Anemia in Children

Anemia in Children

Understanding Anemia

Anemia is usually diagnosed during a routine blood test. In children the common
cause of anemia is low iron level and is treated initially with a one month
course of a daily iron vitamin. The blood test is then rechecked in a month
and if they have gone up, then the diagnosis of iron deficiency is confirmed.
Treatments for iron deficiency anemia include taking an iron vitamin and improving
the dietary intake of iron such as meat, beans, spinach and other foods that
say they are iron fortified. It is best to give iron vitamins with orange juice,
because Vitamin C can help the iron be absorbed.

Another common cause of mild anemia in children, especially with a normal MCV
and no other symptoms, is a recent infection, such as an ear or sinus infection,
which can cause decreased production of red blood cells for a short period of
time (usually about a month).

If the blood counts did not go up after being on supplemental iron for a month,
then further testing is done, which may include a complete blood count, iron
level, total iron binding capacity (TIBC), ferritin level and a reticulocyte
count. Other testing can include a lead level, a blood smear (in which the labs
looks at the blood cells under a microscope to look for abnormalities), a hemoglobin
electrophoresis, and/or a stool guiac test to see if blood is being lost in
your child's bowel movements.

If a CBC (complete blood count) was done, then there are other clues that would
favor a diagnosis of having a low iron level, including having a low MCV (microcytic
anemia), which measures the size of the red blood cells, a high RDW (which measures
the variability in the size and shape of red blood cells) and a low red blood
cell (RBC) count. These measurements are not available in all Pediatrician's
offices, it depends on the type of testing that they do. If they just perform
a 'spun hematocrit' then the MCV and RDW may not be available.



It is usually a much more urgent problem if a child has severe anemia that is
causing symptoms, such as a fast heart rate or respiratory rate, heart murmur,
decreased energy level, fainting, having an enlarged liver (hepatomegaly), or
jaundice. Children with anemia who are symptomatic should be quickly evaluated
for the cause and to begin treatment.

Understanding Anemia

Our blood contains several different types of cells. The ones we have the most
of are the red blood cells. These cells absorb oxygen in the lungs and distribute
it throughout the body. They contain hemoglobin, a red pigment that carries
oxygen to the tissues and carries away the waste material, carbon dioxide. When
there is a decreased amount of hemoglobin available in the red blood cells,
making the blood less able to carry the amount of oxygen necessary for all the
cells in the body to function and grow, the condition is called anemia.

Anemia may occur for any of the following reasons:

Production of red blood cells slows down.

Too many red blood cells are destroyed.

Not enough hemoglobin within the red blood cells are present.

Young children most commonly become anemic when they fail to get enough iron
in their diet. Iron is necessary for the production of hemoglobin. This iron
deficiency causes a decrease in the amount of hemoglobin in the red blood cells.
A young infant may get iron-deficiency anemia if he starts drinking cow's milk
too early, particularly if he is not given an iron supplement or food with iron.
The deficiency occurs because cow's milk contains very little iron and the small
amount present is poorly absorbed through the intestines into the body. In addition,
cow's milk given to an infant under six months of age can cause irritation of
the bowel and small amounts of blood loss. This results in a decrease in the
number of red blood cells, which can cause anemia.

Other nutritional deficiencies, such as lack of folic acid, can cause anemia,
but this is very rare. It is probably most often seen in children fed goat's
milk, which contains very little folic acid.

Anemia at any age can be caused by excessive blood loss. In rare cases, the
blood does not clot properly, and a newborn infant may bleed heavily from his
circumcision or minor injury, and become anemic. Because vitamin K promotes
blood clotting and is often lacking in newborns, an injection of this vitamin
generally is given right after birth.

Sometimes the red cells are prone to being easily destroyed. This is called
hemolytic anemia, and can result from disturbances on the surface of the red
cells or other abnormalities in or outside the cells. Certain enzyme deficiencies
also can alter the function of the red blood cells, increasing their susceptibility
to destruction.

A severe condition involving an abnormal structure of hemoglobin, seen most
often in children of black African heritage, is called sickle-cell anemia. This
disorder can be very severe and is associated with frequent "crises"
and often repeated hospitalizations. Children with sickle-cell anemia may have
unexplained fever or swelling of the hands and feet as infants, and they are
extremely susceptible to infection. If there is a history of sickle-cell anemia
in your family, make sure your child is tested for it.