National iron plus_initiative_guidelines_for_control_of_ida

1. Guidelines for Control of Iron Deficiency Anaemia

2. Adolescent Division Ministry of Health and Family Welfare Government of India

4. Acknowledgements 7KH 1DWLRQDO *XLGHOLQHV IRU &RQWURO RI ,URQ 'H¿FLHQF $QDHPLD HPHUJHG RXW RI ZLGH EDVHG FRQVXOWDWLRQ 3UHSDUDWLRQ RI WKH JXLGHOLQHV ZRXOG QRW KDYH EHHQ SRVVLEOH ZLWKRXW WKH YDOXDEOH FRQWULEXWLRQV RI 0DWHUQDO DQG KLOG 'LYLVLRQV RI WKH 0LQLVWU RI +HDOWK DQG )DPLO :HOIDUH DQG domain experts. $GGLWLRQDO 6HFUHWDU 0LVVLRQ 'LUHFWRU 15+0 0V $QXUDGKD *XSWD¶V HQFRXUDJHPHQW ZDV RXU LQVSLUDWLRQ DQG KHU VWUDWHJLF YLVLRQ VKDSHG WKH JXLGHOLQHV -RLQW 6HFUHWDU 5+ 'U 5DNHVK .XPDU SURYLGHG YDOXDEOH LQVLJKWV DQG IDFLOLWDWHG WHFKQLFDO GLVFXVVLRQV ZKLFK ZHUH FULWLFDO IRU ¿QDOL]LQJ WKH JXLGHOLQHV List of Contributors Ms. Anuradha Gupta Additional Secretary Mission Director, NRHM Dr. Rakesh Kumar Joint Secretary, RCH 'U 9LUHQGHU 6LQJK 6DOKRWUD Deputy Commissioner, Adolescent Health Ms. Anshu Mohan 3URJUDPPH 0DQDJHU $GROHVFHQW +HDOWK Dr. Sheetal Rahi 0HGLFDO 2I¿FHU $GROHVFHQW +HDOWK Technical Experts Professor Umesh Kapil, Department of Community Medicine, AIIMS Dr. HPS Sachdev, Paediatrician, Sita Ram Bhartia Institute of Science Research Dr. PV Kotecha, Professor, Preventive and Social Medicine, *RYHUQPHQW 0HGLFDO ROOHJH 9DGRGDUD 3URI 6XQHHWD 0LWWDO *QDHFRORJLVW 2EVWHWULFLDQ )RUWLV +RVSLWDO Dr. Prema Ramachandran, Director, Nutrition Foundation of India 'U $EKD 6LQJK +HDG 'HSWW RI *QDHFRORJ DQG 2EVWHWULFV /+0 6. +RVSLWDO Dr. Vartika Saxena, Deptt. of Community Medicine, AIIMS, Rishikesh 6SHFLDO 0HQWLRQ 5DMDW 5D 6U $GYRFDF RPPXQLFDWLRQ 2I¿FHU 81)3$ ZDV LQVWUXPHQWDO LQ WKH GHVLJQLQJ DQG SULQWLQJ RI WKLV GRFXPHQW

