Introduction:
Anemia is a common medical condition seen in children. It is not a disease by itself but a symptom of an underlying medical condition. It occurs mainly due to nutritional deficiencies or blood loss. The main function of red blood cells is to transport oxygen to other cells with the help of hemoglobin. Hemoglobin present in the red blood cells allows them to transport oxygen to other body parts. Most children experience the symptoms when their hemoglobin levels drop below 7 grams/dL. It may be classified into iron deficiency anemia, megaloblastic anemia, hemolytic anemia, and sickle cell anemia.
What Causes Anemia In Your Child?
There are three leading causes of anemia. They are:
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The red blood cell count is markedly decreased in the blood circulation.
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Inadequate production of red blood cells.
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Destruction of red blood cells.
The decrease in the circulating blood cells or hemoglobin may be due to;
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Defects in the red blood cells.
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Infections and some underlying diseases.
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Nutritional deficiencies result in the lack of minerals and vitamins.
What Happens to the Body in Anemia?
Erythropoietin is a hormone produced by the kidneys which stimulates the production of red blood cells. The levels of erythropoietin and hemoglobin are inversely proportional. If the hemoglobin levels are high, then the erythropoietin levels will be lower. In the case of oxygen deficiency or tissue hypoxia, then erythropoietin is stimulated for more red blood cell production. The bone marrow produces the red blood cells and is released into circulation. About one percent of the old or defective red blood cells are removed from circulation. Anemia occurs due to an imbalance in the production and removal rates of red blood cells. However, there are two main mechanisms in anemia.
1. Increased Red Blood Cells Destruction:
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Blood Loss: Chronic blood loss is more frequently responsible for anemia. This is because bleeding results in the depletion of red blood cells more quickly than they can be replenished, thus resulting in anemia.
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Acute Blood Loss: Hemorrhage, trauma, or surgery.
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Chronic Blood Loss: Chronic gastrointestinal bleeding, ulcers, hookworm manifestation, urinary losses, as in the case of renal carcinoma, benign prostatic hyperplasia.
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Hemolytic Anemia: Hemolytic anemia occurs when the red blood cells are destroyed prematurely.
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Iron Deficiency Anemia: It is one of the most common forms of anemia found in children. Iron is essential in the formation of hemoglobin, which is a necessary protein in red blood cells. Hemoglobin is a vital element for transporting oxygen throughout the body. Iron deficiency anemia is characterized by low hemoglobin production. It is primarily due to a diet low in iron or gastrointestinal problems leading to decreased iron absorption.
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Acquired: Infection, hypersplenism, immune-mediated conditions, microangiopathy.
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Hereditary: Hemoglobin disorders, defective red blood cell metabolism, and defect in the red blood cell membrane production as in spherocytosis.
2. Defect in the Erythropoietin Mechanism:
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Microcytic anemia.
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Normocytic anemia.
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Macrocytic anemia.
What Are the Common Types of Anemia in Children?
Anemia in the pediatric age group is classified based on the size of their red blood cells.
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Microcytic Anemia: The child’s red blood cells are smaller than usual. Microcytic anemia is mainly due to iron deficiency.
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Normocytic Anemia: The red blood cells are normal in their physiological appearance. The reason for normocytic anemia is multifactorial, and special blood tests are required to diagnose this type.
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Macrocytic Anemia: In macrocytic anemia, the cells are comparatively larger than usual. It is mainly due to the deficiency of vitamin B12, and it is one of the rarest types of anemia.
What Is the Normal Hemoglobin Level?
The values lesser than the mentioned range are considered anemia.
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For Males: 13.5 to 18 grams/dL.
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For Females: 12 to 15 grams/dL.
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In Children: 11 to 16 grams/ dL.
What Are the Symptoms a Child Faces During Anemia?
Generally, the children are asymptomatic in mild cases and are often difficult to diagnose. Here are some common features that you will notice in your baby.
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Pale, yellow skin, cheeks, and lips.
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The inner lining of the eyelids and nail beds looks light pink in color.
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Fatigue and weakness, dizziness.
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Often irritated, taking frequent naps.
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Sore tongue, delayed wound healing.
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They are more prone to jaundice due to the destruction of the red blood cells. They have dark-colored urine.
In severe cases of anemia, you may notice,
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Rapid heartbeat and breathing.
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Swollen hands and feet.
Who Is More Prone to Getting Anemia?
The risk factors for pediatric anemia are:
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Preterm or low birth weight babies.
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Poverty.
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Too much consumption of cows or bovine milk.
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Nutritional deficiencies, less iron in the diet, and an imbalance of minerals and vitamins.
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If the child has undergone any surgery or blood loss due to trauma.
