Anaemia in kids, its causes and cure

Dr Abhay A Bhave

Anaemia is one of the most widespread public health problems, especially in developing countries, and has important health, welfare, social, and economic consequences. These include reduced number of hours at work, low self-esteem, fatigue, restless, legs syndrome at night to impaired cognitive development in children, and in severe cases (especially in pregnancy) increased risk of death, particularly around the delivery period, all contributing to a poor quality of life.

The most distressing fact about anaemia, especially nutritional anaemia (due to poor or inadequate oral intake) is that it is a correctable disorder which if diagnosed early can be treated properly to improve the overall health status of the patient. An anaemic girl during pregnancy could have an anaemic child which will not auger well for our community.

Anaemia is defined as a quantitative and qualitative deficiency of haemoglobin in the red blood cells of the blood. Nutritional anemia is a syndrome caused by malnutrition in which the hemoglobin content of the blood is lower than normal due to a deficiency of 1 or more essential nutrients, usually iron but less frequently folate or vitamin B12 and sometimes both. The imbalance between the absorption of nutrient factors and the body’s needs can arise from low nutrient intake, poor absorption, increased nutrient losses or demands, or poor utilization.

The common cause of anaemia in the community is iron deficiency, a critical element needed by most cells for their functioning and plays a major role in oxygen carrying capacity of the blood as part of the hemoglobin molecule. The symptoms of fatigue, lack of self-esteem and other symptoms are due to the poor oxygenation of the tissues.

Iron deficiency occurs due to inadequate diet (nutritional- is the commonest) or inadequate absorption (malabsorption) and worm infestation or chronic blood loss (excessive bleeding during periods, haemorrhoids or piles).

Iron deficiency can be suspected on a quality assured CBC (complete blood count) by the red cell indices and confirmed by additional tests such as serum iron studies and serum ferritin (storage iron). The gold standard of iron assessment is a bone marrow iron stain test but this is hardly ever needed. Other investigation such as upper and lower gastrointestinal endoscopy to assess intestinal causes of iron deficiency will yield a diagnosis in 67% of cases. The reason for aggressive iron deficiency diagnosis is to identify the cause of iron deficiency and treat it adequately so that it does not become recurrent.

Treatment of iron deficiency is by oral, IV (intravenous) or IM (intramuscular – now rarely used) iron therapy with responses occurring in most patients by 1 month.

The severity and cause of iron deficiency anemia will determine the appropriate approach to treatment. Extreme cases may need blood transfusions (which rapidly increases the haemoglobin and iron status) but should be avoided unless absolutely necessary as it can cause reactions, transmit potential infections and cause immunological issues. Typically, for iron replacement therapy up to 30-100 mg of elemental iron per day is given once a day depending on tolerance, preferably on empty stomach but after food is also fine.

The goal of therapy in individuals with iron deficiency anemia is not only to repair the anemia, but also to build the iron stores. Sustained treatment for a period of 6 to 12 months after correction of the anemia will be necessary to achieve this. Good counseling is needed for patient to remain complaint to full course of iron therapy for best results.

Intravenous or intramuscular iron can be given to patients who are unable to tolerate oral iron but these are expensive, need hospital or clinic visits.

Responses to the iron therapy are assessed by rising haemoglobin level by 1-2 grams in 2-4 weeks and she patient should be encouraged to continue treatment till normalization of iron studies and ferritin.

In India, vitamin B12 and folic acid deficiency is commonly seen with iron deficiency and could be one reason for inadequate response to iron therapy. This B12 deficiency is treated with Intramuscular injections and folate deficiency by folate tablets.

The response to both iron and vitamin deficiencies treatment is gratifying. Shortly after treatment is begun, and several days before a hematologic response is evident, the patient will experience an increase in strength and an improved sense of well-being.

The patients should be counseled about proper diet and lifestyle activities so that this problem does not recur. They should correct the factors responsible for iron deficiency as mentioned in the causes above.

Simultaneously, other causes for anaemia than iron and vitamin deficiency should be looked for such as such as thalassaemia, sickle cell disease, G6PD deficiency, spherocytosis (round shaped red blood cells) as they can impact the response of our therapy.

National efforts to prevent iron deficiency should involve community, government, the private sector (e.g., food industry), and nongovernmental organizations to develop long-term strategies that incorporate behavior modification, food fortification, and integration of iron deficiency–control into ongoing public health programs. Surveillance systems should be implemented to monitor development of these strategies and track the success of interventions.

It is sad that the incidence of anaemia in our teenage and college going population is quite high, which is not good for the future of our community. Haemoglobin assessments at school and college level will help identify and treat such children and improve their health and educational attendance and attention, as well as their output in their formative years. Remember, anemia is CURABLE most of the times!!!

The writer is a Haematologist, Global hospitals, Mumbai