Anemia in children (anemia) is a pathological condition, accompanied by a decrease in the level of hemoglobin and red blood cells in a child’s blood. Anemia in children is an extremely common disease in pediatrics . About 40% of cases of anemia are diagnosed in children under the age of 3 years; 30% – in puberty; the rest – at different age periods of child development.
The frequent occurrence of anemia in children is due to their intensive growth, the activity of the process of erythropoiesis, the progressive increase in the number of formed elements and the BCC. However, the hematopoietic apparatus in children is functionally immature and highly vulnerable to various influences. The normal flow of blood in children requires a large amount of iron, protein, vitamins and trace elements, so any feeding errors, infections, and toxic effects on the bone marrow can cause anemia in a child.
Especially sensitive in this regard are the children of the second half of their lives, who have depleted neonatal reserves of iron. Long-existing anemia in children is accompanied by the development of hypoxia, deep tissue and organ changes. Children with anemia are lagging behind in physical and mental development from healthy peers,
Causes of anemia in children
Factors contributing to the development of anemia in children are divided into antenatal, intrapartum and postnatal.
Antenatal factors act during intrauterine development. For the normal process of blood formation in a child during the period of pregnancy, his body must receive from the mother and accumulate a sufficient amount of iron (about 300 mg). The most intensive transfer of iron from the pregnant woman and its deposition in the fetus occurs at 28–32 weeks of gestation.
Disruption of the normal course of pregnancy during this period ( preeclampsia , fetoplacental insufficiency , the threat of spontaneous abortion , premature detachment of the placenta , bleeding, infectious diseases of the mother, exacerbation of chronic processes) leads to disruption of iron metabolism and its insufficient accumulation in the child’s body.
Anemia in children occurs if a woman also suffered from anemia during pregnancy . Preterm birth leads to the fact that anemia is detected in all premature babies from birth or approximately from the 3rd month of life. The development of anemia in newborns contributes to multiple pregnancies .
Intranatal factors of anemia in children are mainly associated with blood loss during childbirth. Hemorrhage is possible in case of premature detachment of the placenta during childbirth, early or late ligation of the umbilical cord, leakage of blood from the umbilical cord during its improper treatment, the use of traumatic obstetric benefits.
Postnatal factors of anemia in children are included after birth and may be endogenous or exogenous. Causes of endogenous anemia in children can be red blood cell damage due to hemolytic disease of the newborn, abnormal hemoglobin synthesis, and primary constitutional bone marrow failure.
Exogenous anemia in children is most often caused by nutritional causes. In this case, anemia develops predominantly in children of the first year of life who are on uniform milk-feeding. Anemia in young children can occur with insufficient iron in breast milk; early and unreasonable transfer of the child to artificial or mixed feeding; the use of unadapted mixtures, cow or goat milk for feeding; Late introduction to the diet of the child complementary foods. Premature babies and children born with increased body weight need a higher intake of iron in the body. Therefore, the discrepancy between iron intake and consumption can also cause anemia in children in the first year of life.
Anemia in children can occur due to regular blood loss: with private nasal bleeding , blood diseases ( hemophilia , von Willebrand disease ), menorrhagia , gastrointestinal bleeding , after surgical interventions. In children with food allergies , exudative diathesis , neurodermatitis, there is an increased loss of iron through the epithelium of the skin, so these children constitute a risk group for the development of iron deficiency anemia.
In addition to the loss of iron, the development of anemia in children can lead to a violation of its absorption and metabolism. Such disorders are usually found in malabsorption syndrome ( hypotrophy , rickets , lactase deficiency , celiac disease , intestinal form of cystic fibrosis , etc.). Anemia in children can be the result of any infectious or chronic somatic disease ( tuberculosis , bacterial endocarditis , bronchiectasis , pyelonephritis , etc.), leukemia , mycoses , helminthic invasion , collagenoses ( SLE ,rheumatoid arthritis , etc.).
In the development of anemia in children, deficiency of vitamins of group B, microelements (magnesium, copper, cobalt), unfavorable hygienic conditions, depletion of endogenous iron reserves occurring in an infant by 5-6 months is of some importance.
Classification of anemia in children
In accordance with the etiopathogenesis, the following groups of anemias are distinguished:
I. Post-hemorrhagic anemia in children caused by acute or chronic blood loss.
Ii. Anemia in children due to impaired hematopoiesis:
- iron deficiency (hypochromic)
- hereditary and acquired iron-saturated (siderohresticheskie – associated with defects in the synthesis of porphyrins)
- megaloblastic ( B12 – deficient and folic deficient )
- hereditary and acquired dysyrothropoietic
- hereditary and acquired hypoplastic and aplastic (associated with the oppression of blood formation)
Iii. Hereditary and acquired hemolytic anemia in children caused by increased destruction of red blood cells and the predominance of the process of blood destruction over the process of blood formation (membranopathy, fermentopathy, hemoglobinopathy, autoimmune anemia, hemolytic disease of the newborn, etc.).
