly (hemolytic disease)
•Jaundice
•Hypotension
•Metabolic acidosis with severe anemia

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Physiologic Anemia of the
Newborn
At one week postnatal all RBC indices begin declining to a
minimum value reached at about 2 months of age.
Shorter life span on neonatal RBCs (50-70 days)
Switch from HbF to HbA
Seldom produces symptoms
Not altered by nutritional supplements

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Fe++ deficiency
• Most common anemia of childhood
– dietary, occult GI bleeding, cow’s milk
intolerance

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Fe++ deficiency
• Lab–
– CBC: microcytic, hypochromic, low-normal retic.
count
– Decr. ferritin and serum iron
– Incr. TIBC
• DDX– be suspicious!
– chronic disease, thalassemia, plumbism
• Tx–
– Fe++ replacement (watch for constipation) gives
dramatic response
• reticulocytosis in 72 hr, Hgb responds at
~1g/L per wk, iron stores us. replenished by 3 mo

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Mentzer Index
» MCV/RBC > 14 = Iron Deficiency
» MCV/RBC < 13 = Thalassemia Minor

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Feeding in early infancy
» Baby should be breast fed colostrum and mature
milk, both have 49% absorbable iron this is
sufficient with available fetal stores till baby
doubles the birth weight.
» Weaning foods from 6 months onwards should
have one iron rich dietary item and iron
supplementation be given as recommended.

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Iron fortified food.
» Iron supplements have been highly effective in
fortification trials with Egyptian flat breads, curry
powder in South Africa, fish sauce in Thailand,
and sugar in Guatemala.
» In Grenada , flour used in commercial baking is
enriched with iron and B vitamins,.
» Indian researchers have field tested with success
iron fortified salt
» Pasteurized milk (iron 15 mg/ L and vitamin C
100 mg/L)-is used in GB, USA

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Dietary sourses of iron