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Chronic illness or infection.
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Presence of genetic blood disorders running in their families, such as sickle cell anemia.
How to Diagnose Anemia in Your Child?
Generally, pediatric anemia is asymptomatic, and routine blood investigations are required to confirm the diagnosis. The tests advised are:
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Hemoglobin and Hematocrit Tests: This is one of the screening tests to diagnose anemia in children and adults. The hemoglobin test measures the hemoglobin content in the blood. The hematocrit measures the percentage of red blood cells in the body.
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Complete Blood Count: It checks the red blood cells, white blood cells, and platelets. Hematocrit and hemoglobin are also included in this test. The blood is collected through a needle inserted into the vein of the child’s arm. The blood is drawn in a syringe, or sometimes the blood through a needle prick is also done. However, this might cause discomfort to the child.
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Peripheral Smear: A blood sample is viewed under the microscope to check for the appearance of the blood cells, normal function, and appearance.
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Reticulocyte Count: Reticulocytes are immature blood cells. This test measures the number of newly formed red blood cells in the child’s blood. A low reticulocyte count may indicate anemia due to a lack of blood cells, and a high reticulocyte count denotes anemia due to increased destruction of red blood cells.
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Bone Marrow Aspiration and Biopsy: Sometimes, bone marrow tests may also be required. As the red blood cells are produced in the bone marrow, a small amount of bone marrow fluid or solid bone marrow tissue (core biopsy) is done. This checks for the number, size, and appearance of the blood cells and detects any abnormalities.
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Hemoglobin Electrophoresis: It is a diagnostic blood test used to quantify hemoglobin levels and analyze abnormal hemoglobin. It is used to identify the different types of hemoglobin (HgbA, HgbF, HgbS). Hemoglobin electrophoresis plays an important role in diagnosing sickle cell anemia, thalassemia, and polycythemia vera. This test is especially done in newborns to screen them for congenital hemoglobin disorders.
- Iron Studies: Iron studies are a type of blood test used to evaluate the iron levels in the body. This is a common screening test in anemia to rule out iron deficiency. The iron studies mainly include serum iron levels, total iron binding capacity, or transferrin concentrations. The different components of iron studies are described below:
- Serum Iron - It measures iron levels in the liquid part of the blood. Fluctuations in the levels might be suggestive of anemia.
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Ferritin - It measures the iron present in the body. If the body contains less iron, it might be a sign of iron deficiency anemia.
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Total Iron Binding Capacity - It works by measuring the amount of iron in the blood and also measures the iron that can be transported in the blood.
What Are the Possible Complications Associated With Anemia?
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The problem is with normal growth and development.
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Impaired neurological growth, delay in cognitive and mental development.
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Failure of bone marrow, multi-organ failure in untreated cases.
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In rare cases, it may result in leukemia or other cancers.
Are There Any Ways to Prevent Anemia in a Child?
The deficiency of iron is the most common cause of anemia in pediatric patients. This can be prevented by providing enough iron in their diet.
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Always breastfeed your baby. Breastmilk serves as a good source of iron.
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If you feed your child with formula milk, then use formula milk with iron added to its composition.
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Nourish your baby with iron-rich foods. When you start with solid foods, include iron-rich grains, cereals, raisins, egg yolk, and meat in your diet.
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Cow’s milk or bovine milk is not advised in children until one year of age. Cow’s milk lacks iron content. Too much cow’s milk consumption also interferes with the absorption of iron. Iron plays a vital role in the production of red blood cells.
How Is Pediatric Anemia Treated?
The treatment plan for anemia varies for each individual, depending on its cause. In some cases, no complex treatment is needed; a simple dietary change is sufficient. Some cases may require medications, blood transfusions, surgeries, and stem cell transplants. Here are some basic protocols followed in treating anemia. They are:
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Supplementing vitamin and mineral drops or tablets to your child.
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Dietary modifications like iron-rich foods, cereals, bread, rice, organ meats, liver, chicken, duck, leafy vegetables, broccoli, turnips, cabbage, legumes, beans, and peas.
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Blood transfusions.
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Stem cell transplants.
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In rare cases, the spleen is removed (splenectomy) to prevent the destruction of the red blood cells.
Conclusion:
Anemia occurs due to various reasons, so the ideal treatment will be to identify the root cause and then do the treatment. As pediatric anemia is concerned, iron deficiency is the major cause, so it can be easily treated in your child by providing a healthy iron-rich diet. You can ask your pediatrician for the food chart to be followed in the little ones, especially those below one year of age. This food chart will be able to provide your child with a balanced diet. If in case your child is anemic and not due to nutritional deficiencies, then seek a professional and get the underlying medical condition treated.