Anemia in children

Anemia in children is a pathological condition characterized by reduced hemoglobin levels in the blood.

The most common causes of anemia in children are nutrient deficiencies and iron deficiency. Normal hemoglobin levels in the blood of a child up to about six years of age are 125–135 grams per liter, with the last acceptable limit being 110 g/L.

An increased risk of anemia exists primarily for children born prematurely or in multiple pregnancies, as well as those suffering from any concomitant intestinal diseases. The highest incidence rate is observed in children under three years of age, which is associated with insufficient maturity of the organs of the hematopoietic system and their increased susceptibility to negative environmental impacts. Iron deficiency anemia is most common in early childhood.

According to the World Health Organization, this form of anemia occurs in approximately 20-25% of all newborns. Among children under four years of age - in forty-three percent, from five to twelve years - in thirty-seven percent. Also, experts believe that latent iron deficiency anemia, not accompanied by clinical manifestations, occurs much more often. In order to prevent anemia, it is recommended to eat a full and balanced diet, spend more time outdoors, move actively, and get the necessary amount of vitamins and microelements.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]

Causes of anemia in children

• Lack of substances in the body responsible for the production of hemoglobin.
• Various pathological processes associated with disorders of the intestinal tract, in particular, with impaired absorption of nutrients needed for the production of hemoglobin.
• Abnormalities in the functioning of the hematopoietic system in the bone marrow.
• Anatomical and physiological immaturity of the organs of the hematopoietic system.
• Negative impact of unfavorable ecology.
• Presence of worms.
• Increased incidence of disease.
• Disrupted and unbalanced diet and eating regimen.
• Lack of microelements in the body, in particular iron, copper, manganese, cobalt, nickel, as well as vitamins B and C, folic acid.
• If the child was born much earlier than expected (in case of premature pregnancy).

[ 7 ], [ 8 ], [ 9 ], [ 10 ], [ 11 ]

Symptoms of anemia in children

Symptoms of anemia in children are classified depending on the type and severity of the disease. A number of signs are common to all types of anemia. At the same time, its individual types can cause various accompanying symptoms. Only a qualified specialist can differentiate the signs and diagnose the disease. The most common symptoms of anemia in children are the following:

• Paleness of the skin.
• Tachycardia.
• Dyspnea.
• Feeling of noise in the ears, dizziness, headache.
• Rapid fatigue.
• General state of weakness, lethargy.
• Poor appetite.
• Taste disorders (for example, a child may eat chalk).
• Brittle hair and nails.
• Muscle weakness.
• Deterioration in the appearance of the skin (eg, rough skin surface).
• Yellow skin tone.
• Thickening and enlargement of the liver and spleen.
• Frequent infectious diseases.
• Nosebleed.

Deficiency anemia in children

Deficiency anemias in children are the result of a lack of substances in the body that promote the formation of hemoglobin. They are more common among children under one year of age. One of the most common deficiency anemias is alimentary anemia. As a rule, it occurs as a result of improper nutrition associated with insufficient consumption of substances that are necessary for the full growth and development of the child, for example, with a lack of protein or iron. Deficiency anemias can occur with diseases associated with impaired absorption of substances in the intestine, their development can also be facilitated by weakened immunity (increased incidence rate) and prematurity of the child during pregnancy.

[ 12 ], [ 13 ], [ 14 ], [ 15 ]

Iron deficiency anemia in children

Iron deficiency anemia in children is divided into the following forms:

Asthenovegetative

This form of anemia occurs as a result of dysfunction of the brain, manifests itself in the form of insufficient development of psychomotor functions. A child with asthenovegetative anemia is usually irritable, has absent-mindedness, memory, may develop nocturnal enuresis, muscle pain, hypotension.

[ 16 ]

Epithelial

The symptoms of the disease include dystrophy and atrophy of the mucous membranes, skin, nails and hair. The child usually has a poor appetite, heartburn, belching, nausea, flatulence, swallowing disorders, the absorption process in the intestine is disrupted, and with a very low hemoglobin level, pale skin and conjunctiva may be observed.

