anaemia
INTRODUCTION
Anaemia is defined as a reduction of the red blood cell (RBC) volume or hemoglobin concentration below the range of values occurring in healthy persons.
Age
Range (gm/dl)
2wks
13.0 – 20.0
3 months
9.5 – 14.5
6 months – 6yrs
10.5 – 14.0
7 - 12 yrs
11.0 – 16.0
Iron deficiency anaemia in children and infants is very common. It is the most frequent cause of anaemia and perhaps the most common single nutrient deficiency in developing countries like India.
history
Iron was used in the treatment of anaemia since ancient times “Loha Bhasma” was used by the Ayurvedic physicians in treatment of anaemia in India long time ago, Hippocrates, the father of medicine, used iron for treating weak and pale people. The Greek physicians used iron for treating weakness which is one of the important symptoms of anaemia. Sydenham was the first person to put on paper the use of iron. He wrote “we gave mars in the pale colour”.
chemistry and source
IRON : Iron is a chemical element with symbol Fe and atomic number 26. Iron is a group 8 and period 4 element.9 Iron is lustrous and silvery in color. It is one of the few ferromagnetic elements. Its melting point is 1538o C and boiling point is 2862oC. Most of the iron in the earth’s crust is found combined with oxygen as iron oxide minerals such as hematite and magnetite.9 Iron oxidises readily in air and water to form Fe2O3 and is rarely found as a free element. Good sources of dietary iron include red meat, fish, poultry, lentis, beans, leaf vegetables, tofu, chickpeas, black – eyed peas, fortified bread, and fortified breakfast cereals.9 Iron in meat is more easily absorbed than iron in vegetables (haem iron). Iron provided by dietary supplements is often found as iron (II) fumarate, although iron sulphate is cheaper and is absorbed equally well. Iron is most available to the body when chelated to aminoacids – iron in this form is ten to fifteen times more bioavailable11 than any other, and is also available for use as a common iron supplement. Often the aminoacid chosen for this purpose is the cheapest and most common aminoacid, glycine, leading to “iron glycinate” supplements
absorption and metabolism
IRON :
Iron is mainly absorbed in the duodenum. About 10% of dietery iron usually absorbed.15 However, in iron deficient (anaemic) individuals and growing children, a much higher proportion of dietary iron is absorbed to meet the increased body demands.
Factors affecting Fe absorption15
1. Acidity, ascorbic acid and cysteine promote iron absorption
2. In iron deficiency anaemia, Fe absorption is increased to 2-10 times than that of normal.
3. Phytate (found in cereals) and oxalate (found in leafy vegetables) interfere with Fe absorption.
4. A diet with high phosphate content decreases Fe absorption while low phosphate promotes.
5. Impaired absorption of iron is observed in malabsorption syndromes.CLINICAL FEATURES
Severity of anaemia symptoms and management
2. Speed of its development
3. Primary disease causing anemia
4. Presence of other co-morbid conditions
The following symptomatology should alert the clinician to look for anaemia.
a) Often asymptomatic in mild anaemia
b) Weakness, fatigue, lethargy
c) Tiredness, dizziness
d) Light headedness, headache, ,lack of concentration
e) Breathlessness on exertion, palpitation, congestive cardiac failure IRON :
iron deficiency may results from
1. low iron stores
2. reduced iron intake
3. excessive losses of iron from the body
4. decreased iron absorption
5. incresed iron demands RECOMMENDATIONS
investigations
Hb% (gm/dl)
Peripheral smear : 1. microcytic hypochromic 2. normocytic normochromic
3. macrocytic
Reticount
Iron(microgm/dl)
Zinc(microgm/dl)
Copper(microgm/dl)
Lead(microgm/dl)
ALAD activity
%Stimulation ALAD
treatment
· Iron supplementation should be given in case of nutritional anaemia, as the effects of iron deficiency will depend on the duration and severity of the anaemia. If left untreated, it may lead to behavioural or learning problems. These may not be reversible, even with later iron supplementation.
· Iron deficiency anaemia is the commonest cause of nutritional anaemia, it can be prevented by following recommendations :
a) Infants younger than 1yr should drink breast milk or an infant formula supplemented with iron. It is important for breastfed infants to receive iron fortified solid foods starting at about 6 months of age.
b) Children under 2yrs should have no more than 24 ounces of cows milk a day. Cows milk can inhibit absorption of iron, and drinking too much milk can dampen a child’s appetite for other iron rich foods.
c) Foods with nutritious sources of iron should be given to children especially during periods of rapid growth : lean meat, fish, egg yolk, beans, spinach, green leafy vegetables and fortified bread. Iron fortified foods should be given to those who take only vegetarian diet as iron from plant sources is less easily absorbed than meat sources
6. defective iron metabolism
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