ANEMI

A
IN
CHILD
REN
 • Blood counts for 8% of human body weight.
• An average adult has about 5 liter of blood in the
body. Blood is composed of plasma and cells called
corpuscles.
• The blood are mainly RBCS, WBCS, and platelets.

INTROD• During fetal development blood cells are produced

UCTION in liver and spleen.
• After birth new blood cells are synthesized from
stem cell in bone marrow through hematopoiesis.
• In bone marrow there is production of RBCs,
platelets and granulocytes while production of
agranulocytes occurs in spleen, lymph nodes and
other lymphoid tissue.
 FUNCTIONS OF BLOOD

Transportation
Maintain body temperature.
Maintain pH that is suitable for body cell
growth.
Removes toxins from the body.
DISORDERS OF BLOOD

Anemia
Thalassemia
Hemophilia
Purpura
Leukemia
ANEMIA is defined as reduction in the
volume of red blood cells or in the
concentration of hemoglobin, below
the lower limit of the normal range
for age, sex of the individual.
NORMAL HEMOGLOBIN RANGE

AGE HB(gm/dl)

0-1 month 13.4- 19.9

1-2 month 10.7-17.1

2-3 month 9.0-14.1

3-6 month 9.5-14.1

6 month -1 year 11.3-14.1

 CLASSIFICATION

ANEMIA

Based on Based on Hb. Based on

Morphology Concentration Etiology

Impaired Increased
Blood Destruction of
Microcytic Normocytic Macrocytic Red Cell
Loss RBCs
Anemia Anemia Anemia Production

Hypochromic Normochromic
 CLASSIFICATION
1. BASED ON MORPHOLOGY
 Microcytic anemia: abnormally small RBCs are present.
 Normocytic Anemia: RBCs are normal in shape but anemia
occurs due to blood loss, hemolysis or bone marrow failure.
 Macrocytic Anemia: RBCs are abnormally large in shape,
usually due to vitamin B12 or follic acid deficiency.
2. BASED ON HEMOGLOBIN CONTENT
 Hypochromic: abnormally decreased Hb. Content.
 Normochromic: Normal Hemoglobin content.
3. BASED ON ETIOLOGY
 Anemia due to blood loss: acute post hemorrhagic
anemia, chronic post hemorrhagic anemia.
 Anemia due to impaired RBC production: a
disturbance in Red Cell formation may lead to
anemia. Theses disturbances are:
 Deficiency of substance essential for
erythropoiesis: iron deficiency anemia, Vitamin
B12 and follate deficiency.
 Disturbance of proliferation and differentiation of
stem cells: Aplastic anemia(bone marrow stops
producing enough new blood cells), aplasia (RBCs
does not develop) of pure red cells.
 Disturbance in bone marrow function: anemia
due to infection, renal disease, liver disease,
malignancy or endocrinopathies.
 Anemia due to bone marrow dysfunction:
leukemia, myelosclerosis, multiple myeloma.
 Congenital anemia: sickle cell anemia etc.
 Anemia due to increased destruction of RBCs:
 Anemia due to intracorpuscular defect: sickle cell
anemia, thalassemia.
 Anemia due to extracorpuscular defect:
hemolyticus disease of newborn, effect of toxic
drugs, effect of venoms or poison, thermal
injury, transfusion reaction etc.
 DIAGNOSIS OF ANEMIA
 Hemoglobin estimation
 Peripheral blood film examination:

Variation in size of RBCs (anisocytosis- increased

variation size of RBCs is termed as anisocytosis)
normally the diameter of RBC is 6.7-7.7
micrometer.
Microcytes or macrocytes are seen blood smear.
Macrocytes are present in megaloblastic anemia and
aplastic anemia.
Microcytes ae present is Iron deficiency anemia.
Variation in shape of RBCs (poikilocytosis): variation
in shape of RBCs is known as poikilocytosis.
It is seen in megaloblastic anemia, thalassemia and
IDA.
Inadequate Hemoglobin Content (hypochromasia):
normally RBCs appear pink in color, the intensity of
pink color depends on the level of the Hb present in
the red cells.

It is seen in IDA, thalassemia , sideroblastic

anemia(lack of RBC and too much Iron in the blood.
 Red cell indices.

 Leucocyte, reticulocyte and platelet count.

 Bone marrow examination.