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15. Foreword Anaemia, a manifestation of under-nutrition and poor dietary intake of iron is D VHULRXV SXEOLF KHDOWK SUREOHP DPRQJ SUHJQDQW ZRPHQ LQIDQWV RXQJ FKLOGUHQ DQG DGROHVFHQWV 'DWD VXJJHVWV WKDW RXW RI HYHU FKLOGUHQ DJHG PRQWKV LQ ,QGLD DUH DQDHPLF 7KUHH SHU FHQW RI FKLOGUHQ DJHG PRQWKV DUH VHYHUHO DQDHPLF SHU FHQW DUH PRGHUDWHO DQDHPLF DQG SHU FHQW DUH PLOGO DQDHPLF ,Q IDFW WKH SHUFHQWDJH RI FKLOGUHQ ZLWK DQ DQDHPLD LQFUHDVHG IURP SHU FHQW LQ 1)+6,, WR SHU FHQW LQ 1)+6,,, ,QGLD LV DPRQJ WKH FRXQWULHV ZLWK KLJK SUHYDOHQFH RI DQDHPLD LQ WKH ZRUOG ,W LV HVWLPDWHG WKDW DQDHPLD GLUHFWO FDXVHV SHU FHQW RI PDWHUQDO GHDWKV LQ ,QGLD DQG LQGLUHFWO DFFRXQWV IRU DQRWKHU SHU FHQW RI PDWHUQDO GHDWKV 7DNLQJ FRJQL]DQFH RI WKLV WKH 0LQLVWU RI +HDOWK DQG )DPLO :HOIDUH KDV GHYHORSHG WKH 1DWLRQDO *XLGHOLQH IRU RQWURO RI ,URQ 'H¿FLHQF $QDHPLD WR KROLVWLFDOO DGGUHVV ERWK SUHYHQWLYH DQG FXUDWLYH DVSHFW RI WKLV FKDOOHQJH DFURVV DOO OLIH VWDJH DQG YDULRXV levels of care. 7KH GRFXPHQW SURYLGHV D JXLGH IRU DOO VWDNHKROGHUV DQG SDUWQHUV RQ KRZ SROLF PDNHUV KHDOWK SURIHVVLRQDOV FRPPXQLW PHPEHUV DQG IDPLOLHV FDQ WDNH DFWLRQ WR SUHYHQW and control anaemia. I call upon all stakeholders and partners for their continued support in this respect. , VLQFHUHO KRSH WKDW 6WDWHV ZLOO SURDFWLYHO ZRUN RQ WKLV LQLWLDWLYH ZKLFK ZLOO KDYH D ORQJ WHUP LPSDFW RQ WKH KHDOWK RI ,QGLD (Dr. Rakesh Kumar) 'DWHG th -DQXDU D . RAKESH K MAR, I.A.S INT SE RETAR Telefax : 23061723 E-mail : r umar 2@hotmail.com G I H V , H N M H F W N B , N D - 110108

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26. DQG FRQVHTXHQWO WKHLU R[JHQFDUULQJ FDSDFLW LV LQVXI¿FLHQW WR PHHW WKH ERG¶V SKVLRORJLFDO QHHGV The function of the RBCs is to deliver oxygen from the lungs to the tissues and carbon dioxide from the tissues to the lungs. This is accomplished by using haemoglobin (Hb), a tetramer protein composed of haem and globin. Anaemia impairs the body’s ability for gas exchange by decreasing the number of RBCs transporting oxygen and carbon dioxide. $QDHPLD UHVXOWV IURP RQH RU PRUH RI WKH IROORZLQJ SURFHVV GHIHFWLYH UHG FHOO SURGXFWLRQ LQFUHDVHG UHG FHOO GHVWUXFWLRQ RU EORRG ORVV ,URQ LV QHFHVVDU IRU VQWKHVLV RI KDHPRJORELQ ,URQ GH¿FLHQF LV WKRXJKW WR EH WKH PRVW FRPPRQ FDXVH RI DQDHPLD JOREDOO EXW RWKHU QXWULWLRQDO GH¿FLHQFLHV LQFOXGLQJ IRODWH YLWDPLQ % DQG YLWDPLQ $

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29. EDELHV ,URQ GH¿FLHQF DQDHPLD DOVR DGYHUVHO DIIHFWV WKH ERG¶V LPPXQH UHVSRQVH Fig. 1.1: Adverse effects of anaemia ANAEMIA Reduced physical development Impaired sexual and reproductive development Reduced cognitive development Decreased work output Decreased work capacity Diminished concentration Disturbance in perception Poor learning ability Irregular menstruation Low pre-pregnancy iron stores LBW babies and preterm delivery 1