[ 17 ], [ 18 ], [ 19 ], [ 20 ], [ 21 ]

Immunodeficiency

This disease is characterized by frequent acute respiratory viral infections, as well as intestinal pathologies of an infectious nature. In most cases, children with this disease have low iron levels in their blood plasma and weakened protective functions of the body.

Cardiovascular

This form occurs with severe iron deficiency anemia. The child quickly gets tired, his blood pressure is low, there is a rapid heartbeat, systolic noise is heard, dizziness may occur.

[ 22 ], [ 23 ], [ 24 ], [ 25 ], [ 26 ], [ 27 ]

Hepatosplenic

The rarest form of anemia, usually occurring against the background of rickets and severe iron deficiency.

B12 anemia in children

B12 anemia in children is characterized by the formation of abnormally shaped, very large cells in the bone marrow, destruction of red blood cells inside the bone marrow, low platelet count, which leads to increased bleeding and difficulty stopping bleeding. Also, with B12-deficiency anemia, a sharp decrease in neutrophils in the blood can occur, which is extremely life-threatening. With acute vitamin B12 deficiency, disturbances occur in the gastrointestinal mucosa, and nervous disorders occur. Vitamin B12 deficiency often occurs with impaired production of glycoprotein, which is responsible for its normal absorption.

The disease may manifest itself after enteritis or hepatitis, which is associated with impaired absorption of vitamin B12 in the small intestine or its complete removal from the liver. Clinical manifestations of B12 anemia include dysfunction of the hematopoietic system, as well as the nervous and digestive systems. During physical activity, tachycardia occurs, the child quickly gets tired, becomes lethargic. From the digestive tract, there is inhibition of gastric secretion, lack of hydrochloric acid in the gastric juice. The tongue may burn, the skin becomes yellowish, the spleen (sometimes the liver) is slightly enlarged, and the level of bilirubin in the blood is elevated. For treatment, cyanocobalamin is prescribed once a day for one to one and a half months. After improvements occur, the drug is administered once every seven days for two to three months, then twice a month for six months. After the condition has stabilized, vitamin B12 is prescribed for prophylactic purposes for administration once or twice a year (five to six injections).

[ 28 ], [ 29 ], [ 30 ], [ 31 ]

Hypochromic anemia in children

Hypochromic anemia in children occurs as a result of a reduced level of hemoglobin in red blood cells. The diagnosis of the disease is based on a general blood test to determine the number of red blood cells and the level of hemoglobin, as well as the value of color characteristics. With hypochromic anemia, a low level of hemoglobin in all cases is combined with a decrease in color indicators. The size and appearance of red blood cells also affect the diagnosis. With hypochromic anemia, red blood cells have a rounded shape, dark edges and a light spot in the middle. Hypochromic anemia is divided into iron deficiency, iron-saturated, iron redistribution and mixed anemia. The symptoms of the disease depend on its form and may include such signs as a general state of weakness, dizziness, slowing of mental and physical functions, tachycardia, pale skin, etc. As an auxiliary treatment in folk medicine, the following remedy is used: a glass of freshly squeezed pomegranate juice is mixed with lemon, apple and carrot juice (in proportions of one hundred milliliters), fifty to seventy grams of natural bee honey are added, mixed thoroughly and taken two tablespoons three times a day in a warm form. The finished mixture must be kept in the refrigerator, before taking it is necessary to make sure that there are no allergic reactions and consult a doctor.

Aplastic anemia in children

Aplastic anemia in children is a type of hypoplastic anemia and is the most common form. When the bone marrow is affected, the functions of the hematopoietic system are disrupted, the level of leukocytes, platelets and erythrocytes decreases. The etiology of the disease is usually associated with infectious or toxic factors affecting the bone marrow. Aplastic anemia often develops spontaneously and is acute. The skin becomes pale, blood flows from the nose, bruises form under the skin when touched, and a fever may occur. With these symptoms, immediate medical attention is necessary, since this disease is characterized by fairly rapid progression. In most cases, treatment requires chemotherapy and transfusion of erythrocyte suspension obtained from whole blood by removing plasma in order to normalize the functioning of the bone marrow. If there is no positive effect, a bone marrow transplant may be necessary.

