Anemia in children

The blood carries a large amount of nutrients that a child's body needs to grow and develop. Red blood cells or erythrocytes are responsible for this process. With a decrease in their number, anemia occurs in children.

What it is?

Anemia is a condition in which there is not enough hemoglobin or red blood cells. It is quite common in children's practice. According to world statistics, this disease is recorded in every fourth child born.

Erythrocytes should normally carry hemoglobin to the tissues of the whole body. It contains protein structures and iron. This special chemical structure allows erythrocytes to carry out a transport function. They deliver oxygen to all cells in the body.

Hemoglobin levels change significantly with age. During breastfeeding, the baby receives a sufficient amount of iron from breast milk. After the termination of such feedings, the hemoglobin reserves of the baby are enough for several months.

If, after the abolition of breastfeeding, the child's diet is meager and does not contain a sufficient amount of all nutrients and trace elements, then this quite often leads to the development of anemia.

The average normal hemoglobin level in a child by the age of seven is about 120 g / liter. A decrease in this indicator below 110 already indicates the presence of an anemic process.

At an older age, the levels of hemoglobin and erythrocytes change. This is due to the development of functional changes in the hematopoietic organs.

The peak incidence is between 3 and 10 years of age. Every child can get anemia, regardless of age, gender and place of residence. There are many different types of anemias. Different diseases and provoking circumstances lead to the development of each specific form.

Causes

For the development of a persistent decrease in the total number of erythrocytes or hemoglobin, a long-term influence of any factor is necessary. This contributes to the disruption of tissue metabolism in the child's body and leads to the development of anemia.

Among the most common reasons are:

Malnutrition. Insufficient intake of foods containing iron or folic acid leads to the development of anemia.
Low intake of vitamin C or ascorbic acid from food. This biologically active substance is involved in tissue metabolism and contributes to the maintenance of a normal number of red blood cells.
Chronic diseases of the digestive system. Gastritis, enteritis or inflammatory diseases of the gastrointestinal tract often cause metabolic disorders, which leads to anemia.
Diseases of the hematopoietic organs. Pathological conditions that have arisen in the bone marrow or spleen often lead to a disruption in the formation of a new generation of red blood cells.
Prematurity. Early birth leads to the formation of anatomical developmental defects. The organs of the hematopoietic system have deviations in development, which inevitably lead to the development of anemia in the future.
Exposure to adverse environmental factors. Polluted air with a high content of toxic substances leads to disruption of tissue metabolism, and subsequently to persistent anemia.

Helminthic invasions. Settling in the intestines, parasites begin to secrete toxic products of their vital activity. This has an adverse effect on blood and red blood cells.
Multiple pregnancy. In this case, there is an insufficient intake of all the necessary substances for the development of two or more babies at the same time. Quite often, twin babies or twins can have symptoms and manifestations of anemia in the future. During pregnancy with three babies at once, in almost 75% of cases, children have congenital forms of anemic conditions.
Pathologies and diseases that arose during pregnancy. Chronic diseases of the female genital organs, infections, as well as exacerbation of various diseases of the mother can lead to the development of fetal hypoxia. In this case, already in the period of intrauterine development, babies may experience anemic manifestations.

Frequent infectious diseases. An excessive viral or bacterial load leads to a rapid depletion of the immune system. Fighting infections requires a tremendous amount of energy. It is taken from hemoglobin. With frequent infectious diseases, the amount of this substance decreases, which leads to the development of anemia.
Congenital forms. They arise as a result of underdevelopment of the hematopoietic organs. This pathology usually develops in the first trimester of pregnancy. After giving birth, the baby has a low level of hemoglobin or red blood cells.
Oncological diseases. Even with localization of tumors in different organs, anemia can develop. For tumor growth, an increased amount of nutrients is also required, as for normal healthy cells. The increased consumption of nutrients and hemoglobin leads to the development of persistent anemia.

