Anemia in children
11\04\17 anemia in children
Contents
• Objective
• Introduction
• classification
• Approach to anemia
• Management of anemia
• Cause of anemia in our set up
• Iron deficiency anemia
11\04\17
anemia in children
Session objective
At the end of todays session you will be able to
Define anemia in children
Recall classification of anemia
Explain how to approach anemic child
List causes of anemia and identify common cause in
our set up
Outline the management principle of anemia
11\04\17 anemia in children
Definition
• Anemia is defined as a reduction of the hemoglobin
concentration or red blood cell (RBC) volume below the range
of values occurring in healthy persons that lead to reduction of
oxygen carrying capacity of the blood.
• “Normal” hemoglobin and hematocrit (packed red cell volume)
vary substantially with age and sex.
Hct: is perecentage of blood volume that is occupied by red blood
cells.Its typically expressed as percentage .
Hg is a protein found iofn red blood cell that binds oxygen
in the lung and carries it to tissues back to the lung for
exhalation . Hemoglobin level are measured in grams per
deciliter (gccone/dl).
11\04\17 anemia in children
Introduction
Infants (6 months to 1 year):
Normal range is approximately
11.0 to 14.0 g/dL.
- Children (1 to 5 years): Normal
range is approximately 11.0 to
13.5 g/dL.
- Children (6 to 12 years): Normal
range is approximately 11.5 to
15.5 g/dL.
- Adolescents (12 to 18 years):
- Males: Normal range is
approximately 13.0 to 16.0 g/dL.
- Females: Normal range is
approximately 12.0 to 15.5 g/dL.
11\04\17 anemia in children
CLINICAL ASSESSMENT
• WHO grading of anemia
Mild : Hgb 10-11gm/dl
Moderate: 7-10 gm/dl
Severe: less than 7gm/dl
• Clinical assessment
Mild: conjunctival and/or mucosal pallor
Moderate: above+ skin pallor
Severe: above + palmar crease pallor
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Epidemiology
• In Ethiopia, 57% of children age 6-59 months
suffered from some degree of anemia (hemoglobin
levels below 11 g/dl).
• Twenty-five percent of children are classified with
mild anemia, 29% with moderate anemia, and 3%
with severe anemia. EDHS 2016
11\04\17 anemia in children
Physiology of RBCs
Main function of RBC:
carriage of blood gases mainly O2 (99%) and to less
extent CO2 (13%) by the haemoglobin carrier.
It has also role in the in the acid-base balance
through formation of bicarbonate
Regulate blood flow
Regulation of blood pressure
• 120 days life span
11\04\17
anemia in children
11\04\17 anemia in children
Pathophysiologic
1, Disorders of effective red cell production
Marrow failure: Aplastic anemia, Pure red cell aplasia,
Marrow replacement and Pancreatic insufficiency-
marrow hypoplasia syndrome
Impaired erythropoietin production: Chronic renal
disease, Hypothyroidism, hypopituitarism and Chronic
inflammation
Abnormalities of cytoplasmic maturation: Iron
deficiency, Thalassemia syndromes, and Lead poisoning
Abnormalities of nuclear maturation: Vitamin B12
deficiency, Folic acid deficiency and Thiamine-
responsive megaloblastic anemia
Primary dyserythropoieitc anemias
11\04\17 anemia in children
2, Disorders of increased red cell destruction or loss
Defects of hemoglobin: Structural mutants (eg. HbSS)
Diminished globin production (eg. Thalassemias )
Defects of the red cell membrane
Enzymatic defect
Antibody-mediated hemolysis
Mechanical injury to the erythrocyte
Acute/Chronic blood loss
Hypersplenism
11\04\17 anemia in children
Morphologic classification
• Anemias may be classified also according
to:
RBC size (mean corpuscular volume, MCV),
I. Microcytic :MCV values less than 2 SC below
the mean
1 (or <80 fL in adults);
II. Macrocytic: MCV values more than 2 SD
above the mean
III.Normocytic: MCV values within two standard
deviations of the mean
11\04\13 anemia in children
malabsorption.
Types of Anemia 3. Folate Deficiency Anemia:
1. Iron Deficiency Anemia: Often related to poor diet or
Most common type in malabsorption.
children. 4. Hemolytic Anemia:
2. Vitamin B12 Deficiency Caused by the destruction of
Anemia: Less common but red blood cells.
can occur due to dietary 5. Aplastic Anemia: A rare
deficiencies or condition where the bone
malabsorption. marrow fails to produce
3. Folate Deficiency Anemia: enough blood cells.
Often related to poor diet or 6. Sickle Cell Anemia: A
malabsorption. genetic disorder affecting
4. Hemolytic Anemia: hemoglobin structure.
Caused by the
destrucchanges.
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Symptoms
anemia in children
11\04\17 anemia in children
Approach to Anemia
Anemia in a child is not a diagnosis, it’s a sign of
underlying disease.
The goal is to determine the underlying cause of
anemia.
Appropriate investigations of anemic child
should follow a detailed history & examination.
Correct interpretation of RBC parameters and CBC
should direct supplementary tests.