[ 32 ], [ 33 ], [ 34 ], [ 35 ]

Hemolytic anemia in children

Hemolytic anemia in children is characterized by excessive destruction of red blood cells and can be hereditary or acquired. In hereditary anemia, there is increased destruction of red blood cells with the release of hemoglobin from them. Defective red blood cells can remain viable for eight to ten days and are destroyed mainly in the spleen. The first signs of the disease can appear immediately after birth or be detected at any other age. With hemolytic anemia, the skin turns yellow, becomes pale, there is a delay in physical and, in some cases, mental development. The spleen and liver can be enlarged and compacted. Crises that occur with this disease can last seven to fourteen days and are accompanied by a fever, headaches, a sharp decline in strength, muscle weakness, decreased motor activity, etc. To relieve or alleviate the symptoms of the disease, surgical intervention can be performed to remove the spleen.

Anemia in children under one year

Anemia in children under one year of age is divided into anemia of newborns, anemia of premature babies, alimentary anemia resulting from poor nutrition, post-infectious anemia and severe anemia of the Yaksh-Gayem type.

Alimentary anemia is observed at the age of up to six months and is a consequence of a lack of iron, salt, vitamins and proteins. In most cases, it occurs in the absence of breastfeeding. The development of anemia is manifested in the form of a deterioration in appetite, pale skin, muscle weakness. Feces are dry or clayey, the liver may be slightly enlarged. The child is lethargic, quickly gets tired, jaundice may occur. In severe forms of the disease, the mental and physical condition is disturbed, the skin becomes excessively pale, there is an increase in lymph nodes, liver, body temperature rises, a noise is heard in the heart, shortness of breath appears. The hemoglobin level drops sharply, while the level of red blood cells may remain normal. In case of iron deficiency, it must be included in the diet. Treatment of the disease is aimed at correcting nutrition and eliminating the causes that cause it.

[ 36 ], [ 37 ], [ 38 ], [ 39 ]

Anemia in premature infants

Anemia in premature babies occurs in about twenty percent of cases, and much more often during infancy. The severity of anemia is directly related to the gestational age of the child, which corresponds to the gestational age - the younger it is, the more severe the disease. In the first few months after birth, premature babies weighing less than one and a half kilograms and a gestational age of less than thirty weeks require a transfusion of red blood cells in about ninety percent of cases. Anemia in premature babies is characterized by a progressive decrease in hemoglobin (ninety to seventy g / l or less), a reduced level of reticulocytes (preceded by red blood cells in the process of hematopoiesis) and suppression of the functions of bone marrow hematopoiesis. A distinction is made between early and late anemia in premature babies. The former, as a rule, develops in the fourth to tenth week after birth. The reticulocyte level is less than one percent, the maximum hemoglobin level is seventy to eighty g / l, the hematocrit value decreases to twenty to thirty percent. Symptoms of anemia in premature babies coincide with the symptoms of general anemia and can manifest themselves in the form of pale skin, rapid heartbeat, etc. In the development of anemia in premature babies, a lack of folic acid, vitamin B6, such trace elements as zinc, copper, selenium, molybdenum, as well as the negative impact of infectious agents are also important. Late anemia in premature babies appears at about three to four months of age. The main symptoms of this disease are loss of appetite, pale and dry skin, mucous surfaces, an increase in the size of the liver and spleen, an acute iron deficiency is noted.

[ 40 ], [ 41 ], [ 42 ]

Degrees of anemia in children

Degrees of anemia in children are divided into mild, moderate and severe. With a mild degree, the child becomes inactive, lethargic, has a decreased appetite, the skin turns pale, the level of hemoglobin and red blood cells decreases slightly. With moderate anemia, activity is noticeably reduced, the child eats poorly, the skin becomes dry and pale, the heartbeat increases, the liver and spleen are compacted and enlarged, the hair becomes thinner and becomes brittle and fragile, systolic murmur is heard, the level of hemoglobin and red blood cells decreases. In severe forms of the disease, there is a lag in physical development, muscle weakness, painful thinness, problems with bowel movements, excessive dryness and pale skin, brittle nails and hair, swelling of the face and legs, problems with the cardiovascular system, and decreased saturation of red blood cells with hemoglobin with color indices of less than 0.8.