 Iron Deficiency ANEMIA

• Iron deficiency anemia is the most common

hematologic disorder of infancy and childhood. It
is caused by lack of sufficient iron for the
synthesis of hemoglobin.
 Iron Absorption and
Metabolism
• The iron required for hemoglobin synthesis is derived from two
sources-ingestion of food rich in iron and recycling of iron from
broken RBCs.
• Dietary iron is absorbed in the small intestine and either passed
into bloodstream or stored in intestinal epithelial cells as ferritin.
The iron in blood stream binds to iron-transport molecule-
transferrin and is then delivered to the RBCs in the bone
marrow, where it combines with the other components of
hemoglobin. If iron is not used for hemoglobin formation, it is
stored as ferritin or hemosiderin. Normally about 67% of the
body's iron is bound to heme and 30% of iron is stored as ferritin
or hemosiderin.
 ETIOLOGY
Several factors may contribute to iron deficiency anemia including:
 Increased blood loss

 Insufficient iron supply at birth

 Insufficient iron intake

 Impaired iron absorption

 Impaired iron absorption: Factors that reduce iron

 Malabsorption syndrome

 Chronic diarrhea

 Intake of antacids and tea after meals

 PATHOPHYSIOLOGY
Due to etiological factor

When sufficient iron is not available for hemoglobin synthesis

The production of hemoglobin is decreased

The newly formed RBCs become smaller (microcytic) and less filled with Hb
(Hypochromic)

Decreased hemoglobin level

Decreased oxygen carrying capacity

Anemia
 Clinical Features
The most common clinical feature of iron deficiency anemia is
pallor. When hemoglobin level falls below 5-6 g/dL,
following features may develop in the child:
 Irritability
 Listlessness

 Constipation
 Cardiac enlargement
 Tachycardia
 Cont…
 Weakness
 Dyspnea on exertion

 Poor attention span

 Reduced alertness Cardiac failure may occur
 Long-standing or chronic iron deficiency anemia
causes epithelial changes in some patients like
koilonychia (spoon-shaped nails), atrophic glossitis,
and angular stomatitis.
 DIAGNOSTIC EVALUATION
Anemia may be mild, moderate or severe. It can be
diagnosed on the following basis:

History of the child:

Blood test:

 Hemoglobin level is below 11 g/dL.

 Hematocrit is below 33%.

 Mean corpuscular volume is below 70 um³ in infants

and below 75 μm³ in children.

 Reticulocyte count is reduced.

 Serum ferritin concentration is below 10 mg/mL.

 CONT…

 Serum iron value is below 30 µg/dL.

 Total iron-binding capacity (TIBC) is elevated to 350

µg/dL in an attempt to absorb more iron from
exogenous sources.

 Ratio of serum iron to TIBC is below 10-12%.

Peripheral blood smear: The smear shows microcytic and

hypochromic red cells which may vary in shape
(poikilocytosis) and size (anisocytosis).

Stool test: Stool is tested for presence of occult blood

which indicates bleeding from the gastrointestinal tract
 MANAGEMENT
MEDICAL MANAGEMENT

Oral iron therapy: A therapeutic dose of 6 mg/kg/

day of elemental iron given orally in three divided
doses. It should be taken for at least 6-8 weeks
after the hemoglobin has reached normal level.

Parenteral iron therapy: A parenteral iron

preparation, iron dextran which contains 50 mg
elemental iron per mL, is used, when therapeutic
result of oral iron therapy is not achieved.
Blood transfusion: When the hemoglobin level is
below 4 g/dL, only packed red cells should be
given slowly. Also, one or two doses of frusemide
1-2 mg/kg, intravenously should be given to
prevent circulatory overload.
 NURSING MANAGEMENT OF PATIENTS ON
IRON THERAPY
Proper administration of iron supplements:
Parents should be educated that:

Iron medication should be given between meals,

when presence of free hydrochloric acid is
greatest, because an acid environment facilitates
iron absorption.

The medication should be given with any form of

ascorbic acid (vitamin C) such as a citrus fruit or
juices.
SIDE EFFECTS OF IRON THERAPY
Side effects of oral iron therapy include:

abdominal cramps,

nausea,

vomiting,

diarrhea, or

constipation.

Iron should be given with meals to prevent gastrointestinal

irritation.
Improving dietary iron intake:

Iron is present widely in animal and plant

foods, e.g. meat, liver, kidney, egg yolk, green
leafy vegetables, and fruits like apple.

At the time of weaning, iron-rich diet should

be given to the infant.

Food should be prepared in utensils made up

of iron, to increase the iron content of the
food.
 PREVENTION
• Formulas for full term infants should contain iron, so that infant gets
about 1 mg iron/kg/day.
• Iron-fortified milk formulas should be used for nonbreastfed infants.
• Weaning diet should include iron-rich foods like pulses, green
vegetables, fruits, etc.
• Children should be made to wear shoes while playing to prevent
worm infestation.
• Hookworm infestation should be managed with antihelminthic drugs.
• Food should be cooked in iron utensils.
• Iron supplements should be administered to preterm and low birth
weight infants having low iron stores.
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