ANEMIA IN

CHILDREN
(age 0-5)

By
AKSHY BALASUBRAMANIYAM
KARTHICK SEKAR
POOJA SUBASH
SAFEER AHAMATH
SHIVANESH SARAVANAN
TEJAS SURESHKUMAR
 INTRODUCTION
• It is greek word
• "Ana" = absent/ decresed
• 'emia' blood
• Anemia is a low red blood cell count or a low hemoglobin level.
• It's a common problem in children.
• There are many different types of anemia.
• Risk factors for children include being premature, living in poverty, having too much
cow's milk, a diet low in iron, and certain long-term illnesses.
The most frequently noted anemia
symptoms include:
• pale skin, lips, hands, or under the eyelids
• increased heart rate (tachycardia)
• breathlessness, or difficulty catching a breath (dyspnea)
• lack of energy, or tiring easily (fatigue)
• dizziness, or vertigo, especially upon standing
• Headache
• irritability.
 What causes child anemia?
• Anemia is common in toddlers and teens when rapid growth spurts require more iron
and other nutrients than normal.
• There are many causes of anemia in children, including genetics, diets low in iron or
vitamin B12, infections, some types of cancer, and medication-related
medical treatments.
Is anemia curable in child?
• In most cases, anemia is a short-term, treatable condition.
• In some cases, however, children with certain other forms of anemia may require
ongoing medical treatment to maintain their blood counts and prevent
complications like organ failure.
• Hemoglobin is a molecule composed of two globulin chains and four heme groups.
• It has been described as the respiratory protein of the RBC, related to its important role in
the transport of oxygen and carbon dioxide.
• • Hemoglobin is able to bind reversibly with oxygen, which allows it to be released to the
tissues when needed.
• Carbon dioxide is then picked up by unbound hemoglobin for transport to the lungs and
excretion.
• The fetus is able to produce a unique type ofhemoglobin,fetal hemoglobin (HgF)which
more efficiently binds and releases oxygen within the relatively hypoxic
intrauterine environment.
• Clinically, this is determined either as a hematocrit (% of RBCs per spun whole blood
sample) or hemoglobin (directly measured concentration) greater than 2 standard
deviations below the normal mean for age.
• For children between 6 months and 2 years of age, this represents a hemoglobin <11
grams/dl or hematocrit < 33%.
• Hemoglobin is considered a more sensitive indicator of anemia than hematocrit, as it is not
affected by variations in RBC size within the specimen; however, both are commonly
utilized in clinical practice.
Sources of iron
The sources of iron are:
Birth - 6 months
• Breast milk alone
• Iron-fortified formula from birth 6 months to 1 year
• Infant formulas based on cow's milk contain 1.0 to 1.5 mg of iron per litre; soy-based formula and
iron-fortified formula based on cow's milk contain 12 to 13 mg of iron per litre. The availability of
iron from soy-based formulas appears to be lower than that from milk-based products.
• Iron-fortified formula (supplementing with formula or if no breastfeeding) The iron source of
fortified formulas is ferrous sulfate, which is significantly more available than the iron used in infant
cereals.
• Iron-fortified infant cereals
• Iron-enriched breakfast cereals and breads
• Meats (poultry), yolk egg
• Fish
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. Cook in iron vessels.
Iron fortified food
• Iron EDTA has 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
• One litre of human milk contains only 0.3 to 0.5 mg of iron. About 50% of the iron is
absorbed, in contrast to a much smaller proportion from other foods.
• Term infants who are breast-fed exclusively for the first 6 months may not be at risk for
iron depletion or for the development of iron deficiency. However, if solid foods are
given they may compromise the bioavailability of iron from human milk.
• Although some term infants who are exclusively breast- fed may remain iron-sufficient
until 9 months of age, a source of dietary iron is recommended starting at 6 months (or
earlier if solid foods are introduced into the diet) to reduce the risk of iron deficiency.
Types of anemia in children
Children's anemia can be classified by the size of
their red blood cells.
The types are:
•Microcytic anemia
•Normocytic anemia
•Macrocytic anemia.
These are the three major types of anemia ,each type can be further divided.
 MICROCYTIC ANEMIA

