Iron deficiency 2021

Iron deficiency in children

1. Iron deficiency
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics(2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. Al-Quran suraHadeed57:25

3. Nutrition During the First 1000 Days of Life
1000 Days
Meeting macro-and micronutrient requirements during ‘the first
1,000 days (pregnancy and early childhood) is crucial for short-and
long-term health and cognitive function

4. First 1000 Days of Life
•Causes of poor growth and
stunting in children
•maternal under-nutrition
•intrauterine growth retardation
•lack of Mother Feeding
•inappropriate complementary
feeding
•repeated infections
•Micronutrient deficiencies are
associated with Malnutrition
Nestle NutrInstWorkshop Ser, vol70, pp1–10,

5. IRON deficiency

6. Clinical scenario
•Mother brings her 4 year old girl with complaints of
excessive crying and eating earth and wall paint.
•Nutritional history reveals that child takes animal
milk many times per day. She buys one liter of milk
daily from milk delivery person. Child does not like
other foods and takes little amount from family
meals.

7. Clinical scenario
•On examination, child is having pallor seen on
hands and tongue. He cries and resists the
examination.
•There is soft heart murmur audible on auscultation.
•Liver is just palpable and spleen is not palpable

8. Iron in Human body
•Iron is an essential part of Hemoglobin carrying
oxygen to tissues
•Iron is a part of cytochrome in each cell responsible
for energy production
•Iron is stored in the body as Ferritin in bone
marrow, liver and spleen

9. Iron in Hemeof Hemoglobin

10. Iron in Human body
•Adults:3-5 gm
•Children:55mg / kg
Hemoglobin = 70% (200 mg Iron in 500 ml blood)
Body stores = 26%
Myoglobin (muscles) = 3.9%

11. Iron –absorption and utilization

12. Clinical Features of Iron deficiency
•Pallor and Anemia
•Restless behavior / irritability in children
•Pica
•Poor appetite
•Glossitis -atrophy of papillae of tongue
•Kilonychia–spoon shaped nails

13. Complications of Iron deficiency
•Low physical performance
•Impaired cognitive functions / learning disability
•Increased risk of seizures / febrile seizures in
children
•Breath-holding spells in children

14. Diagnosis of
IRONdeficiency

15. Diagnosis of IRON deficiency
•Clinical Diagnosis (pallor and pica)
•Spleen not enlarged
•Lab Diagnosis
•Hemoglobin low, TRBC count low
•MCV, MCH, MCHC all are low
•Blood film -Microcytic Hypochromic anemia
•Platelets more than normal
•Serum Ferritin level < 10 ng/ml
•Serum Iron level < 70 mcg/dl

16. Blood peripheral film in Iron deficiency anemia

17. Epidemiology of
Iron deficiency

18. Sources of IRON
•Red Meat
•Green vegetables
•Recommended Dietary Allowance(RDA)
•IRON 10 mg/day
•Only 10 % of ingested Iron is absorbed in body
•HemeIron is better absorbed than other forms

19. Causes of IRON deficiency
•Low IRON intake in diet
•Preterm / LBW infants
•Animal milk intake
•Inadequate solid food after 6 months of age
•Worm infestations –Ankylostomaduodenale
•Malabsorption
•Chronic blood loss

20. Hookworm (Ankylostomaduodenale)

21. Iron deficiency in Pakistan
•Anemia is seen in 53.7 % of children in Pakistan (NNS 2018)
•Iron deficiency seen in 28.6 % of children (NNS 2018)
•Anemia is seen in 41.7 % of women in Pakistan (NNS 2018)
•Iron deficiency seen in 18.2 % of women (NNS 2018)
•Iron deficiency is most common and widespread nutritional
deficiency in the world. It is estimated that that 30 % of the
world's population has iron deficiency

22. How to treat a child with
IRON deficiency ?

23. Treatment of IRON Deficiency
•Diet modification (less milk, more meat products)
•Oral Iron therapy = 3 –6 mg / kg / day
•Intravenous Iron administration = 5 mg / kg / day
IV slowly in 2-3 hours given for 1-3 doses (given in
severe anemia or oral iron intolerance)
•Packed RBC transfusion (for rapid correction of
severe anemia)

24. IRON toxicity
•Iron toxicity can occur after an acute overdose
•A single dose of 20 –60 mg/kg can be toxic
•Clinical features may include nausea, vomiting,
abdominal cramps, diarrhea, GI hemorrhage,
shock, metabolic acidosis
•Intravenous Deferioxamineis the specific iron
chelating agent given as an antidote in severe iron
toxicity

25. How to prevent IRON deficiency
in children ?

26. Prevention of Iron deficiency
•Adequate variety of semisolid food given after 4 -6
months of age
•Iron supplementation : starting at 4 months of age all
infants and children are given daily requirement of Iron
= 1-2 mg / kg / day
•Multiple micronutrient sachet provides 10 mg Iron daily
•Iron fortification : Iron is added to common cereals
(Wheat) which is taken by all population

27. Micronutrients are
essential for
Growth and Health

28. Multiple Micronutrient sachet (MMS) for
prevention of Micronutrient Deficiency

29. MNP (micronutrient powders)
one sachet daily at 6 –59 months of age

30. Micronutrient Sachets
•Vitamin A = 400 µg RE
•Vitamin D = 5 µg
•Vitamin E = 5 mg
•Vitamin C = 30 mg
•Thiamine (vitamin B1) 0.5 mg
•Riboflavin (vitamin B2) 0.5 mg
•Niacin (vitamin B3) 6 mg
•Vitamin B6 (pyridoxine) 0.5 mg
•Vitamin B12 (cobalamine) 0.9 µg
•Folate 150 µg
•Iron = 10 mg
•Zinc = 4.1 mg
•Copper = 0.56 mg
•Selenium = 17 µg
•Iodine = 90 µg

31. Thank you