1. Iron Deficiency Anemia pada Anak

8/16/2019 1. Iron Deficiency Anemia pada Anak

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IRON DEFICIENCY ANEMIAIN INFANCY AND CHILDHOOD

Sony Wicaksono

Susanto Nugroho

Departent o! Chi"# Hea"th$Facu"ty o! Me#icine%&ni'ersity o! (ra)i*aya+

Dr, Sai!u" An)ar -enera" Hospita"


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Objectiveo

• To understand the burden of iron

deficiency anemia (IDA)

•To understand the IDA diagnosis andmanagement


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Keypoints

• Introduction

• Iron metabolism

• Iron deficiency anemia• anagement


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Introduction

Iron #e.ciency aneia is the ost coonhaeato"ogic #isease in in!ants / chi"#ren

reains the counity hea"th pro0"ein In#onesia

Se'era" stu#ies iron #e.ciency aneiaassociate# )ith 1 % poor cogniti'e !unction

% "o)er achie'eent scores in schoo"

% ipaire# psychootor #e'e"opent% 0eha'iora" pro0"es

Palti H, Meijer A, Adler B. Early Hum Dev 1985 ; 10 : 2172!"#erri$ A, Em%&d A, Bell '(, )%ldi&* '. Ar+# Di (#ild 2001; 8-; -805


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De'e"openta" an# (eha'iora" E2ectso! Iron De.ciency Aneia 3IDA4 in In!ants

H%lt M(. Devel%me&tal a&d /e#avi%ral e$e+t % ir%& de+ie&+y a&emia i& i&a&t. utriti%& 3%day 1


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ASEAN Human Development Index 2002

&ND5 Report 6778


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Iron defciency anemia 2001underfves children in Indonesia

Household Survey, 2001

&t%r% 6. Pe&i&*ata& ualita Hidu A&a Melalui Pe&+e*a#a& A&emia )ii Bei.Diajia& ada ama&ye A&ti A&emia 20042008. Dee, 'aarta, 1 Maret 2007


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Iron metaolisms

(o#y iron #istri0ution an# transport

Iron a0sorption

Iron re9uireent

A&dre (. Medi+al Pr%*re: Di%rder % r%& Meta/%lim. E&*l ' Med 1999;!-1: 198495

H%$/ra&d A


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(o#y iron #istri0ution

A&dre (. Medi+al Pr%*re: Di%rder % r%& Meta/%lim.

E&*l ' Med 1999; !-1: 198495


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Iron re!uirements

Estiate# #ai"y iron re9uireentsIn chi"#en 3a'erage41

% &rine$ s)eat$ !eces 1 7,: g+#ay

% -ro)th 1 7,; g+#ay

%


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Etiolo"y o# iron defciency

$ess 1 year> $o% iron stora"e &$'( or "emelli)> $ac* o# iron supplements in exclusively reast+

#ed in#ants eyond months o# a"e> -n#ortifed mil* #ormula

A"e 1+2 year> ./il*aholics.> Increased iron needs due to chronic in#ection> /alasorption> 'lood loss e" parasitic in#ection and

/ec*els diverticulum


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Etiolo"y333

A"e 2+4 year> 5oor inta*e o# iron+rich #ood> Increased iron needs due to chronic in#ection> 'lood loss e" 5arasitic in#ection and

/ec*els diverticulum

A"e 4 year 6 adolescence> 'lood loss e" 5arasitic in#ection or

polyposis

Adolescence 6 adult> (oman 7 e" menorrha"ia

=a&%y P. 1995. . !550.)lader B. &: el%& 3e>t/%% % ediatri+. 17t# ed.; 200-. . 141-4.

"a&d%val (, et al. Hemat%l ?&+%l (li& Am 200-;18:1-2!!8.illi ", et al. Am @am P#yi+ia& 2007;75:4718.

"e*el )B, et al. Pediatr 6ev 2002;2!:758-.


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Sta"in" o# iron defciency

6aati H d. A&emia deie&i /ei. Dalam Perm%&% B, d. Edit%r.Buu Ajar Hemat%%&%l%*i a&a 2005: !0-!1.