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67. *XLGHOLQHV IRU RQWURO RI ,URQ 'H¿FLHQF $QDHPLD 8 Fig. 2.2: Prevalence of anaemia among adolescent girls (12–19 years) and young women (20–29 years) in India6,7 80 12--14 years 68.6 69.7 55.8 56.1 47.2 27 39.1 38.5 20.5 20.7 14.9 1.1 1.7 1.71 16 15--17 years 15--19 years 20--29 years 70 60 Any anaemia (12.0 g/dl) Mild anaemia (10.0–11.9 g/dl) Severe anaemia (7.0 g/dl) Moderate anaemia (7.0–9.9 g/dl) 50 40 30 Percentage 20 10 0 Source: NFHS-3, 2005-06 and the National Nutrition Monitoring Bureau Survey (NNMBS), 2006 Prevalence of anaemia among pregnant women, men and women of reproductive age (WRA) $QDHPLD LV D PDMRU KHDOWK SUREOHP IRU DGXOWV DV ZHOO DIIHFWLQJ SHU FHQW RI ZRPHQ SHU FHQW RI SUHJQDQW ZRPHQ DQG SHU FHQW RI PHQ 7KH SUHYDOHQFH RI DQDHPLD DPRQJ HYHU PDUULHG ZRPHQ LQFUHDVHG IURP SHU FHQW LQ 1)+6 WR SHU FHQW LQ 1)+6 )LJXUH

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142. ± HDUV

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144. WKURXJKRXW WKH FDOHQGDU HDU LH ZHHNV HDFK HDU ‡ $OEHQGD]ROH PJ

145. WDEOHWV IRU ELDQQXDO GHZRUPLQJ IRU KHOPLQWKLF FRQWURO $6+$ WR GLVWULEXWH ,)$ VXSSOHPHQWV WR ZRPHQ LQ UHSURGXFWLYH DJH JURXS GXULQJ GRRUVWHS GLVWULEXWLRQ RI FRQWUDFHSWLYHV Note: All health facilities to have adequate supply of IFA supplements for WRA.

146. 23 7KHUDSHXWLF $SSURDFK WKURXJK WKH /LIH FOH 6L[ 0RQWKV ± 0RQWKV $6+$V DQG $10V ZLOO VFUHHQ FKLOGUHQ IURP PRQWKV XS WR HDUV RI DJH IRU VLJQV RI DQDHPLD DV SHU ,QWHJUDWHG 0DQDJHPHQW RI 1HRQDWDO DQG KLOGKRRG ,OOQHVV ,01,

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153. *XLGHOLQHV IRU RQWURO RI ,URQ 'H¿FLHQF $QDHPLD 24 Table 7.1: Management of anaemia on the basis of haemoglobin levels in children 6 months–5 years Level of Hb Treatment Follow-up Referral No Anaemia ! JPGO

154. PJ RI HOHPHQWDO LURQ DQG PFJ RI IROLF DFLG LQ ELZHHNO UHJLPHQ Mild Anaemia ± JPGO

155. PJ RI LURQ .J GD IRU 2 months )ROORZXS HYHU GDV E ANM +E HVWLPDWLRQ DIWHU FRPSOHWLQJ PRQWKV RI treatment to document +E! JPGO In case the child has not responded to the treatment of DQDHPLD ZLWK GDLO GRVH RI LURQ for 2 months, refer the child to the )58'+ ZLWK ),01, WUDLQHG 02 Paediatrician/Physician for further LQYHVWLJDWLRQ Moderate Anaemia ± JPGO

156. PJ RI LURQ .J GD IRU 2 months )ROORZXS HYHU GDV E ANM +E HVWLPDWLRQ DIWHU FRPSOHWLQJ PRQWKV RI treatment to document +E ! JPGO In case the child has not responded to the treatment of DQDHPLD ZLWK GDLO GRVH RI LURQ for 2 months, refer the child to the )58'+ ZLWK ),01, WUDLQHG 02 Paediatrician/Physician for further LQYHVWLJDWLRQV Severe Anaemia JPGO

157. Refer XUJHQWO WR DH/FRU Table 7.2: Dose of IFA syrup for anaemic children 6 months–5 years Age of child Dose Frequency PRQWKV± PRQWKV ± NJ

158. 1 ml of IFA syrup Once a day HDU± HDUV ± NJ

159. PO RI ,)$ VUXS Once a day HDUV± HDUV ± NJ

160. 2 ml of IFA syrup Once a day Follow-up of children undergoing treatment of anaemia to be done by ANM onitoring by SH for co liance of yru e ery ay for a erio of onth ollo u by e ery ay f chil continue to ha e anae ia Hb e ti ation at ub centre after onth of yru refer the chil to PHC for further anage ent