Bleeding or the effects of trauma. Large blood loss causes an overall decrease in hemoglobin and red blood cell levels. Such forms are called posthemorrhagic. They can also occur due to tuberculosis or the breakdown of a large tumor.
Hereditary. They have a pronounced genetic predisposition. So, with Fanconi's anemia, there is a violation of the formation of new erythrocytes due to insufficiently good functioning of the bone marrow. Such forms are rare in children.
Long-term use of various medicines. Cytostatic drugs, sulfa drugs, benzene compounds, and some antibacterial drugs can cause manifestations of anemia.
Incorrectly provided surgical aid during labor. Untimely removal of the placenta, poor-quality cord ligation or other mistakes during childbirth can cause the development of anemia in the child in the future.
Rheumatological diseases. Systemic lupus erythematosus or rheumatoid arthritis are often causes that lead to anemic symptoms in babies. The first symptoms are registered as early as 2 years.
Autoimmune diseases. They lead to a decrease in the total content of hemoglobin in the composition of red blood cells, which leads to the development of anemia.

Classification by disease mechanism

Currently, there are a huge variety of different anemic conditions. Modern classifications make it possible to distribute pathologies similar for the reasons for the development of certain groups. This allows doctors to pinpoint the cause of the disease and verify the diagnosis.

All anemic conditions can be divided into several groups:

Hemolytic. They are characterized by increased destruction of red blood cells. Often they occur as hereditary diseases or as a result of prolonged use of drugs.
Post-hemorrhagic. They occur after massive bleeding, leading to a pronounced loss of circulating blood volume. They can meet at any age. They are characterized by both a decrease in the total number of erythrocytes and hemoglobin.
Iron deficient. They are characterized by low iron levels. Such deficient forms of anemias occur mainly with malnutrition, as well as chronic bowel diseases. They can also become the only manifestation of a growing tumor. May be hyper and hypochromic.
Folic acid deficiency. They occur with a reduced content of folic acid. Most often, they begin to develop during the period of intrauterine development. They can also be found in babies after birth as a result of insufficient intake of folic acid from the outside, as well as in chronic diseases of the stomach and intestines.

B12-deficient. They are characterized by a low content of vitamin B12 in the body. They develop in diseases of the gastrointestinal tract, as well as during helminthic invasions. Often combined with folate deficiency anemia.
Hereditary. As a result of Minkowski-Shoffard disease, there is a rapid and pathological destruction of altered red blood cells. Hereditary forms of the disease are rare. Every three out of ten thousand babies born have this disease. The disease manifests itself as early as 1 year of a child's life, which has a genetic predisposition.
Hypoplastic or aplastic. They arise in connection with the disrupted work of the bone marrow. As a result of this condition, new erythrocytes are practically not formed. The accelerated destruction of red blood cells only aggravates the anemic condition.

Severity classification

During the development of anemia, the level of hemoglobin decreases. The lower it is, the more unfavorable anemic symptoms can develop. This classification allows you to establish the severity of the disease, taking into account the quantitative determination of the level of hemoglobin in the blood.

According to the level of decrease in this indicator, all anemias are divided into:

Lungs. The hemoglobin level is over 90 g / liter. The severity of clinical symptoms is insignificant. Often this condition is detected by chance during screening or when taking a complete blood count due to other diseases.
Moderately heavy. The hemoglobin level is between 70 and 90 g / liter. The symptoms are more pronounced. Strong changes in tissue respiration are observed. The condition requires compulsory treatment and the appointment of drugs for a course admission.
Heavy. They arise when hemoglobin drops below 70 g / liter. They are accompanied by a strong violation of the general condition. They require the immediate establishment of the cause of the disease and the urgent prescription of drugs.

Symptoms

The first signs of an anemic state can appear even in young children. They are often non-specific. This makes it much more difficult to establish a diagnosis in the early stages. Usually, the symptoms of anemia begin to manifest themselves quite clearly when hemoglobin drops below 70-80 g / liter.

The most common manifestations of anemia are:

General condition change. Babies become more lethargic. Even after the usual activities, they get tired faster. Teens develop fatigue rapidly even after 2-3 lessons at school. Habitual daily stress can lead to increased general weakness.
Pale skin. In some cases, the skin even takes on a slightly earthy color. With a pronounced decrease in the level of hemoglobin, you can notice blue lips and paleness of visible mucous membranes.
Fast change of mood. Kids are more often naughty. Even the calmest child can become moody and very whiny.
An increased sense of anxiety. The child becomes more nervous. Some babies have sleep disturbances.
A persistent rise in body temperature to subfebrile numbers. It usually rises to 37 degrees and lasts for a long time. At the same time, the baby does not have a runny nose, cough, or any other catarrhal symptoms.
Changing eating habits. Disorders of the processes of tissue metabolism lead to the development of abnormal or uncharacteristic taste desires for the child. For example, some kids start chewing on chalk. The child's appetite may decrease, and taste preferences may change.

