IRON DEFICIENCY

ANEMIA IN CHILDREN
DR DEEPA K KRISHNAN
Hb Levels to diagnose Anemia in children
Anemia Mukt Bharat Dashboard: https://anemiamuktbharat.info
SOURCES OF IRON

HEME NON HEME

• FISH • GLV
• MEAT • JAGGERY
• LIVER • RAGI
• DATES
• NUTS
• SPROUTS
BIO AVAILABILITY OF IRON
• HEME 20 -30%

• WHEAT 2-3%

• RICE 5-13%

• BREAST MILK 50% (0.1 to 0.3 mg/l)

• FORMULA MILK 4-6% (12 mg/l)
IRON CYCLE IN THE BODY
• RBC has a life span of 21 days

• Destroyed in the spleen

• Free iron retransported back to bone marrow and other tissues

• Only 1-1.5 mg of iron is excreted daily

• RDA is about 10mg as 10% of ingested iron is absorbed

PERINATAL RISK FACTORS
• Maternal iron deficiency

• Prematurity

• FMH

• TTS

• Other perinatal hemorraghic events

CLINICAL FEATURES
• Fatiguability,irritability,anorexia

• Pallor

• Palpitations,exertional dyspnoea

• CCF

• Pedal oedema

• Mild hepatosplenomegaly
NON HEMATOLOGICAL
CONSEQUENCES
• Koilonychia,platynychia

• Angular stomatitis,glossitis

• Plummer Vinson syndrome

• Pica
• Impaired immunity
SITES TO LOOK FOR PALLOR
1. Lower palpebral conjunctiva
2. Dorsum of the tongue
3. Oral mucosa
4. Palmar and plantar creases
5. Skin and nails

GRADING OF PALLOR
SEVERE PALLOR-Palmar creases become faint and pale
MODERATE PALLOR-Paleness of the mucosae present, but pink hue of palmar
crease is maintained
Effects of Iron Deficiency may develop before onset of Anemia

- Brain enzymes involved in cognition and behavior

- Permanent adverse effects on learning and behavior
- The changes in infancy may be irreversible.
- Beyond infancy also there is impact on learning capacity and
intelligence
- Linear growth may also be affected.
Non-hematologic effects of iron deficiency may occur before
the onset of anemia
- May irreversibly affect cognition and learning
- Risk of seizures
- Strokes
- Breath Holding Spell
- Pica- Lead ingestion
- Pagophagia
 INVESTIGATIONS
CBC and PS
low Hb,low RBC count,low MCV,low MCH ,increased RDW
microcytic hypochromic anisopoiklocytosis
SERUM IRON <40 ugm/dl
TIBC &TRANSFERRIN SATURATION
TIBC <350ugm/dl,Tsat <12 %
SERUM FERRITIN <12ngm/ml
SOLUBLE PLASMA TRANSFERRIN RECEPTOR increased in IDA.
• CONTENT OF HEMOGLOBININ RETICULOCYTES CHR
• <27.5 pg

• BONE MARROW EXAMINATION

• Micro normoblastic erythroid hyperplasia

• Absent stainable iron on Prussian blue
 TREATMENT
• Oral Iron Therapy

• Dose is 3-6mg of elemental iron /kg/d continued for 2-3

• months and another 2-3 months to build up iron stores

• Ferrous sulphate,ferrous gluconate,ferrous fumarate

• Iron aminoacid chelates, iron polymaltose complex

• Parenteral iron therapy

• ferric carboxy maltose and iron sucrose

• DOSE
• Iron in mg= weight in kgxHb deficit in gm/dlx4

• SIDE EFFECTS OF ORAL IRON

• Nausea,vomiting ,diarrhoea and abdominal discomfort

• SIDE EFFECTS OF PARENTERAL IRON

• Skin rash,arthralgia,myalgia and anaphylaxis (rarely)
RESPONSE TO IRON THERAPY
• 12-24hr increased appetite and reduced irritability

• 36-48hr initial BM response, erythroid hyperplasia

• 48-72hr reticulocytosis peaking at 5-7 days

• 4-30 days increase in hemoglobin level

• 1-3 months repletion of iron stores

 PREVENTION
• Dietary modification

• Periodic deworming

• Fortification of food
THANK YOU