161. 7KHUDSHXWLF $SSURDFK WKURXJK WKH /LIH FOH 25 ‡ $IWHU FRPSOHWLRQ RI WUHDWPHQW RI DQDHPLD DQG GRFXPHQWLQJ +E OHYHO ! JPGO WKH ,)$ VXSSOHPHQWDWLRQ WR EH UHVXPHG ‡ 7UHDWPHQW RI DQDHPLD ZLWK LURQ VKRXOG EH ZLWKKHOG LQ FDVH RI DFXWH LOOQHVV 6HYHUH $FXWH 0DOQXWULWLRQ DQG LQ D NQRZQ FDVH RI KDHPRJORELQRSDWK $QDHPLD LQ WKHVH FDVHV VKRXOG EH WUHDWHG DV SHU WKH VWDQGDUG WUHDWPHQW JXLGHOLQHV E WKH DWWHQGLQJ SKVLFLDQ DV SHU the merit of the individual case. Management of severe anaemia at FRU/DH (as per F-IMNCI) in children 6 months–5 years History to be taken for Examination for ‡ 'XUDWLRQ RI VPSWRPV ‡ 8VXDO GLHW EHIRUH WKH FXUUHQW LOOQHVV

162. ‡ )DPLO FLUFXPVWDQFHV WR XQGHUVWDQG WKH FKLOG¶V VRFLDO EDFNJURXQG

163. ‡ 3URORQJHG IHYHU ‡ :RUP LQIHVWDWLRQ ‡ %OHHGLQJ IURP DQ VLWH ‡ $Q OXPSV LQ WKH ERG ‡ 3UHYLRXV EORRG WUDQVIXVLRQV ‡ 6LPLODU LOOQHVV LQ WKH IDPLO VLEOLQJV

164. ‡ 6HYHUH SDOPDU SDOORU ‡ 6NLQ EOHHGV SHWHFKLDO DQGRU SXUSXULF VSRWV

165. ‡ /PSKDGHQRSDWK ‡ +HSDWRVSOHQRPHJDO ‡ 6LJQV RI KHDUW IDLOXUH JDOORS UKWKP UDLVHG -93 UHVSLUDWRU GLVWUHVV EDVDO FUHSLWDWLRQV

166. Investigations Indication for blood transfusion Blood transfusion ‡ )XOO EORRG FRXQW DQG H[DPLQDWLRQ RI D WKLQ ¿OP IRU FHOO PRUSKRORJ ‡ %ORRG ¿OPV IRU PDODULD parasites ‡ 6WRRO H[DPLQDWLRQ IRU RYD FVW DQG RFFXOW EORRG ‡ $OO FKLOGUHQ ZLWK +E ” JPGO ‡ KLOGUHQ ZLWK +E ± JPGO ZLWK DQ RI WKH IROORZLQJ – Dehydration – Shock – Impaired consciousness – Heart failure ± 'HHS DQG ODERXUHG EUHDWKLQJ ± 9HU KLJK SDUDVLWDHPLD ! RI 5%

167. ‡ ,I SDFNHG FHOOV DUH DYDLODEOH JLYH PONJ RYHU ± KRXUV SUHIHUDEO ,I QRW JLYH ZKROH EORRG PONJ RYHU ± KRXUV Indications for further investigations and referral for management: ‡ DVHV RI DQDHPLD DQG +HSDWRVSOHQRPHJDO6SOHQRPHJDO LI PDODULD KDV EHHQ H[FOXGHG RU QRW VWURQJO VXVSHFWHG ‡ KLOGUHQ ZLWK VLPLODU KLVWRU LQ WKH IDPLO VLEOLQJV

168. ‡ DVHV RI DQDHPLD ZLWK VLJQL¿FDQW OPSKDGHQRSDWK EOHHGLQJ PDQLIHVWDWLRQV ‡ DVHV RI DQDHPLD ZLWK DEQRUPDOLPPDWXUH FHOOV RU PDUNHG OHXFRFWRVLV RU ELFWRSHQLD or pancytopenia on smear examination ‡ KLOGUHQ ZKR DUH QRW UHVSRQGLQJ WR DGHTXDWH GRVH RI LURQIRODWH JLYHQ IRU ZHHNV