[ 43 ], [ 44 ]

Mild anemia in children

Mild anemia in children may not have pronounced clinical symptoms, while the existing iron deficiency provokes further development and complications of the disease. In such cases, timely diagnosis helps prevent the progression of the disease. However, it should be noted that in some cases, clinical symptoms of mild anemia can be expressed even more strongly than in severe cases. To make a diagnosis, it is necessary to take into account such factors as the level and average volume of red blood cells, color characteristics, content and concentration of hemoglobin in red blood cells, the presence of iron in the blood serum, etc. There is a simple method for determining iron deficiency at home. If, after eating beets, the urine acquires a pink tint, most likely, there is iron deficiency in the body. In this case, you should consult a doctor.

[ 45 ], [ 46 ], [ 47 ], [ 48 ]

Anemia of the 1st degree in children

Anemia of the 1st degree in children is characterized by a decrease in the hemoglobin level to one hundred to eighty grams per liter of blood. At this stage of the disease, external signs of anemia may be absent or pallor of the skin and lips may be observed. To correct the condition after the conducted studies, the attending physician prescribes therapeutic nutrition and iron preparations.

[ 49 ], [ 50 ], [ 51 ], [ 52 ], [ 53 ]

Anemia stage 2 in children

Anemia of the 2nd degree in children manifests itself in the form of a drop in the hemoglobin level below eighty grams per liter. At this stage of the disease, the child may lag behind in mental and physical development, there is also a disruption of the digestive tract, cardiovascular system, shortness of breath appears, the heartbeat increases, dizziness may occur, the child is often sick, feels lethargic and weak. In such cases, inpatient treatment under strict medical supervision is recommended.

[ 54 ], [ 55 ], [ 56 ]

Classification of anemia in children

Etiopathogenetic classification of anemia in children includes the following types:

I. Anemias of endogenous etiology:

• Benign constitutional.
• Congenital hemolytic anemia of newborns.
• Congenital familial hemolytic diseases.
  • Minkowski-Chauffard type.
  • Cooley's disease.
  • sickle cell.
  • oval cell, macrocytic.
• Anemia in premature infants.
• Malignant.
• Ehrlich's aplastic anemia.
• Chlorosis.

II. Anemias of exogenous etiology:

• Posthemorrhagic.
• Alimentary.
• Infectious and post-infectious.
• Toxic.
  • parasitic intoxications.
  • chronic and acute.
  • malignant neoplasms.
  • related to non-compliance with hygiene standards.

[ 57 ], [ 58 ], [ 59 ], [ 60 ]

How to treat anemia in children?

To correctly determine how to treat anemia in children, it is necessary to know the exact causes and mechanisms of its development. In case of iron deficiency, for example, it is necessary to take iron supplements in combination with a complete and balanced diet. It is recommended to take such medications between meals or an hour before meals, the medicine should be washed down with natural fruit juices, preferably citrus, if there is no allergic reaction. After normalizing the amount of hemoglobin, treatment should be continued, completing the full course. Complex treatment includes complete and proper nutrition, products containing iron (beef, cod liver, milk, buckwheat, eggs, chicken and rabbit meat, semolina, beef kidneys, walnuts, etc.). Herbal medicine is prescribed for disorders in the digestive system and impaired absorption of nutrients. To normalize the intestinal microflora and relieve inflammation, mint and chamomile decoctions, as well as decoctions of rose hips, sage, oak bark, and St. John's wort are recommended for use. The complex treatment also includes preparations containing vitamins and minerals. In case of iron deficiency, the drug hemoferon is used. Hemoferon is taken orally half an hour before meals. The dosage is calculated based on body weight: three to six milligrams of hemic iron per kilogram of body weight. The approximate dosage for children under three months is 2.5 ml, from four to nine months - 5 ml, from ten months to one year - 7.5 ml, from one year to three years - about 10 ml, from four to six years - 12.5 ml, from seven to ten years - 15 ml.

