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1. Iron deficiency anaemia in newborn ( Железодефицитная анемия ) Atharva patil Group -1428

2. Introduction Iron is a nutrient that your child needs to grow and develop properly. But some kids don't have enough iron. This also is called an iron deficiency. Iron helps move oxygen from the lungs to the rest of the body. It also helps muscles store and use oxygen. If your child's diet lacks iron, you child might develop an iron deficiency. The condition is a common problem in children. It can range from mild to serious. Without treatment, it can affect a child's growth and development. Sometimes, being low on iron can leave the body without enough healthy red blood cells, which carry oxygen. There may be insufficient intake of food needed or discrepancy between intake and loss of iron (transport).The deficiency may vary depending on child to child. example, a one-year-old infant loses about 0.2 mg of iron/day, calculated on the basis of body surface area, from values measured in adults. The amount needed for growth averages roughly 0.6 mg.• Consequently, about 75% of the 0.8 mg of absorbed iron needed per day during this period, is for growth.

3. Who's at risk of iron deficiency? Infants at highest risk of iron deficiency include those who:Are born prematurely or have a low birth weight.Drink cow's milk or goat's milk before age 1.Aren't given other foods that contain iron after age 6 months. Drink formula that isn't fortified with iron Children at highest risk of iron deficiency include those who:Are ages 1 to 5 and drink more than 24 ounces (710 milliliters) of cow's milk, goat's milk or soy milk a day.Have certain health conditions, such as chronic infections or restricted diets.Have been exposed to lead.Don't eat enough iron-rich foods. irritability or pica (in iron deficiency), jaundice (in hemolysis), shortness of breath, or palpitations . Physical examination may show jaundice, tachypnea, tachycardia, and heart failure,

4. CLASSIFICATION OF ANEMIA CLASSIFICATION DUE TO HAEMOGLOBIN CONTENT IN RBC. NORMALLY HAEMOGLOBIN CONTENT IN ERYTHROCYTE IS 0,8-1,05. THIS INDEX IS NAMED COLOR INDEX (CI) HYPERCHROMIC -CI>1,05 (B12 AND PHOLATE-DEFICIENCY) HYPOCHROMIC-CI <0,8 (IRON DEFICIENCY) NORMOCHROMIC- CI IS NORMAL (INHERITED HAEMOLYTIC ANAEMIAS) CLASSIFICATION BASED ON THE DEGREE OF REGENERATION. NORMALLY RETICULOCYTES CONSTITUTE 0.5 TO 1.5% OF THE RBC. REGENERATIVE -NORMAL RETICULOCYTES COUNT (MOST OF ANEMIAS) HYPOREGENERATIVE -RETICULOCYTES <0.5 (CHRONIC POSTHEMORRHAGIC) NON-REGENERATIVE ANEMIA-RETICULOCYTES ARE ABSENT (BONE MARROW APLASIA) HYPERREGENERATIVE RETICULOCYTES >1,5 (INHERITED HEMOLYTIC ANEMIAS)

5. Anisocytosis describes red blood cells that are of different sizes. Normal red blood cells are generally the same size. Having red blood cells of unequal sizes may be a sign of anemia, a condition that can cause symptoms like fatigue and shortness of breath

6. [ Poikilocytosis means that there are red blood cells of varying shapes in blood smear.It refers to an increase in abnormal red blood cells of any shape that makes up 10% or more of the total population. Poikilocytes can be flat, elongated, teardrop-shaped, crescent-shaped, sickle-shaped, or can have pointy or thorn-like projections, or may have other abnormal features.

