1. An 18-month-old child was brought in for a check up and was found to have pale skin and signs of iron-deficiency anemia. 2. Tests confirmed low hemoglobin and iron levels. Iron-deficiency anemia is caused by not getting enough iron from diet or blood loss and can impact development. 3. Treatment includes oral iron supplements calculated based on weight, replacing the iron deficit, and addressing the underlying cause. An iron-rich diet containing meat, leafy greens, and iron-fortified foods also helps manage iron-deficiency anemia.

1. KAHER INSTITUTE OF NURSING
SCIENCES BELAGAVI
Topic: Iron Deficiency Anemia
Mr. Jagadeesh Hubballi
Asst.prof
KAHER INS
Belagavi

2. Typical Scenario
• 18 month old child brought in by mom for check
up
• Healthy, URTI a few weeks ago (in daycare) Picky
eater, but drinks lots of milk * Growing well,
pudgy, Grand-mother thought he was a bit pale.
• Pale, chubby, wt at 95%, *HR 140, RR 20, BP
90/50, SPO2 97% *Conjunctiva and mucous
membranes slightly pale *Chest clear *No
organomegaly, no adenopathy

3. Cont…
• *CBC Hgb 5.4, Plt 735, WBC 8.5 with normal
diff *MCV, MCHC decreased *Retic count
low *Smear Microcytic, hypochromic cells
*Ferritin ↓

4. Anemia
• Anemia is defined as: A decrease in the
concentration of circulating red blood cells or
in the hemoglobin concentration and a
concomitant impaired capacity to transport
oxygen

5. Etiological factors
• Diets low in iron. A child gets iron from the food
in his or her diet. But, only a small amount of the
iron in food is actually absorbed by the body.
• Full-term newborns, born to healthy mothers,
have iron that they get during the last 3 months
of pregnancy.
• Infants of mothers with anemia or other health
problems may not have enough iron stored. And
infants born early may not get enough iron.

6. Cont…
• At 4 to 6 months of age, the iron stored during
pregnancy is at a low level. And more iron is used
as the infant grows.
• The American Academy of Pediatrics (AAP)
advises feeding your baby only breastmilk for the
first 6 months. But breastmilk does not have a lot
of iron, so infants that are breastfed only, may
not have enough iron.
• Older infants and toddlers may not get enough
iron from their diets.

7. Cont…
• Body changes. When the body goes through a growth
spurt, it needs more iron for making more red blood
cells.
• Gastrointestinal tract problems. Poor absorption of
iron is common after some forms of gastrointestinal
surgeries. When you eat foods containing iron, most of
the iron is absorbed in the upper small intestine. Any
abnormalities in the gastrointestinal (GI) tract could
alter iron absorption and cause iron-deficiency anemia.
• Blood loss. Loss of blood can cause a decrease of iron.
Sources of blood loss may include gastrointestinal
bleeding, menstrual bleeding, or injury.

8. Symptoms
• Pale skin
• Irritability or fussiness
• Lack of energy or tiring easily (fatigue)
• Fast heart beat
• Enlarged spleen
• Wanting to eat odd substances, such as dirt or ice
(also called pica)
• Iron deficiency may have effects on neurologic
and intellectual functions

9. Cont…
• Iron deficiency may have effects on neurologic
and intellectual functions
• Decreased cognitive performance often
accompanies iron deficiency and iron
deficiency anemia
• Koilonychia: "spoon nails”
• Smooth, bald, burning tongue
• Angular Cheilosis or Stomatitis

10. Diagnostic evaluations
• Hemoglobin and hematocrit. This is often the
first screening test for anemia in children. It
measures the amount of hemoglobin and red
blood cells in the blood.
• Complete blood count (CBC). A complete blood
count checks the red and white blood cells, blood
clotting cells (platelets), and sometimes, young
red blood cells (reticulocytes). It includes
hemoglobin and hematocrit and more details
about the red blood cells.

11. Cont…
• Peripheral smear: A small sample of blood is
examined under a microscope. Blood cells are
checked to see if they look normal or not.
• Iron studies: Serum ferritin (decreased) -
Serum iron (decreased) - Iron binding capacity
(increased)

12. Management
• Treatment will depend on your child’s symptoms,
age, and general health. It will also depend on how
severe the condition is.
• Beginning at 4 months of age, infants that are only
breastfed or partially breastfed should be given a
daily iron supplement until they begin eating iron-
rich foods.
• Infants that are formula-fed do not need iron
supplements. The formula has iron added to it.
Whole milk should not be given to infants less than
12 months old.

13. Cont…
• Infants and toddlers from 1 to 3 years old
should have foods rich in iron. They include
cereal that has iron added, red meats, and
vegetables with iron. Fruits with vitamin C are
also important. The vitamin C helps the body
absorb the iron.

14. Treating iron-deficiency anemia
includes:
1.Use oral iron
2.Replace iron deficit in total
3.Establish and treat the cause
4.The therapeutic dose should be calculated in
terms of elemental iron
5. A daily total of 4 -6 mg/kg of elemental iron in
three divided doses provides an optimal amount
of iron
6.A parenteral iron preparation (iron dextran) is an
effective form of iron

15. Cont…
Oral administration of simple ferrous salts ( sulfate,
gluconate, fumartate) provides inexpensive and
satisfactory therapy.
Parenteral therapy:
• Iron dextran: (IM-IV) 50 mg iron/mL Low and
high molecular weight
• Iron sucrose : (IV) safe even with sensitivity
to iron dextran
• Ferric carboxymaltose: (IV) given at single doses
of up to 1000 mg iron per week over of 15
minutes

16. Cont…
Blood transfusion
• Is indicated only when anemia is very severe
and Superimposed infection may interfere
with the response.
• In severely anemic children with hemoglobin
values less than 4 g/dL should be given only 2
-3 mL/kg of packed cells at any one time.

17. Short term Prevention of IDA In
infancy
• Avoid gestational ID
• Try to prevent premature delivery and low
birth weight
• Increase birth spacing
• Delay pregnancy beyond teens
• Delay ligation of umbilical cord (by 30-60
seconds)

18. Sustainable approaches to elimination
of micronutrient deficiency e.g. iron
• Foods consumed regularly
• Consumed in sufficient quantities
• Consumed in stable amounts
• Centrally processed foods
• Iron obtained from animal products is much
more easily absorbed by the body than iron
from plant sources,

19. Home Message
• Anemia is a sign, not a disease.
• Anemias are a dynamic process.
• Its never normal to be anemic.
• The diagnosis of iron deficiency anemia
mandates further work-up

20. • Iron-rich diet. Eating a diet with iron-rich foods
can help treat iron-deficiency anemia. Good
sources of iron include:
• Iron-enriched cereals, breads, pasta, and rice
• Meats, such as beef, pork, lamb, liver, and other
organ meats
• Poultry, such as chicken, duck, turkey, (especially
dark meat), and liver
• Fish, such as shellfish, including clams, mussels,
and oysters, sardines, and anchovies

21. Cont…
• Leafy greens of the cabbage family, such as
broccoli, kale, turnip greens, and collards
• Legumes, such as lima beans and green peas;
dry beans and peas, such as pinto beans,
black-eyed peas, and canned baked beans
• Yeast-leavened whole-wheat bread and rolls

22. Key points
• Iron-deficiency anemia is not having enough
iron in the blood. Iron is needed for
hemoglobin.
• Breastfed only infants should be given iron
beginning at 4 months of age.
• When infants are 12 months old, they should
be screened for iron-deficiency anemia.
• Iron supplement and iron-rich foods are used
to treat iron-deficiency anemia.

23. THANK
YOU