Pronounced chilliness. Usually babies complain that their arms and legs are very cold.
Instability of blood pressure. Some babies often have hypotension.
Rapid pulse. The lower the level of hemoglobin in the child's body, the higher the tachycardia. With an excessively reduced amount of hemoglobin, there is a decrease in oxygen in the tissues. This leads to the development of tissue hypoxia and starvation of heart muscle cells.
Weak immunity. Insufficient amounts of nutrients as a result of decreased hemoglobin levels lead to poor functioning of the cells of the immune system. With such a long-term condition, secondary immunodeficiencies develop.
Disorders of the digestive system. Babies may have diarrhea or constipation, and a feeling of difficulty swallowing while eating.
Secondary non-specific signs: excessive hair loss, frequent dental caries, severe dry skin, the formation of small ulcers near the lips, increased brittle nails.

Features of iron deficiency anemia in babies

This type of anemic condition is most common in pediatric practice. It occurs as a result of insufficient intake of iron from food, as well as in some cases with the active destruction of erythrocytes present in the body. Various diseases of the gastrointestinal tract lead to this.

Iron deficiency anemia is common throughout the world. According to European studies, every second child with anemic syndrome has an iron deficiency. Normally, the content of this trace element in the body is about four grams. This amount is quite enough to perform basic functions.

Almost 80% of iron is contained in hemoglobin. There it is in an active state, since red blood cells constantly carry out a transport function to carry oxygen and nutrients throughout the body.

There is also a safety stock. It is found in the liver and macrophages. This iron is inactive. The body makes such a strategic reserve in case of severe blood loss or possible injury, which will be accompanied by severe bleeding. The share of reserve iron is 20%.

Iron enters the body with food. For the proper functioning of the hematopoietic organs, 2 grams of this substance is usually sufficient. However, if the child has chronic diseases of the stomach or intestines, then the amount of incoming iron should be higher. This is also facilitated by the concomitant rapid loss of red blood cells as a result of erosions or ulcers that occur in diseases of the gastrointestinal tract.

For the treatment of iron deficiency anemia in babies, a special diet is required. It takes a long time to observe such nutrition until the condition stabilizes completely.

Usually, it may take 6 months or more to normalize iron levels in the body and permanently consolidate the result.

In severe cases of the disease, the appointment of special iron-containing drugs is required. Such drugs help to replenish the iron deficiency in the child's body and lead to the normalization of the condition. They are assigned, as a rule, for long-term admission. During treatment, mandatory monitoring of the hemoglobin content in the blood is carried out.

Diagnostics

In order to establish the presence of anemia, a routine blood test should first be performed. A decrease in the level of hemoglobin or erythrocytes below the age norm indicates the presence of signs of anemic syndrome.

To establish the type of anemia, the color indicator is often also assessed. Normally, it should be 0.85. If this value is exceeded, they speak of hyperchromic anemias, and if this value decreases, they speak of hypochromic anemias. Such a simple diagnosis helps doctors establish the correct diagnosis and identify the cause that contributed to the development of the anemic condition.

With iron deficiency anemia, they resort to determining the total amount of iron in the body, as well as transferrin indicators. It shows how well the red blood cell is filled with iron from the inside. Ferritin levels help clarify the nature and cause of iron deficiency anemia.

To determine hypoplastic anemias, a determination of the level of bilirubin will be required. An analysis of the content of vitamin B12 and folic acid in the body will help in clarifying the diagnoses of anemic conditions that occur when they are deficient.

In difficult diagnostic cases, the pediatrician will recommend contacting a gastroenterologist, cardiologist, rheumatologist, nephrologist. These specialists will help clarify the presence of chronic diseases of various internal organs, which could be the cause of the development of anemic syndrome in a child.