7. VASA-OCCLUSIVE CRISIS OCCURS WHEN THE MICROCIRCULATION IS OBSTRUCTED BY SICKLED RED BLOOD CELLS RESULTING IN ISCHEMIC INJURY.• THE MAJOR COMPLAINT IS PAIN, USUALLY AFFECTING BONES SUCH AS FEMUR, TIBIA AND LOWER VERTEBRAE.• ALTERNATIVELY, VASO-OCCLUSION MAY PRESENT AS DACTYLITIS, HAND AND FOOT SYNDROME (PAINFULAND SWOLLEN HANDS AND/OR FEET), OR AN ACUTE ABDOMEN.• THE SPLEEN MAY UNDERGO AUTO-INFARCTION AND IS OFTEN NOT PALPABLE BEYOND 6 YR OF AGE.• INVOLVEMENT OF THE KIDNEY RESULTS IN PAPILLARY NECROSIS LEADING TO INABILITY TO CONCENTRATE URINE (ISOSTHENURIA).

8. Prenatal period the presence of IDA or latent iron deficiency in the mother during time of pregnancy: antenatal complicated course of pregnancy, violation of uteroplacental circulation, fetomaterial and fetoplacental bleeding, fetal transfusion syndrome in multiple pregnancies Intrapartum fetoplacental transfusion, premature or late ligation of the umbilical cord, intranatal bleeding due to traumatic obstetric aids or abnormalities in the development of the placenta or umbilical cord. Postnatal period Factors that cause insufficient Intake of iron into the body alimentaryy (artificial and mixed feeding with unadapted mixtures, untimely introduction of complementary foods, unbalanced nutrition with a predominance of plant foods, lack of proteins, etc.);- violation of intestinal absorption of iron malabsorption syndrome (celiac disease, cystic fibrosis, lactase deficiency, exudative enteropathy), recurrent acute intestinal infections, gastric resection. Disruption of iron transport :hypotransferrinemia,atransferrinemia . Endocrine diseases :- hypothyroidism. Ovarian dysfunction.

9. Iron Deficiency in Children-.Infants who experience iron deficiency during the first 6-12 mo of life are likely to experience persistent effects of the deficiency that alter functioning in adulthood. A lack of sufficient iron intake may significantly delay the development of the central nervous system as a result of alterations in morphology, neurochemistry, and bioenergetics. Depending on the stage of development at the time of iron deficiency, there may be an opportunity to reverse adverse effects, but the success of repletion efforts appear to be time dependent. Publications in the past several years describe the emerging picture of the consequences of iron deficiency in both human and animal studies. The mechanisms iron accumulation in the brain and perhaps redistribution are being understood. The data in human infants are consistent with altered myelination of white matter, changes in monoamine metabolism in striatum, and functioning of the hippocampus. Rodent studies also show effects of iron deficiency during gestation and lactation that persist into adulthood despite restoration of iron status at weaning. These studies indicate that gestation and early lactation are likely critical periods when iron deficiency will result in long-lasting damage. biological dimension suspected of being altered by iron deficiency is neurochemistry and specifically the monoaminergic pathways (12-14). In both animal models and cell culture experiments, there are reproducible findings that dopamine and norepinephrine metabolism are altered by iron deficiency. Iron deficiency appears to alter the synthesis and catabolism of the monoamines, and early repletion of iron status after gestational iron deficiency only overcomes the lasting effects (15.16). The evidence for alterations in dopamine or norepinephrine in humans is limited.

10. Behavior changes due to anemia study had a focus on social-emotional behavior . As with the motor control studies, there was again a strong linear relation between severity of iron deficiency and behaviors of infants at 9 mo of age. The iron-deficient infants had less engagement with the interviewer than iron-sufficient infants, were more shy, and showed less positive affect. These results are highly consistent with other studies that have examined emotionality and behaviors in iron-deficient infants ). These data are also consistent with a study in South Africa in which maternal iron status was also evaluated and in which there was the observation that mother-child interactions were altered by iron deficiency.

11. Laboratory Tests :   - Complete Blood Count (CBC): A CBC test measures various components of the blood, including hemoglobin levels, hematocrit (percentage of red blood cells in the blood), and mean corpuscular volume (MCV). Low hemoglobin and hematocrit levels, along with small red blood cells (low MCV), may indicate iron deficiency anemia.      - Serum Ferritin: Ferritin is a protein that stores iron in the body. Low levels of serum ferritin can indicate depleted iron stores and suggest iron deficiency anemia.      - Iron Studies: Additional tests such as serum iron, total iron-binding capacity (TIBC), and transferrin saturation can provide more information about iron levels and transport in the body.