169. *XLGHOLQHV IRU RQWURO RI ,URQ 'H¿FLHQF $QDHPLD 26 KLOGUHQ ± HDUV 7HDFKHUV DQG $::V UHVSHFWLYHO ZLOO XQGHUWDNH VFUHHQLQJ IRU DQDHPLD RI LQVFKRRO DQG RXWRIVFKRRO FKLOGUHQ LQ WKH DJH JURXS ± HDUV $OO FKLOGUHQ ZLWK FOLQLFDO SDOORU ZLOO EH UHIHUUHG WR 3+0RELOH 0HGLFDO WHDPV IRU +E HVWLPDWLRQ DQG WUHDWPHQW RI DQDHPLD KLOGUHQ XQGHUJRLQJ +E HVWLPDWLRQ XQGHU 8QLYHUVDO 6FUHHQLQJ 3URJUDPPH ZLOO DOVR EH UHIHUUHG WR 3+)58'+ DFFRUGLQJ WR VHYHULW RI DQDHPLD IRU PDQDJHPHQW Facility-level Management ‡ $Q FKLOG UHSRUWLQJ WR DQ IDFLOLW 3+ OHYHO DQG DERYH

170. ZLWK DQ LOOQHVV ZLOO EH DVVHVVHG FOLQLFDOO E WKH DWWHQGLQJ 0HGLFDO 2I¿FHU IRU DQDHPLD URXWLQHO DQG VKRXOG EH DGYLVHG +E HVWLPDWLRQ LI WKH FKLOG LV IRXQG WR EH DQDHPLF FOLQLFDOO ‡ $OO FKLOGUHQ UHIHUUHG IURP FRPPXQLW E $:: RU $10 IURP VXEFHQWUH RU IURP VFKRROV WR 3+ GXH SDOPDU SDOORU ZLOO XQGHUJR +E OHYHO HVWLPDWLRQ EHIRUH LQLWLDWLQJ WUHDWPHQW KLOGUHQ ZLOO EH FDWHJRULVHG DV KDYLQJ PLOG PRGHUDWH DQG VHYHUH DQDHPLD RQ EDVLV RI +E OHYHOV DQG IRU IXUWKHU PDQDJHPHQW DV SHU 7DEOH Table 7.3: Management of anaemia on the basis of haemoglobin levels in children 5–10 years Level of Hb Treatment Follow-up Referral Mild Anaemia (11–11.4 gm/dl) PJ RI LURQ.J day for 2 months )ROORZXS HYHU GDV +E HVWLPDWLRQ DIWHU FRPSOHWLQJ PRQWKV RI WUHDWPHQW WR DVVHVV LI +E HVWLPDWHV DUH ! JPGO In case the child has not responded WR WKH WUHDWPHQW RI DQDHPLD ZLWK GDLO dose of iron for 2 months, refer the FKLOG WR WKH )58'+ ZLWK ),01, trained MO/Paediatrician/Physician IRU IXUWKHU LQYHVWLJDWLRQ Moderate Anaemia (8–10.9 gm/dl) PJ RI LURQ.J day for 2 months )ROORZXS HYHU GDV +E HVWLPDWLRQ DIWHU FRPSOHWLQJ PRQWKV RI WUHDWPHQW WR DVVHVV LI +E HVWLPDWHV DUH ! JPGO In case the child has not responded WR WKH WUHDWPHQW RI DQDHPLD ZLWK GDLO dose of iron for 2 months, refer the FKLOG WR WKH )58'+ ZLWK ),01, trained MO/Paediatrician/Physician IRU IXUWKHU LQYHVWLJDWLRQV Severe Anaemia (8 gm/dl) 5HIHU XUJHQWO to DH/FRU Note: ‡ $IWHU FRPSOHWLRQ RI WUHDWPHQW RI DQDHPLD DQG DWWDLQLQJ +E OHYHO ! JPGO WKH ,)$ VXSSOHPHQWDWLRQ WR EH UHVXPHG ‡ 7UHDWPHQW RI DQDHPLD ZLWK LURQ VKRXOG EH ZLWKKHOG LQ FDVH RI DFXWH LOOQHVV VHYHUH DFXWH PDOQXWULWLRQ DQG LQ D NQRZQ FDVH RI KDHPRJORELQRSDWK DQG DQDHPLD LQ WKHVH FDVHV VKRXOG EH WUHDWHG DV SHU WKH VWDQGDUG WUHDWPHQW JXLGHOLQHV E WKH DWWHQGLQJ SKVLFLDQ DV SHU WKH PHULW RI the individual case.

