Anemia in children – is a hematological syndrome characterized by decreased concentration of hemoglobin and number of erythrocytes per unit volume of blood. In various forms of anemia in children there is a General weakness, fast fatigue, pallor of skin and mucous membranes, dizziness, palpitations. Anemia in children is diagnosed according to clinical and laboratory data (General blood analysis, determination of bilirubin, serum iron, total iron-binding capacity the ability of serum, examination of bone marrow, etc.). General principles of treatment of anemia in children include the organization of a balanced diet, timely introduction of complementary foods, vitamin therapy, iron supplementation, according to testimony – conduct blood transfusions.
Anemia in child
Anemia in children (anemia) – a pathological condition accompanied by decreased level of hemoglobin and erythrocytes in the blood of the child. Anemia in children is an extremely common disease in Pediatrics. About 40% of cases of anemia diagnosed in children under 3 years; 30% in puberty; the rest in different age periods of child development.
Common occurrence of anemia in children due to their intensive growth, the activity of the process of erythropoiesis, a progressive increase in the number of formed elements. However, the apparatus of hematopoiesis in children is functionally immature and very vulnerable to various influences. The normal course of hematopoiesis in children requires great quantities of iron, protein, vitamins and minerals, so that any feeding errors, infections, toxic effects on bone marrow can cause anemia in the child. Particularly sensitive are children, the second half of life who have depleted neonatal iron reserves. Long-existing anemia in children is accompanied by the development of hypoxia, deep tissue and organ changes. Children with anemia are lagging behind in physical and mental development from peers, often suffer from intercurrent diseases prone to development of chronic pathological processes and various complications.
Causes of anaemia in children
Factors contributing to the development of anemia in children are divided into the antenatal, intrapartum and postnatal period.
Antenatal factors acting during fetal development. For normal processes of hematopoiesis the child for the period of pregnancy the body needs to obtain from the mother and accumulate sufficient amount of iron (300 mg). The most intensive transfer of iron from the pregnant and its deposition in the fetus occurs at 28-32 weeks of gestation. Disruption of the normal course of pregnancy (gestosis, fetoplacental insufficiency, danger of spontaneous abortion, premature detachment of the placenta, bleeding, maternal infections, worsening of chronic processes) leads to impaired metabolism of iron and its lack of accumulation in the organism of the child.
Anemia in children is more likely to occur if the woman also suffered from anemia during pregnancy. Premature birth cause anemia is diagnosed in all premature infants with birth or from approximately the 3rd month of life. The development of anemia in newborn infants contributes to multiple births.
Intrapartum factors of anemia in children is associated mainly with blood loss during childbirth. Blood loss is possible in case of premature detachment of the placenta in childbirth, early or late ligation of the umbilical cord, the expiration of blood from the umbilical cord residue by improper handling, use of traumatic obstetric benefits.
Postnatal factors of anemia in children are included after birth and can be endogenous or exogenous. Endogenous causes of anemia in children may be damage to the red blood cells due to hemolytic disease of the newborn, abnormal synthesis of hemoglobin, the primary constitutional marrow failure.
Exogenous anemia in children is most often due to nutritional reasons. In this case, the anemia develops mainly at children of the first year of life, which is monotonous for milk feeding. Anemia in young children may occur when there is insufficient iron content in breast milk; early and unjustified transfer of the child to artificial or mixed feeding; the use of non-adapted mixtures, cow’s or goat’s milk for feeding; late introducing a child’s diet lures. A higher intake of iron in the body is in need of premature babies and children born with increased body weight. Therefore, the mismatch between receipt and consumption of iron can also cause anemia in children the first year of life.
Anemia in children may arise from regular blood loss: when private nasal bleeding, blood diseases (hemophilia, von Willebrand disease), menorrhagia, gastrointestinal bleeding, after surgery. In children with food allergies, exudative diathesis, neurodermatoses increased loss of iron through the epithelium of the skin, so these children are at risk for the development of iron deficiency anemia.
In addition to the loss of iron to the development of anemia in children may result in the violation of his absorption and exchange. These disorders are commonly found in the syndrome of malabsorption (malnutrition, rickets, lactase deficiency, celiac disease, intestinal form of cystic fibrosis, etc.) Anemia in children can result from any infectious or chronic somatic diseases (tuberculosis, bacterial endocarditis, bronchiectasis, pyelonephritis, etc.), leukemia, fungal infections, parasitic infestations, collagen diseases.
In the development of anemia in children there is a deficiency of vitamins of group B, trace elements (magnesium, copper, cobalt), unfavorable hygienic conditions, depletion of endogenous iron coming from infants to 5-6 months.
