Iron Deficiency Anemia in children: The basic facts

This is a class presentation

1. Iron Deficiency
Anemia
Facilitator: Prof. Dr. Binod Man Shrestha
Presenter : Sunil Timilsina
1
st
year Resident MD(GP &EM)

2. INTRODUCTION
•An essential trace element
Functions
•O
2 carrier - haemoglobin
•O
2 storage- myoglobin
•Energy production- cytochromes ,kreb’s
cycle enzymes
•Immunity- peroxidases,catalases
•Brain function development

3. Sources
•Heme- dried fish, mutton, chicken, pork
•Non heme- nuts, eggs, green leafy vegetables,raisins
•Cow’s milk is a poor source.
Recommended daily allowance (RDA)
•Infants(upto 12 months)- 79 micro grams/kg
•Children(1 to 3yrs)- 12mg
•Children (4 to 9 yrs)- 22mg
•10 to12 yrs - 34mg(boys) 19mg(girls)
•13 to 15 yrs - 41mg(boys) 28mg(girls)
•16 to 18 yrs - 50 mg(boys) 30mg(girls)
Source: Essential Pediatrics – O.P. Ghai

4. IRON METABOLISM
Mechanism of iron absorption

5. Transport Storage and Excretion
Other causes - menses,g.i or
other forms of bleeding

6. CAUSES OF IRON DEF( in
children)
IN INFANTS-
•Low birth weight ( preterm and small for date)
•Early cord clamping ( as much as 80-100ml of blood
may remain in placenta)
•If there’s hemorrhage from the cord, placenta
•Later: poor intake( malnutrition), parasitic infestation
• Cow’s milk – poor source and allergy may cause occult
g.i bleeding
•Diet rich in iron to be added during weaning

7. IN CHILDREN
Decreased intake - malnutrition,poor source food
Decreased iron absorption
High conc. of phytates, ca salts and rich fiber in
vegetarians
Celiac dz and malabsorption syndrome

8. Increased iron demand
Premature and LBW infants-grow rapidly
Error of iron metabolism
IPH, SA and congenital transferrin def ( iron not
utilised for erythropoiesis but is stored in tissues.)
Increased iron loss
Hookworm infestation
Polyposis, Prolapse rectum
Ulcerative colitis
Meckel’s diverticulum, dysentry

9. Effects of iron deficiency
Reduced weight gain and growth velocity
Low endurance, decreased work capability
Poor attentiveness, poor memory
Poor academic performance
Reduced leucocyte defence capacity
Features of anemia:
•Pallor
•Do not thrive well, appear off coloured
•Easily fatigued, leg cramps
•Frequent infections

10. •Atrophied tongue papillae.
•Changes in intestine- malabsorption
•Nails – thin brittle and flat, Koilonychia
•Pica
•Spleen enlargment (15% cases)
•Severe anaemia – cardiac enlargement, systolic and even diastolic flow
murmurs, congestive cardiac failure

11. Lab Investigation: Blood
hemoglobin level estimation
Age Anemia (Hb in g/dl)
Cut- off Mild Moderat
e
Severe
6 months
to 5 years
< 11 10-10.97—9.9 <7
5-11
years
<11.5 11.0-11.4 8-10.9 <8
12-14
years
<12 11-11.98-10.9 <8
15-19
years
Girls <12 11-11.98-10.9 <8
Boys <13 11-12.9 8-10.9 <8
Source: Hemoglobin concentrations for diagnosis of Anemia, WHO (2011)

12. Findings:
•Blood hb- reduced
•Peripheral Smear -Microcytic hypochromic anemia,
decreased/normal reticulocyte count
•Serum Iron – reduced ( <30mcg/dL)
•TIBC – increased ( >350 mcg/dL)
•Transferrin saturation- markedly reduced ( <15%)

13. PERIPHERAL BLOOD SMEAR
Severe iron-deficiency anemia. Microcytic and
hypochromic red cellssmaller than the nucleus of a
lymphocyte associated with marked variation in
size(anisocytosis) and shape (poikilocytosis).
(beta thalassemia, lead poisoning, SA, congenital
absence of iron binding protein)
Normal

14. TREATMENT
•Underlying cause of iron def to be treated
•Deworming of pts, change in dietary habits, wearing
shoes- imp measures
•Oral Iron therapy
•Commercially available preparations
•Anhydrous ferrous sulphate(37%)
• Exsiccated ferrous sulphate(30%)
•Ferrous fumarate(33%)
•Ferrous succinate(23%)
3-6mg of elemental iron/ kg body weight orally in three
divided doses or as single dose
-continued for at least 6 to 8wks after hb has reached normal level.

15. Parenteral iron:
Iron requirements are calculated from the equation:
•2.3 x body wt(kg) x (15- observed hb in g/dl) + 500mg( for repleting iron stores)
•Given in divided doses 1-3 mg in 150ml normal saline over 30-90min.
Blood transfusion: considered in emergency- urgent surgery,hhg, severe anaemia
with congestive cardiac failure.

16. Situation in Nepal
Indicator Status (%) Target SDG-
2030(%)
Anemia among
children <5 years
53 <15
Anemia among
children 6-23
months of age
68 <50
Anemia in
adolescent girls
(10-19 yrs)
43.6 <15

18. References
•Essential Pediatrics- O.P.Ghai 9
th
edition
•Pathologic Basis of Disease- Robbins and Cotran 7
th
edition
•Harper’s Biochmistry 25
th
edition
•Annual Health Report, 2077/78

19. Thank you