171. 7KHUDSHXWLF $SSURDFK WKURXJK WKH /LIH FOH 27 Management of severe anaemia at FRU/DH in children 5–10 years History taking for Examination for ‡ 'XUDWLRQ RI symptoms ‡ 8VXDO GLHW EHIRUH WKH FXUUHQW LOOQHVV

172. ‡ )DPLO FLUFXPVWDQFHV WR XQGHUVWDQG WKH FKLOG¶V VRFLDO EDFNJURXQG

173. ‡ 3URORQJHG IHYHU ‡ :RUP LQIHVWDWLRQ ‡ %OHHGLQJ IURP DQ VLWH ‡ $Q OXPSV LQ WKH ERG ‡ 3UHYLRXV EORod transfusions ‡ 6LPLODU LOOQHVV LQ WKH IDPLO VLEOLQJV

174. ‡ 6HYHUH SDOPar pallor ‡ 6NLQ EOHHGV SHWHFKLDO DQGRU SXUSXULF VSRWV

175. ‡ /PSKDGHQRSDWK ‡ +HSDWRVSOHQRPHJDO ‡ 6LJQV RI KHDUW IDLOXUH JDOORS UKWKP UDLVHG -93 UHVSLUDWRU GLVWUHVV EDVDO FUHSLWDWLRQV

176. Investigations Indication for blood transfusion Blood transfusion ‡ )XOO EORRG FRXQW DQG H[DPLQDWLRQ RI D WKLQ ¿OP IRU FHOO PRUSKRORJ ‡ %ORRG ¿OPV IRU PDODULD parasites ‡ 6WRRO H[DPLQDWLRQ IRU RYD FVW DQG RFFXOW EORRG ‡ $OO FKLOGUHQ ZLWK +E ” JPGO ‡ KLOGUHQ ZLWK +E JPGO ZLWK DQ RI WKH IROORZLQJ – Dehydration – Shock – Impaired consciousness – Heart failure – 'HHS DQG ODERXUHG EUHDWKLQJ – 9HU KLJK SDUDVLWDHPLD ! RI 5%

177. ,I SDFNHG FHOOV DUH DYDLODEOH JLYH PONJ RYHU KRXUV SUHIHUDEO ,I QRW JLYH ZKROH EORRG PONJ RYHU KRXUV Indications for further investigations and referral for management: ‡ DVHV RI DQDHPLD DQG +HSDWRVSOHQRPHJDO6SOHQRPHJDO LI PDODULD KDV EHHQ H[FOXGHG RU QRW VWURQJO VXVSHFWHG ‡ KLOGUHQ ZLWK VLPLODU KLVWRU LQ WKH IDPLO VLEOLQJV

178. ‡ DVHV RI DQDHPLD ZLWK VLJQL¿FDQW OPSKDGHQRSDWK EOHHGLQJ PDQLIHVWDWLRQV ‡ DVHV RI DQDHPLD ZLWK DEQRUPDOLPPDWXUH FHOOV RU PDUNHG OHXFRFWRVLV RU ELFWRSHQLD or pancytopenia on smear examination ‡ KLOGUHQ ZKR DUH QRW UHVSRQGLQJ WR DGHTXDWH GRVH RI LURQIRODWH JLYHQ IRU ZHHNV $GROHVFHQWV LQ WKH $JH *URXS ± HDUV Screening 6FUHHQLQJ IRU DQDHPLD LQ DGROHVFHQWV ZLOO EH XQGHUWDNHQ E WHDFKHUV IRU LQVFKRRO DGROHVFHQWV DQG E $:: IRU RXWRIVFKRRO DGROHVFHQWV E DVVHVVPHQW RI SDOPDU QDLO EHG DQG WRQJXH SDOORU $GROHVFHQWV ZLWK FOLQLFDO SDOORU ZLOO EH UHIHUUHG WR 3+0RELOH PHGLFDO WHDPV IRU +E WHVWLQJ DQG WUHDWPHQW