Symptoms of anemia in children
The blood hemoglobin rate in children under 6 is 125–135 g / l; Anemia in a child is discussed if this indicator falls below 110 g / l (in children under 5 years old) and below 120 g / l (in children over 5 years old).
Visible changes in anemia in children are observed on the side of the skin and its appendages: the skin becomes pale, dry, scaly; nails are deformed and become brittle ; hair lose a healthy shine. A characteristic sign of anemia in children is the symptom of Filatov – pallor of earlobes when viewed in transmitted light. In severe forms of anemia, children appear cracks in the palms and soles, in the corners of the mouth; developing aphthous stomatitis , glossitis . Children with anemia are weakened, asthenic, often suffer from acute respiratory viral infections , bronchitis and pneumonia , acute intestinal infections .
From the nervous system, experiencing hypoxia, there is sluggishness, tearfulness, rapid exhaustion, dizziness, superficial sleep, enuresis . A decrease in muscle tone is detected, the child does not tolerate physical exertion, and quickly gets tired. At children of the first year of life the hypotrophy is noted, there is a regress of psychomotor development.
With anemia in children, dysfunctions of the cardiovascular system in the form of arterial hypotension , orthostatic collapse, syncope , tachycardia , systolic murmur are detected .
On the part of the digestive system in children with anemia, frequent regurgitation and vomiting after feeding, flatulence, diarrhea or constipation , decreased appetite, and an increase in the spleen and liver are observed .
Diagnosis of anemia in children
The basis of the diagnosis of anemia in children is laboratory research. In general, a blood test for anemia in children reveals a decrease in hemoglobin (Hb less than 120-110 g / l), a decrease in Er (<3.8 x 10 12 / l), a decrease in CPU <0.85. Biochemical blood tests include determination of serum iron, transferrin saturation with iron, serum ferritin concentration, bilirubin, vitamins. In some cases, puncture and bone marrow examination are required .
In the process of diagnosis is determined by the form and severity of anemia in children.
The latter is estimated by the content of erythrocytes and hemoglobin:
- mild anemia – Hb 110-90 g / l, Er – up to 3.5×1012 / l;
- moderate anemia – Hb 90-70 g / l, Er – up to 2.5×1012 / l;
- severe anemia – Hb less than 70g / l, Er – less than 2.5×1012 / l.
According to the testimony, children with anemia may need to be consulted by narrow specialists ( pediatric gastroenterologist , pediatric rheumatologist, pediatric nephrologist , pediatric gynecologist , etc.), examination of the gastrointestinal tract ( EGD , abdominal ultrasound ) and kidney ( ultrasound of the kidneys ).
Treatment of anemia in children
With anemia in children, it is necessary to organize the correct daily regimen and a balanced nutrition of the child, drug therapy and restorative measures. Children are recommended adequate stay in the fresh air, extra sleep; appointed gymnastics and massage, UFO.
Babies with anemia who are breastfed should promptly introduce lures (juices, egg yolk, vegetables, meat puree). At the same time, it is necessary to adjust the diet of a nursing woman, add intake of multivitamins and iron preparations. Babies who are bottle-fed are given iron-fortified milk formulas. The diet of older children should contain liver, beef, legumes, greens, seafood, fruit and vegetable juices.
Drug therapy for anemia in children includes the prescription of iron and multivitamin preparations until the clinical and laboratory parameters are fully normalized (on average, 6-10 weeks). In severe cases, blood transfusion may be required .
Prognosis and prevention
The prognosis of iron deficiency anemia in children is usually favorable. With timely diagnosis, proper nutrition, treatment of anemia and associated diseases, full recovery occurs. Severe anemia in children can be a reason to postpone vaccination.
The antenatal stage of the prevention of anemia in children includes adequate nutrition for the pregnant woman, adequate exposure to fresh air, and taking mineral-vitamin complexes containing iron. Postnatal prevention of anemia in children is reduced to breastfeeding, the introduction of complementary foods at the recommended time, the prevention of diseases of an early age, the organization of good care and optimal treatment for the child, and preventive treatment and prevention courses in risk groups.
Anemia in children – hematological syndrome, characterized by a decrease in the concentration of hemoglobin and the number of red blood cells per unit blood volume. In various forms of anemia in children, there is a general weakness, rapid fatigability, pallor of the skin and mucous membranes, dizziness, palpitations. Anemia in children is diagnosed according to clinical and laboratory data (complete blood count, determination of bilirubin, serum iron, total serum iron-binding capacity, bone marrow punctate, etc.). The general principles of treatment of anemia in children include the organization of a balanced diet, the timely introduction of complementary foods, vitamin therapy, iron supplements, PTL (gymnastics, massage, ultraviolet irradiation therapy);