Ultrasound examination of the liver and spleen makes it possible to clarify the presence of pathology in these organs responsible for hematopoiesis. For aplastic anemias, a bone marrow biopsy may be required. Only with such a study can it be determined as a result of which the anemic syndrome developed.

Complications

If not diagnosed early, the anemic condition can be very dangerous. Prolonged oxygen starvation of body tissues leads to the development of persistent deviations in the work of internal organs. The longer hypoxia develops, the greater the likelihood of complications.

Most often, anemic syndrome leads to:

The development of immunodeficiency states. Insufficiently active work of the immune system contributes to the baby's easy susceptibility to various infectious diseases. Even a common cold can last long enough and require higher doses of drugs.
The development of cardiovascular pathologies. The anemic state contributes to the development of oxygen starvation. This process is especially dangerous for the heart muscle and the brain. With prolonged hypoxia, resulting from anemia, myocarditis may occur. This condition is manifested by a violation of the contractile function of the heart and leads to the appearance of disturbances in the heart rhythm.
The appearance of persistent disorders of the nervous system. Severe dizziness, a sensation of pulsation in the temples, a diffuse severe headache - all these signs can be manifestations of complications of an anemic condition.
The development of pathological conditions of the organs of the gastrointestinal tract. Long-term stool disorders can lead to the development of dysbiosis and irritable bowel syndrome in babies.
Memory impairment and difficulty in memorizing new material. The most dangerous is this manifestation of the disease at school age. An inability to concentrate and memory can contribute to a child's decline in school performance.
Asthenization. With a severe course of the disease in babies, the appearance of a strong general weakness is observed. With prolonged development of the disease, there is even some hypotrophy and even muscle atrophy. The child looks overly tired and exhausted.

Treatment

According to clinical guidelines, all forms of anemic conditions should be treated from the moment the hemoglobin level decreases below the age norm.

Therapy for anemia begins with identifying the cause that led to its development. It makes no sense to replenish the lost hemoglobin if it is regularly lost in the body.

In order to establish the cause, additional examinations and analyzes are required. With their help, it is possible to carry out a high-quality differential diagnosis and prescribe the necessary therapy.

Treatment of anemia is complex. It includes not only the appointment of medications, but also recommendations for normalizing the daily routine and nutrition. Medicines are prescribed only with a pronounced decrease in the level of hemoglobin in the body. With a mild form of the disease, treatment begins with the appointment of a special diet.

Basic principles of anemia therapy:

Complete nutrition enriched with all essential vitamins and minerals. A special emphasis in the children's diet is placed on foods high in iron, vitamin B12, folic acid, copper, as well as all the necessary trace elements involved in hematopoiesis.
Prescribing drugs. They are discharged by the attending physician. Appointed for a course appointment. After 1-3 months from the moment of starting the medication, regular monitoring of the level of hemoglobin and erythrocytes is carried out. Such monitoring allows you to evaluate the effectiveness of the selected drugs.
Normalization of the daily routine. Adequate sleep, rest in the daytime, as well as a decrease in intense physical and psycho-emotional stress is required for a child to improve the therapy process.
Surgery. It is used when a tumor or pathological processes in the spleen become the culprit of the disease. Splenectomy in most cases helps to improve the course of the disease in this form of the disease.
Treatment of secondary chronic diseasesthat could cause anemia. Without eliminating the primary focus of inflammation, it is impossible to cope with the normalization of the hemoglobin level. If there is a bleeding ulcer or erosion in some organ, then even despite the regular intake of drugs, it is not possible to achieve complete stabilization of well-being. Elimination of all the causes that caused the anemic syndrome is required first.

Iron preparations

In the treatment of iron deficiency anemia, the prescription of drug treatment is required in the overwhelming majority of cases. Often, keeping to only one diet is not enough.

If within three months, against the background of regular consumption of foods rich in iron, hemoglobin has not returned to normal, you should show the baby to the pediatrician. To completely stabilize the condition, the doctor will prescribe iron preparations.

Several types of drugs can be used to treat iron deficiency conditions. They can contain ferrous and ferric iron in different chemical combinations. The effectiveness of these funds is different. Dosages are selected individually, taking into account the severity of the condition, the initial well-being of the child, as well as his age.