Classification of anemia in children
In accordance with the pathogenesis distinguish the following groups of anemia:
I. Post-Hemorrhagic anemia in children due to acute or chronic blood loss.
II. Anemia in children due to a violation of hematopoiesis.
- Deficiency of iron (hypochromic)
- Pereditary and acquired gelatination (sideroahrestical – are associated with defects in the synthesis of porphyrins)
- Megaloblastic (B12–deficient and polyesterine)
- Hereditary and acquired dizèritropoètičeskie
- Hereditary and acquired aplastic and hypoplastic (associated with oppression)
III. Hereditary and acquired hemolytic anemia in children due to the increased destruction of red blood cells and a predominance of the process of kirovogradshchina over the process of krovoobrashseniya (membranacei, fermentopathy, hemoglobinopathies, autoimmune anemia, hemolytic disease of the newborn, etc.).
Symptoms of anemia in children
Rate of hemoglobin in children under 6 years is 125-135 g/l; about anemia in a child’s say in the case, if this figure falls below 110 g/l (in children up to 5 years) and below 120 g/l (in children older than 5 years).
Visible changes in anemia in children are observed in the skin and its appendages: the skin becomes pale, dry, scaly; the nails become deformed and brittle; hair a healthy Shine. Characteristic sign of anemia in children is a symptom Filatov – pale earlobes when viewed in transmitted light. In severe forms of anemia in children cracks on the palms and soles, in the corners of the mouth; it develops aphthous stomatitis, glossitis. Children with anemia are weakened, stanichny, often sick respiratory catarrh, bronchitis and pneumonia, acute intestinal infections.
From the nervous system, subjected to hypoxia, there is lethargy, tearfulness, rapid exhaustion, dizziness, superficial sleep, enuresis. Revealed a decrease in muscle tone, the child does not tolerate physical activity, tired quickly. In children the first year of life is marked wasting, occurs regression of psychomotor development.
Anemia in children revealed dysfunction of the cardiovascular system in arterial hypotension, orthostatic collapse, syncope, tachycardia, systolic murmur.
From the digestive system in children with anemia, there are frequent regurgitation and vomiting after feeding, flatulence, diarrhea or constipation, decreased appetite, possible enlargement of the spleen and liver.
Diagnosis of anaemia in children
Basis for the diagnosis of anaemia in children account for laboratory studies. In a General blood test for anemia in children revealed a decrease in Hb (less than 120-110 g/l), lower Er (<3,8×1012/l), decrease CPU <0,85. Biochemical blood analysis includes the determination of serum iron, transferrin iron saturation, ferritin concentration in serum, bilirubin, vitamins. In some cases it is required to puncture and examination of the bone marrow.
In the diagnostic process determines the form and severity of anemia in children. The latter is evaluated on the content of erythrocytes and hemoglobin:
- Anemia mild – Hb 110-90 g/l, Er – 3,5×1012/l;
- Anemia of moderate degree – Hb 90-70 g/l, Er – 2,5×1012/l;
- Severe anemia – Hb is less than 70g/l, Er – less than 2. 5×1012/L.
On the testimony of children with anemia may require consultation of specialists (pediatric gastroenterologist, children’s rheumatology, children’s nephrologist, child gynecologist etc.), examination of the gastrointestinal tract and kidneys.
Treatment of anaemia in children
Anemia in children requires the organization of the correct mode of the day and balanced diet of the child, drug therapy and restorative activities. Children are encouraged sufficient exposure to fresh air, the extra sleep; appointed exercises and massages.
Children with anemia, breastfeeding, should be timely to introduce fishing lures (juices, egg yolk, vegetables, meat sauce). It is also necessary to adjust the diet of lactating women to add taking a multivitamin and iron preparations. Children receiving artificial feeding, are assigned to the adapted dairy mixes enriched with iron. Diet of older children should contain liver, beef, legumes, greens, seafood, fruit and vegetable juices.
Drug therapy of anemia in children includes the administration of iron preparations (hemofer, aktiferrin, ferropleks, conferon, etc.) and multivitamin preparations before full normalization of clinical and laboratory parameters (average 6-10 weeks). In severe cases can require blood transfusions.
Forecast and prevention of anaemia in children
Prognosis of iron deficiency anemia in children is usually favorable. With timely diagnosis, proper nutrition, treatment of anemia and related diseases there comes a full recovery. Severe anaemia in children can be a ground for postponement of the vaccination.
Prenatal stage of prevention of anemia in children include good nutrition pregnant woman, sufficient exposure to fresh air, mineral-vitamin complexes containing iron. Postnatal prevention of anemia in children reduced to natural-feeding, introduction of complementary feeding at the recommended time, prevent disease early age, good care and optimal for the child, the preventive treatment-and-prophylactic courses in high-risk groups.