12. 1. Rapid growth spurts: Infants and young children go through rapid growth spurts that can increase their iron requirements. If their diet does not provide enough iron to support this growth, they may become deficient. 2. Exclusive breastfeeding: Breast milk is low in iron compared to formula. While breast milk is the best source of nutrition for infants, it may not provide enough iron for some babies, especially after the first 4-6 months when their iron stores start to deplete 3. Intestinal parasites: Parasitic infections in the intestines can cause blood loss and decrease the absorption of nutrients, including iron 4. Chronic infections: Some chronic infections or diseases can lead to inflammation that affects iron absorption and utilization in the body. Hypoxia drumstick fingers with spoon shaped achylia 5. Blood loss: In rare cases, infants and children may experience blood loss due to conditions like gastrointestinal bleeding, chronic illness, or trauma, leading to iron deficiency. 6. Dietary factors: A diet low in iron-rich foods or high in foods that inhibit iron absorption (such as calcium- rich foods) can contribute to iron deficiency. 7. Celiac disease or other digestive disorders: Conditions that affect the absorption of nutrients in the intestines, such as celiac disease or inflammatory bowel disease, can lead to iron deficiency. begins after the introduction of gluten-containing products into the diet - from the second half of life): - lactase deficiency (begins from the first days, after drinking breast milk); 8. Haemolytic anemia. Jaundice

13. Cell shape change in iron deficiency anemia

14. Sickle cell anemia SICKLE CELL DISEASE (SCD) IS AN INHERITED DISEASE CAUSED BY A SINGLE-GENE MUTATION AFFECTING THE B-GLOBIN GENE (HBB) ON CHROMOSOME 11• SICKLE CELL ANEMIA IS AN AUTOSOMAL RECESSIVE DISEASE THAT RESULTS FROM THE SUBSTITUTION OF VALINE FOR GLUTAMIC ACID AT POSITION 6 OF THE BETA-GLOBIN GENE.• SICKLE CELL ANEMIA (HBSS), HOMOZYGOUS HBSS, OCCURS WHEN BOTH B-GLOBIN ALLELES HAVE THE SICKLE CELL MUTATION (BS).

15. Recommendations Iron-Rich Foods: Introducing iron-rich foods into the infant's diet can also help boost iron levels. Foods such as fortified cereals, pureed meats, beans, lentils, and dark green leafy vegetables are good sources of iron. Consult with a pediatrician or a nutritionist to create a balanced diet that includes iron-rich foods appropriate for the infant's age. Vitamin C: Vitamin C can enhance the absorption of iron from plant-based sources. Including foods rich in vitamin C, such as citrus fruits, strawberries, and bell peppers, in the infant's diet can help optimize iron absorption. Avoiding Iron Inhibitors: Certain substances can inhibit the absorption of iron. Avoid giving cow’s milk to infants under 12 months of age, as it contains calcium and casein, which can interfere with iron absorption. Tea and coffee should also be avoided, as they contain compounds that can inhibit iron absorption Regularr Monitoring: Regular follow-up appointments with a healthcare provider are essential to monitor the infant’s iron levels and response to treatment. Blood tests may be conducted periodically to assess iron status and adjust treatment if needed.A

16. Treatment • For therapeutic purposes, an adequate and safe hematological response to oral iron intake can be achieved in 4-6 weeks with 3-6 mg/kg of elemental iron • After 4 weeks, check for a response consisting of a hemoglobin increase of 1 g/dl, a hematocrit increase of 3 percent, or a value within the normal range. If there is a response, continue iron drops (or iron-fortified formula) for 2 more months and then discontinue supplemental iron drops.If there is no response, check compliance with supplemental iron regimen, determine serum ferritin concentration, or both. A serum ferritin concentration of >15 µg/liter suggests that the anemia is not due to iron deficiency. • In a prophylactic program-1-2 mg/kg