Description
Anemia in children is a frequent condition, most commonly caused by iron deficiency, but also linked to hemoglobinopathies, chronic diseases, and nutritional deficiencies. Diagnosis involves history taking, dietary evaluation, physical examination, and laboratory tests such as complete blood count, peripheral smear, and iron studies. Treatment depends on etiology: iron deficiency requires iron supplementation and dietary modifications, while infections or underlying illnesses need targeted therapy. Severe cases may warrant blood transfusions. Hemoglobinopathies and chronic conditions require specialized management. Early diagnosis and appropriate treatment are vital to support normal growth, development, and prevent long-term complications in affected children.
Summary Listen
- Anemia is defined as a reduction in hemoglobin concentration below two standard deviations of the mean for a given age and sex. The prevalence is high, particularly in children aged 6-59 months, with nutritional anemia, especially iron deficiency, being the most common cause. Anemia reduces oxygen delivery to tissues, leading to hypoxia.
- Clinical features include pallor, fatigue, weakness, irritability, poor concentration, poor feeding in infants, tachycardia, and shortness of breath. Neurological symptoms like developmental delay, behavioral issues, and pica can also occur. In aplastic anemia, bruising and recurrent infections are common.
- The WHO criteria for anemia vary by age, with recent changes lowering the cutoff for 6-23 month olds to <10.5 g/dL. Cutoffs for other age groups are 11 g/dL (24-59 months), 11.5 g/dL (5-11 years), 12 g/dL (12-14 years), 13 g/dL (adolescent males), and 12 g/dL (adolescent females). Severity is classified based on hemoglobin levels, with severe anemia defined as <7 g/dL for 6 months-5 years, and <8 g/dL for older children.
- The diagnostic approach involves a thorough history, clinical examination, and laboratory investigations. History should focus on dietary factors, chronic diseases, medication use, family history, and potential blood loss. Examination findings such as angular cheilitis, koilonychia, splenomegaly, and lymphadenopathy provide diagnostic clues.
- Screening lab tests include a complete blood count (CBC) to assess hemoglobin and red cell indices. Reticulocyte count, corrected reticulocyte count, and peripheral blood smear analysis provide information about bone marrow activity and the type of anemia. Bone marrow examination is useful in diagnosing aplastic anemia, leukemia, and secondary metastases. Iron studies, serum folate, vitamin B12 levels, and hemoglobin electrophoresis help determine the etiology of anemia.
- Anemia can be classified based on etiology (disturbance of erythropoiesis) or morphology (red cell size and hemoglobin content). Morphological classification distinguishes between microcytic, normocytic, and macrocytic anemias, each associated with different underlying causes. Red cell indices such as MCV, MCH, and MCHC are used to categorize anemia morphologically.
- Treatment strategies for nutritional anemia include dietary modifications, iron-fortified foods, and oral iron supplementation. The dose and duration of iron supplementation vary depending on the age and severity of the anemia. Vitamin B12 and folic acid deficiencies are treated with appropriate supplementation. Underlying causes, such as parasitic infestations, should be addressed.
- Management of thalassemia involves regular blood transfusions, monitoring for iron overload, and chelation therapy if necessary. Hydroxyurea may be used in sickle cell disease. Genetic counseling and prenatal diagnosis are recommended for families at risk. Multi-disciplinary care is essential.
- Preventive measures include maternal iron and folic acid supplementation during pregnancy, exclusive breastfeeding for the first six months, iron-rich complementary feeding after six months, iron supplementation in high-risk infants, deworming programs, and malaria prevention measures.
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