For babies under three years old, the physiological need for iron of 3 mg / kg per day is used to calculate the dose. For older children - 50 mg / kg. In adolescence, 100 mg / kg is already required. This calculation formula is used for preparations containing ferrous iron. If ferric iron is used, then the dosage is on average 4 mg / kg.

The control over the effectiveness of the selected drugs is carried out according to the indicators of the general blood test. The effect of the treatment does not come quickly. Usually, at least 2-3 months should pass to normalize the hemoglobin level. First, young blood cells - reticulocytes - appear in the blood. Subsequently, an increase in the level of hemoglobin and erythrocytes is observed.

Most often, iron supplements are prescribed in the form of tablets or sweet syrups. However, the use of these dosage forms may not always be acceptable. If the child has ulcerative processes in the stomach or intestines, then he is prescribed iron-containing drugs in the form of injections. These funds have excellent absorption and reach the hematopoietic organs well.

The most commonly used to normalize iron levels are: Ferrum Lek, Hemofer, Conferon, Ferroplex and many others. The selection of the drug is chosen by the attending physician, taking into account the chronic diseases of the child. When taking iron-containing medicines, remember that they stain the stool black.

Nutrition

The organization of the children's menu for anemia should be given due attention. Only good nutrition will help normalize the level of hemoglobin and quickly bring the child's body back to normal.

The baby's diet should definitely include foods with a maximum iron content. These include: beef, veal, rabbit meat, chicken and poultry drumsticks, offal (especially liver). In the diet of a child suffering from anemia, such foods should occupy more than 50%. Each meal should contain at least one iron-containing product.

If the baby is still too small and is breastfed, then it is better to give preference to special artificial mixtures that contain a high iron content in their composition. They are also perfectly balanced in terms of their nutritional components and contain additional amounts of trace elements necessary for optimal blood formation.

For a sufficient intake of folic acid in the body, a variety of vegetables and herbs should be added to the baby's diet. All green foods are high in folate. These substances are needed for good blood formation, especially for babies with folate deficiency anemia.

For infants, you can add a variety of juices and purees made from green apples and pears. Such products will greatly diversify the children's table and will also have the ability to normalize the level of folic acid in the body.

In order to compensate for the low level of vitamin B12, one should not forget about the inclusion in the child's diet of cereals made from various grains. Buckwheat or barley porridge will be an excellent choice when drawing up a menu for a baby suffering from B12-deficiency anemia. To achieve the best effect, it is better to alternate cereals.

The nutrition of a baby with anemia should be balanced and varied. For active hematopoiesis, a regular intake of all types of animal and plant products is required. Fresh fruits and vegetables, quality meat and fish products, as well as poultry and grains contribute to the quality of new red blood cells.

Prevention

Compliance with preventive measures will help reduce the possible risk of developing anemic conditions. Every pediatrician should suspect anemia during regular examinations and examinations of the child. Even the simplest laboratory tests can help detect anemic signs.

To prevent anemia, use the following guidelines:

See your child's doctor regularly. Conducting a general blood test as a screening will allow you to identify the first manifestations of anemic syndrome in time.
Try to carefully plan your baby's diet. Be sure to include all age-approved animals and plant foods. Meat, poultry and fish must be present in the baby's diet every day.
If you have a hereditary predisposition to anemia, consult your hematologist. He will be able to give precise recommendations and prescribe appropriate treatment.
Rest more often if you have multiple pregnancies and be more careful about your diet. Prefer iron-rich foods, as well as fresh vegetables and herbs. Such nutrition will contribute to the correct laying of the hematopoietic organs in future babies and will not contribute to the development of anemia.
Develop a love for a healthy lifestyle in your child. Try to keep your baby outdoors regularly.
Use iron supplements in preventive dosages for premature babies. They will help prevent the development of anemic syndrome in the future. Such preventive courses are prescribed by a pediatrician.

Normalization of hemoglobin levels leads to an improvement in well-being. After achieving a stable therapeutic result, babies begin to feel much better, become more active and mobile. Regular monitoring of hemoglobin levels is necessary at any age to prevent anemia.