179. *XLGHOLQHV IRU RQWURO RI ,URQ 'H¿FLHQF $QDHPLD 28 Facility level management of anaemia in adolescents $OO DGROHVFHQWV UHIHUUHG WR 3+ ZLWK SDOORU ZLOO XQGHUJR +E OHYHO HVWLPDWLRQ EHIRUH LQLWLDWLRQ RI WUHDWPHQW $GROHVFHQWV ZLOO EH FDWHJRULVHG DV KDYLQJ PLOG PRGHUDWH DQG VHYHUH DQDHPLD RQ WKH EDVLV RI +E OHYHOV DQG IXUWKHU PDQDJHPHQW RI DQDHPLD ZLOO EH DV SHU 7DEOH Table 7.4: Management of anaemia on the basis of haemoglobin levels among adolescents 10–19 years Level of Hb Treatment Follow-up Indication for referral Mild Anaemia (11–11.9 gm/dl) PJ RI elemental iron daily for PRQWKV )ROORZXS HYHU PRQWK +E HVWLPDWLRQ DIWHU FRPSOHWLQJ PRQWKV RI WUHDWPHQW WR DVVHVV LI +E HVWLPDWHV DUH ! JPGO In case of no improvement LQ +E OHYHOV DIWHU PRQWKV RI WUHDWPHQW DGROHVFHQW ZLOO EH UHIHUUHG to DH/FRU for further LQYHVWLJDWLRQ Moderate Anaemia (8–10.9 gm/dl) PJ RI elemental iron daily for PRQWKV ,QYHVWLJDWH )ROORZXS HYHU GDV +E HVWLPDWLRQ DIWHU FRPSOHWLQJ PRQWKV RI WUHDWPHQW WR DVVHVV LI +E HVWLPDWHV DUH ! JPGO In case of no improvement LQ +E OHYHOV DIWHU PRQWKV RI WUHDWPHQW DGROHVFHQW ZLOO EH UHIHUUHG to DH/FRU for further LQYHVWLJDWLRQ Severe Anaemia (8 gm/dl) Refer urgently to DH/FRU Severely anaemic adolescents ZRXOG EH OLQH OLVWHG E $10 7KH PRGHUDWHO DQDHPLF FDVHVDGROHVFHQWV ZLWK QRQUHVSRQVH WR PRQWKV RI LURQ ZLOO QHHG WKH IROORZLQJ LQYHVWLJDWLRQV WR GHWHUPLQH WKH FDXVH RI DQDHPLD ‡ RPSOHWH EORRG FRXQWV ‡ ([DPLQDWLRQ RI SHULSKHUDO EORRG VPHDU ‡ %ORRG ¿OPV WR EH H[DPLQHG IRU PDODULD SDUDVLWHV SDUWLFXODUO LQ KLJK PDODULD ULVN DUHDV

180. ‡ 6WRRO H[DPLQDWLRQ IRU RYD FVW DQG RFFXOW EORRG Table 7.5: Management of severely anaemic adolescents at FRU/DH Investigations Indication for blood transfusion Blood transfusion ‡ )XOO EORRG FRXQW DQG H[DPLQDWLRQ RI D WKLQ ¿OP IRU FHOO PRUSKRORJ ‡ %ORRG ¿OPV IRU PDODULD parasites ‡ 6WRRO H[DPLQDWLRQ IRU RYD FVW and occult ‡ :LWK +E ” JPGO ‡ :LWK +E JPGO ZLWK DQ RI WKH IROORZLQJ – Dehydration – Shock – Impaired consciousness – Heart failure – 'HHS DQG ODERXUHG EUHDWKLQJ – Very hLJK SDUDVLWDHPLD ! RI 5%

181. ,I SDFNHG FHOOV DUH DYDLODEOH JLYH PONJ RYHU ± KRXUV SUHIHUDEO ,I QRW JLYH ZKROH EORRG PONJ RYHU ± KRXUV

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