11\04\17 anemia in children
Cause of anemia in our set up
Micro-nutrient deficiencies
- Iron deficiency
- Folic deficiency
- Vitamin B12
Infectious diseases
- HIV - Hookworm
- Malaria - Trichuris tricuria
- Visceral leishmaniasis - Schistosomiasis
Blood loss- either due to bleeding disorders, leach infestations,
trauma
Malignancy and chronic illness
11\04\17 anemia in children
Symptoms
Signs
Symptoms can vary based on
During a physical examination
the severity and type of
signs may include:
anemia but may include:
- Pallor (especially noticeable
- Fatigue or weakness
in the conjunctiva and nail
- Pale skin (pallor)
beds)
- Shortness of breath
- Tachycardia (increased heart
- Dizziness or lightheadedness
rate)
- Cold hands and feet
- Systolic murmur (due to
- Rapid heartbeat
increased cardiac output)
(tachycardia)
- Signs of jaundice (in
- Irritability (especially in
hemolytic anemia)
infants)
- Splenomegaly (enlarged
- Poor appetite or growth
spleen) in certain types
delays
03/17/2025 anemia in children
LABORA
TORY
EVALUA
TION
The most important test is CBC.
1. RBC indices.
2. Reticulocyte count.
3. Peripheral Blood smear.
4. Other CBC parameters
11\04\17 anemia in children
Diagnosis
Diagnosis typically involves: 5.Iron studies: Including
1. Medical History and serum iron, ferritin, total iron-
Physical Examination: binding capacity (TIBC), and
Assessing symptoms and transferrin saturation for iron
family history. deficiency anemia.
2. Complete Blood Count 6. Vitamin B12 and Folate
(CBC): To check levels of Levels: For megaloblastic
hemoglobin, hematocrit, and anemias.
red blood cell indices. 7. Bone Marrow Biopsy: In
3. Peripheral Blood Smear: To cases where aplastic anemia
examine the shape and size of or malignancy is suspected.
red blood cells.
4. Reticulocyte Count: To
assess bone marrow response
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Management of Anemia
Treatment depends on the severity and underlying cause of the
anemia.
Supportive measures- ABC
Blood transfusion based indication
Treating the underlying cause
Inpatient care is indicated:-
- in patients with CHF who are severely anemic
- in those with unstable vital signs (eg, hypotension, active
bleeding).
- Patients who may be stable but who have severe anemia may
also be admitted for diagnostic workup.
11\04\17 anemia in children
Iron deficiency anemia
• Most common nutritional anemia in children
• It is estimated that40-50% of children under 5 years
of age in developing countries are iron deficient
• Peak prevalence occurs during late infancy and
early childhood when the following may occur:
-Rapid growth with exhaustion of gestational iron
-Low levels of dietary iron
-Complicating effect of cow milk-induced exudative
enteropathy due to whole cow milk ingestion
11\04\17 anemia in children
Etiologic factors
• Deficient intake
• Growth
• Blood loss
• Impaired absorption
• Inadequate presentation to erythroid
precursors
• Abnormal intracellular transport/utilization
11\04\17 anemia in children
Treatment
Oral supplementation: 6mg/kg/day of elemental
iron
• for at least 3 months
• check retic count after 2 weeks
• side effects (educate family)
– goal: to replace iron stores, not just circulating
Hgb
– Nutritional counseling
– failure to respond to therapy?
11\04\17 anemia in children
Folic Acid Deficiency
• Folate deficiency, next to iron deficiency, is
one of the commonest micronutrient
deficiencies worldwide.
• humans cannot synthesize folate and depend
on dietary sources
• Is absorbed in the proximal small intestine
• Important for the synthesis of purines
11\04\17 anemia in children
Etiology
Inadequate folate intake
Decreased folate absorption
Congenital abnormalities in folate transport
and metabolism
Drug-Induced Abnormalities in Folate
Metabolism
11\04\17 anemia in children
Clinical manifestations
• peak incidence at 4-7 mo of age
irritability, chronic diarrhea, and poor weight
gain
Haemorrhages from thrombocytopenia can
occur in advanced cases
11\04\17 anemia in children
Treatment
folic acid may be administered orally or
parenterally at 0.5-1.0 mg/day for 3-4wks
If the specific diagnosis is in doubt, smaller
doses of folate (0.1 mg/day) may be used for 1
wk as a diagnostic test
Maintenance therapy with a multivitamin
(containing 0.2 mg of folate) is adequate
Transfusions are indicated only when the
anemia is severe or the child is very ill.
11\04\17 anemia in children
• .3. vitamin B12 Deficiency
• - Vitamin B12 injections or high-dose oral supplements.
• 4. Hemolytic Anemia
• - Treatment varies based on cause; may include
corticosteroids or other immunosuppressive therapies.
• 5. Aplastic Anemia
• - May require immunosuppressive therapy or bone
marrow transplant.
• 6. Sickle Cell Disease
• - Pain management, hydration, hydroxyurea therapy to
reduce crises.
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Complications
Complications can arise from Prevention
untreated anemia: Preventive measures include:
1. Severe fatigue affecting daily - Ensuring a balanced diet rich
activities and school in iron, vitamin B12, and
performance.
folate for growing children.
2. Growth delays in children due
to chronic low oxygen levels. - Regular pediatric check-ups
3. Increased risk of infections duethat include screening for
to impaired immune function in anemia during well-child
some types of anemia. visits.
4. Heart problems such as
cardiomyopathy due to chronic
hypoxia from severe anemia.
5. Developmental delays if not
addressed early enough.
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11\04\17 anemia in children 30
