Anemia during Infancy

Etiology anemia • Decreased red cell production (generally develops

gradually and causes chronic anemia)– Marrow failure (aplastic anemia, malignancy)– Impaired erythropoietin production( severe

malnourish, hypothyroid, renal disease)– Defect in red cell maturation and ineffective

erythropoiesis ( iron/ folat acid/ B12 def, thalassemia) • Increased red cell destruction (hemolysis)

– Extracellular causes (AIHA, HUS, infection)– Intracellular causes ( membrane defects, enzyme

defects, hemoglobinopathies)• Blood loss

IRON DEFICIENCY ANEMIA

Prevalence • USA decreasing ; 2.5% in healthy population.• Developing nations : the prevalence of anemia is

extremely high. This is particularly true in preschool-aged children, in whom the prevalence reached as high as 90% of the sample population studied.

Risk factors :• Nutrition inadekuat intake, malabsorpsi• Infection• Low sosio economic• Malnutrition• Prematuritas• Anemia pada ibu hamil

Phatophysiology • The main physiologic role of RBCs is to deliver oxygen

to the tissues.• Certain physiologic adjustments can occur in an

individual with anemia to compensate for the lack of oxygen delivery.

(1)Increased cardiac output

(2)Shunting of blood to vital organs

(3)Increased 2,3-diphosphoglycerate (DPG) in the RBCs, which causes reduced oxygen affinity, shifting the oxygen dissociation curve to the right and thereby enhancing oxygen release to the tissues

(4)Increased erythropoietin to stimulate RBC production.

Clinic manifestation • Iron-deficiency anemia is produce many systemic

abnormalities, among them blue sclerae, koilonychia, impaired exercise capacity, and functional alterations in the small bowel. The most important systemic abnormality produced by iron deficiency in infancy is the alteration in cognitive performance.

• In all these studies, the iron status of the subjects was well defined both before and after therapy. Lower scores on the Bayley mental-development index were observed in the infants with iron-deficiency anemia.

• The study by Walter et al, reported that performance scores were lower among infants who had had anemia for at least three months than among those who had had

anemia for less than three months.

• In the study by Walter et al. and the studies by Lozoff et

al., the reversal of the anemic, iron-deficient state did not produce an improvement in the test scores, suggesting that iron-deficiency anemia at a critical period of brain growth and differentiation may produce irreversible abnormalities.

• Kilbride et al, Anaemia during pregnancy as a risk factor for iron-deficiency anaemia in infancy The incidence of iron-deficiency anaemia was very high in anemic mothers during pregnancy

• Because iron-deficiency anemia can have damaging

long-term consequences, it should be prevented in every child

Hematologic marker for identifying iron deficiency

Iron Needs during Infancy and Childhood

• In the normal infant born at term iron stores are adequate to maintain iron sufficiency for approximately four months of postnatal growth.

• In the premature infant total-body iron is

lower than in the full-term newborn, although the proportion of iron to body weight is similar. Premature infants have a faster rate of postnatal growth than infants born at term, so unless the diet is supplemented with iron, they become iron-depleted more rapidly than full-term infants. Iron deficiency can develop by two to three months of age in premature infants.

Therapy • The most economical and effective medication in the

treatment of iron deficiency anemia is the oral administration of ferrous iron salts.

• They should be continued for about 2 mo after correction of the anemia and its etiological cause in order to replenish body stores of iron. Ferrous sulfate is the most common and cheapest form of iron utilized. Tablets contain 50-60 mg of iron salt. 3-6 mg/kg/d PO divided tid suggested, depending on severity of anemia

• Response to iron therapy can be documented by an increase in reticulocytes 5-10 days after the initiation of iron therapy. The hemoglobin concentration increases about 1 g/dL weekly until normal values are restored.

• Diet

The Committee on Nutrition of the American Academy of Pediatrics recommends:

• Full-term infants be provided with iron (1 mg per kilogram per day, to a maximum of 15 mg per day), starting at no later than four months of age and continuing until three

years of age• For low-birth-weight infants, the requirement is 2 mg per

kilogram per day, to a maximum of 15 mg per day,

starting at no later than two months of age• Infants with birth weights of less than 1000 g should

receive 4 mg per kilogram per day, and infants with birth weights between 1000 and 1500 g should receive 3 mg per kilogram per day. For these infants, iron supplementation at the higher dose should continue throughout the first year of life

• After one year of age, the diet becomes more varied and there is less information from studies on which to base dietary recommendations. The recommended dietary allowance decreases to 10 mg per day for children between 4 and 10 years of age and then increases to 18 mg per day at the age of 11 to provide for the accelerated growth that takes place during adolescence

Diet counseling to prevent iron deficiency in children :

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