Stage I 1 Iron #ep"etion 3)ithout aneia4

Stage II 1 Iron #e.ciency 3)ithout aneia4

Stage III 1 Iron #e.ciency 3)ith aneia4 IRON DEFICIENCY ANEMIA


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Iron defciency%ith and %ithout anemia

Anemia &Iron Defciency %ith Anemia &ID 8 A) + Serum hemo"loin 7 elo% normal + Depleted #erritin stores + Disturin" co"nitive 9 ehavior development

Iron Defciency %ithout Anemia &ID 6 A) + Serum hemo"loin 7 normal + Deplete #erritin stores + Decrease iron concentrations in some tissues

+ Stron"ly potential disturin" co"nitive andehavior development

+ :ritical periode 7 1 6 2 years o# a"e

'%y+e ( M+(a&& '(, Ame B. Am ' (li& utr 2007;85:9!1 -5


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Dia"nosis

> History fndin"s 7+ onset 9 severity o# anemia, a"e+ parasitism, lood loss &acute or chronic)+ inade!uate diet &!uantity 9 !uality)+ poor asorption

+ increased re!uirements

> :linical #eatures 7→ symptoms 9 si"ns &"eneral 9 specifc)

> $aoratory fndin"s 7→ hematolo"ic 9 iochemical mar*ers


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:linical #eatures

> Depend on speed o# onset, severity &de"rees o# iron

defciency), a"e 9 H;2 dissociation curve

> +10 "?d$)

+ tachycardia, cardiome"aly, a oundin" pulse,

a systolic @o% murmur at apex

> A painless "lossitis, angular stomatitis, rittle,

rid"ed or spoon nails (koilonychia), dyspha"ia as

result o# pharyn"eal %e &5aterson+elly or

5lummer+Binson syndrome)


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La0oratory .n#ings !or i#enti!ying iron#e.ciency

6aati H d. A&emia deie&i /ei. Dalam Perm%&% B, d. Edit%r.Buu Ajar Hemat%%&%l%*i a&a 2005: !0-!1.


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Creatment

Elemental e

+ Do7 + m"?*"'(?d &2+ dosa"es)+ It may ta*e up to 2 mo a#ter hemo"loin has

een corrected+ Adverse eFects 7


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In#ication !or routine iron supp"eentationchi"#ren ? : yrs o"#

=a&&%tti ==, 3iel+# 'M, Bla+ MM, a&d Bla+ 6E,Am ' (li& utr2004;8-:124174


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Lan@ko)sky 5, =:, p, B:%:7,-"a#er (, In1 Ne"son


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Indication 7 I# hemo"loin levels = "?d$

Crans#usion

=a&%y P. 1995. . !550.)lader B. el%& 3e>t/%% % ediatri+. 17t# ed.; 200-. .

141-4.

Dept o# :hild Health Dr Sai#ul An%ar Hospital7H = ?d$ "?d$

H "?d$, %ith cardiorespiratory disturances,severe in#ection, dehydration, sur"icalprocedures


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Diet

/il* 7 2 oJ?day

Iron rich #ood &fsh, liver, meat) rather than rice,

spinach, %heat, soyean

K asorption7 tanin, calsium, phytates

L asorption7 vitamin :, H:l, amino acid,

#ructosa,

meat

=a&%y P. 1995. . !550.)lader B. el%& 3e>t/%% % ediatri+. 17t# ed.; 200-. .

141-4."a&d%val (, et al. Hemat%l ?&+%l (li& Am 200-;18:1-2!

!8.


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5revention

5rimary prevention Exclusive reast#eedin"

+ Che asorption o# iron #rom reast mil* ishi"her than that #rom %hole co%s mil* &40M

vs10M)

+ Iron+#ortifed co%s mil* 7 M

/il* consumption 7 2 oJ?day &other7 1 oJ?day)

=a&%y P. 1995. . !550)lader B. el%& 3e>t/%% % ediatri+. 17t# ed.; 200-. .

141-4"a&d%val (, et al. Hemat%l ?&+%l (li& Am 200-;18:1-2!!8

illi ", et al. Am @am P#yi+ia& 2007;75:4718"e*el )B, et al. Pediatr 6ev 2002;2!:758-

?i @A. E&*l ' Med 199!;!29:190!


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5rimary prevention3

Alle& =H. ' utr 2002;1!2:81!"9"=a&%y P. 1995. . !550

"a&d%val (, et al. Hemat%l ?&+%l (li& Am 200-;18:1-2!!8?i @A. E&*l ' Med 199!;!29:190!


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:onclusions

IDA is a maor prolem in developin" countries

Iron supplementation resulted in a similar rate o# success#ul

treatmento# anemia &H 9 #erritin)

Iron supplementation+ Che increases in H concentration %erecomparale

+ Improvement o# co"nitive #unction+ :ost eFective+ No or #e%er side+eFect


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1. Iron Deficiency Anemia pada Anak