• Microcytic anaemia is any of several types of anemia characterized by smaller

than normal red blood cells (called microcytes).
• The normal mean corpuscular volume (abbreviated to MCV on full blood count
results, and also known as mean cell volume) is approximately 80–100 fL.
• When the MCV is <80 fL, the red cells are described as microcytic and when >100
fL, macrocytic (the latter occurs in macrocytic anemia). The MCV is the average
red blood cell size.
• In microcytic anemia, the red blood cells (erythrocytes) contain less hemoglobin and are
usually also hypochromic, meaning that the red blood cells appear paler than usual.
• This can be reflected by a low mean corpuscular hemoglobin concentration (MCHC), a
measure representing the amount of hemoglobin per unit volume of fluid inside the cell;
normally about 320–360 g/L or 32–36 g/dL.
• Typically, therefore, anemia of this category is described as "microcytic,
hypochromic anemia".
CAUSES OF MICROCYTIC ANEMIA
Typical causes of microcytic anemia include:
• Childhood
• Iron deficiency anemia by far the most common cause of anemia in general and of
microcytic anemia in particular
• Thalassemia
 NORMOCYTIC ANEMIA
• Normocytic anemia is a type of anemia and is a common issue that occurs for men
and women typically over 85 years old.
• Its prevalence increases with age, reaching 44 percent in men older than 85 years.
• The most common type of normocytic anemia is anemia of chronic disease.
CLASSIFICATION OF NORMOCYTIC
ANEMIA
• A normocytic anemia is when the red blood cells (RBCs) are of normal size.
• Normocytic anemia is defined when the mean corpuscular volume (MCV) is
between 80 and 100 femtolitres (fL), which is within the normal and expected
range.
• However, the hematocrit and hemoglobin are decreased.
• In contrast, microcytic anemias are defined as an anemia with a mean corpuscular
volume (MCV) less than 80 fL and macrocytic anemias have a mean corpuscular
volume over 100 fL.
 CAUSES OF NORMOCYTIC ANEMIA
• An acute loss of blood of a substantial volume.
• A decreased production of normal-sized red blood cells (e.g., anemia of chronic disease, aplastic
anemia).
• An increased production of HbS as seen in sickle cell disease (not sickle cell trait).
• An increased destruction or loss of red blood cells (e.g., hemolysis, posthemorrhagic anemia,
hypersplenism).
• An uncompensated increase in plasma volume (e.g., pregnancy, fluid overload).
• A B2 (riboflavin) deficiency.
• A B6 (pyridoxine) deficiency or a mixture of conditions producing microcytic and macrocytic anemia.
 DIAGNOSIS OF NORMOCYTIC ANEMIA
• An acute loss of blood of a substantial volume.
• A decreased production of normal-sized red blood cells (e.g., anemia of chronic disease, aplastic
anemia).
• An increased production of HbS as seen in sickle cell disease (not sickle cell trait).
• An increased destruction or loss of red blood cells (e.g., hemolysis, posthemorrhagic anemia,
hypersplenism).
• An uncompensated increase in plasma volume (e.g., pregnancy, fluid overload).
• A B2 (riboflavin) deficiency
• A B6 (pyridoxine) deficiency.
• Amixture of conditions producing microcytic and macrocytic anemia.
 MACROCYTIC ANEMIA
• Macrocytic anemia is a blood disorder that happens when your bone marrow
produces abnormally large red blood cells.
• These abnormal blood cells lack nutrients red blood cells need to function
normally.
• Macrocytic anemia isn't a serious illness but it can cause serious medical issues
if left untreated.
• It is of two types :
• Megaloblast
• Non-megaloblast
SYMPTOMS OF MACROCYTIC ANEMIA
• Weakness, pain, numbness, or tingling in the hands or feet instability when
walking memory loss.
• These symptoms may resolve after treatment but can become permanent
if left untreated.
 DIAGNOSIS OF MACROCYTIC ANEMIA
• Tests that can help diagnose macrocytic anemia include:
• Hemoglobin: A standard complete blood count (CBC) measures
hemoglobin. If it is below 12 grams per deciliter (g/dL)Trusted Source
it can indicate anemia.
• Red blood cell indices: These measurements are part of the CBC. A
mean corpuscular volume higher than 100 fL means that the red
blood cells are large and macrocytic.
• Blood smear: This involves looking at the blood cells under a
microscope to see if they are macrocytic or megaloblastic. It also
shows if cells are cancerous.
• Reticulocyte count: This is the number of immature red blood cells
How is iron-deficiency anemia treated in a
child
• Treatment will depend on your child's symptoms, age, and general health. It will
also depend on how severe the condition is to prevent iron-deficiency anemia, the
AAP says: 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.
• 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.
TREATING IRON DEFECIENY ANEMIA
INCLUDES
Iron supplements:
• Iron drops or pills are taken over several months to increase iron levels in the
blood.
• Iron supplements can irritate the stomach and discolor bowel movements.
• They should be taken on an empty stomach or with orange juice to increase
absorption.
• They are much more effective than dietary changes alone.
• If the child can't take drops or pills, IV iron may be needed, but this is very unusual.
Most types of anemia in children can be
diagnosed with these blood tests:
Hemoglobin and hematocrit:
• This is often the first screening test for anemia in children.
• It measures the amount of hemoglobin in the blood and the amount of red blood
cells in the blood sample.
Complete blood count (CBC):
• If hemoglobin or hematocrit is abnormal, a complete blood count may be done.
• This test adds important information about the blood, including the size of red
blood cells (called the mean corpuscular volume or MCV).
 Peripheral smear:
• This test is done with a smear of blood on a slide that is checked under a microscope.
• By looking at a child's blood cells under a microscope, a lab specialist may be able to diagnose a type of
anemia that causes red cells to grow or develop abnormally.
Reticulocyte count:
• Reticulocytes are immature blood cells.
• A reticulocyte count measures the amount of newly formed red blood cells in the child's blood sample.
• Anemia caused by not enough red blood cells being made results in a low reticulocyte count.
• Anemia caused by too many red blood cells being lost causes a high
 TREATING ANEMIA
• Treating anemia in children depends on the type of anemia and its cause.
• In some cases, treatment may simply be a change in diet or the use of diet
supplements.
• In other cases, a blood transfusion or long- term treatment may be needed.
SOURCE
• Google scholar
• National institute of health
• The DHS programme. (https://dhsprogram.com/topics/Anemia.cfm)