Treatment of iron deficiency anemia in children

Treatment for iron deficiency anemia is primarily aimed at eliminating the cause of the disease and replenishing iron reserves in the body with iron-containing drugs. The main principles in the treatment of iron deficiency conditions in children are the following:

• Compensation for iron deficiency with the help of medications and a therapeutic diet.
• Continue treatment after normalization of hemoglobin levels.
• Carrying out emergency blood transfusions only if there is a threat to life.

The preparations used in ferrotherapy are divided into ionic (salt and polysaccharide iron compounds) and non-ionic (part of the hydroxide-polymaltose complex of 3-valent iron). The daily dose of an iron-containing preparation is calculated taking into account the age of the child. The recommended daily dose of salt preparations containing iron in the treatment of iron deficiency for children under three years of age is 3 mg / kg of body weight; for children aged three years and older - 45-60 mg of elemental iron per day; for adolescents - up to 120 mg / day. When using preparations of 3-valent iron hydroxide-polymaltose complex, the daily dosage for young children is 3-5 mg / kg of body weight. The positive effect of taking iron preparations appears gradually. After normalization of the hemoglobin level, an improvement in the condition of the muscles is noted, two weeks after the start of treatment, an increase in the level of reticulocytes is noted. The disappearance of clinical symptoms of anemia is usually observed in one to three months after the start of therapy, and complete replenishment of iron deficiency - in three to six months from the start of treatment. The daily dose of an iron-containing drug after increasing the hemoglobin level is half the therapeutic dose. If treatment is not completed, there is a high probability of relapse of the disease. For intramuscular administration of iron, the drug Ferrum Lek is used. The maximum daily dose for intramuscular injections for children weighing up to five kilograms is 0.5 ml, with a weight of five to ten kilograms - 1 ml. The approximate duration of treatment for mild anemia is two months, for moderate anemia - two and a half months, for severe anemia - three months.

Nutrition for anemia in children

Proper and complete nutrition for anemia in children is very important. In the first months after birth, the child should receive the required amount of iron with mother's milk. With the further introduction of complementary foods (approximately at the age of six to seven months), breast milk improves the absorption of iron from other products. Children with low weight, often sick, or born much earlier than expected especially need to monitor their iron intake. Starting from eight months, the child's diet should include meat, which is a full source of iron, buckwheat and barley porridge. Starting from the age of one year, in addition to meat, the diet should include fish. The combined use of meat and fish products in combination with vegetables and fruits improves the absorption of iron from them. Taking vitamin C also improves the absorption of iron. Nutrition for anemia in children can include dishes and products from diet table No. 11. Diet No. 11 includes high-calorie foods, the required amount of proteins, fats and carbohydrates, vitamins, and minerals. The recommended diet is five times a day. Diet table No. 11, recommended for children with anemia, includes the following dishes and products: bread, flour products, soups, meat, fish, liver, cottage cheese, cheese, butter, eggs, buckwheat, oatmeal, pasta, pea or bean puree, berries, vegetables, fruits, natural honey, rosehip decoction.

Prevention of anemia in children

Prevention of anemia in children is carried out using laboratory blood tests for the timely detection and prevention of further development of mild forms of anemia. Based on a general examination and laboratory data, the local pediatrician prescribes the necessary preventive measures. The risk group includes children with a hereditary predisposition to this disease, if the mother had iron deficiency in the body during pregnancy, late toxicosis, edema or other factors that inhibit the process of hematopoiesis in the fetus. Also at risk are children with insufficient body weight at birth; children who are bottle-fed and do not receive enough nutrients; children born prematurely. Children born prematurely are prescribed iron preparations for preventive purposes from the third month after birth until two years. Prevention of anemia in children also consists of a complete and balanced diet containing the required amount of proteins, vitamins and minerals. A child should eat meat, liver, eggs, fish, cheese, cottage cheese, vegetables and fruits, natural juices. For general strengthening of the body, it is necessary to lead a healthy lifestyle, walk in the fresh air, do physical exercise and toughen up.