Anemia in Children

What is Anemia in Children?

Anemia in children is a series of diseases that can have various causes and a different course, externally manifested by pallor of the skin and mucous membranes, an altered state of the internal organs; in the blood decreases the number of red blood cells and hemoglobin.

Hemoglobin is an iron substance that can form a compound with oxygen. Erythrocytes contain hemoglobin combined with oxygen. Erythrocytes donate oxygen to the cells, and carbon dioxide is taken in, which is released in the lungs, and the body exhales it. Next, oxygen enters the red blood cells again. And this process lasts until the child lives, matures, grows old.

Newborns have a lot of red blood cells and high levels of hemoglobin. He needs it, even not yet born. Every day infants have less and less hemoglobin and red blood cells in the blood, because it is no longer in the womb and can breathe. Red blood cell longevity is 3-4 months. They produce red bone marrow.

Types of anemia

  1. Post-hemorrhagic (occur due to blood loss, it is acute and chronic)
  2. Hemolytic anemia (acquired or hereditary)
  3. Mixed anemia
  4. Caused by lack of bone marrow production of red blood cells

The latter type includes:

  • protein deficiency
  • iron deficiency
  • copper deficiency
  • vitamin deficiency
  • thalassemia
  • orotic aciduria

Deficiency anemia in children is the most common.

The severity of the disease is divided into light, medium and heavy. The separation is carried out by the amount of hemoglobin and erythrocytes, measured in grams per 1 liter of blood.

Sideoblastic anemia in children is a disease arising from violations of the heme synthesis, both hereditary and acquired. Hypochromic microcytic erythrocytes that are mixed with normal ones are found in a child. Red blood cells are different in diameter.

Congenital sideroblastic anemia is considered to be quite a rare type, usually in boys. There may also be cases of transmission of the disease by autosomal dominant and sporadic cases of the disease.

Pearson syndrome in a child is a unique variant of congenital sideroblastic anemia. Anemia, dependent on transfusions, manifests itself early, and also shows neutropenia and thrombocytopenia. Also, children with this diagnosis find vacuolization of erythrocytes and precursors of myeloid cells. This anemia belongs to the macrocytic, because in some cases it is confused with the anemia of Diamond — Blackfen.

Megaloblastic anemia in children is a group of diseases in which megaloblasts are present in the bone marrow and macrocytes in peripheral blood.

Folic deficiency anemia (FDA) in children is ranked as megaloblastic anemia.

Hemolytic anemia (GA) is characterized by shortening the life of red blood cells, the development of hemolysis of red blood cells of varying degrees of intensity.

The causes and pathogenesis of these diseases are different, but the similarities in the complex of symptoms:

  • disruption of bilirubin metabolism due to the indirect fraction,
  • hyperregenerative anemia,
  • hepatolienal syndrome

Hemolytic anemia in children may be hereditary or acquired.

Types of hereditary hemolytic anemia:

  • Fermentopathy
  • Membranopathies
  • Arising from defects in the structure and synthesis of hemoglobin

Acquired hemolytic anemia is divided into:

  • Infectious
  • Immune and immunopathological
  • Vitamin deficiency
  • Caused by chemical damage to red blood cells
  • Caused by mechanical damage to red blood cells

Hereditary hemolytic anemia in a child is associated with a violation of the erythrocyte membrane, erythrocyte fermentopathy, or hemoglobin instability. This group includes hereditary microspherocytic hemolytic anemia, which is inherited in an autosomal dominant manner. It is manifested by a decrease in the osmotic stability of erythrocytes, hemolysis of varying intensity, splenomegaly, spherocytosis, jaundice.

Hereditary non-spherocytic hemolytic anemias, which result from the deficiency of red blood cell enzymes, are mostly accompanied by hemolysis with a nonspecific change in the erythrocyte morphology: polychromasy, basophilia, target-like red blood cells, spherocytosis.

Isoimmune hemolytic anemia in children occurs due to such factors:

  • autoimmune hemolytic anemia in the mother
  • hemolytic disease of a newborn baby
  • red blood cell transfusions incompatible with the ABO system, Rh factor, etc.

Autoimmune anemia in children – arising from the breakdown of immunological tolerance to antigens of erythrocytes of peripheral blood, erythrocyocytes and other predecessors of erythropoiesis. There are two types of such anemia: idiopathic and symptomatic.

Causes of Anemia in Children

The causes of anemia in children may be different, for example:

  • kidney disease, liver
  • gastrointestinal tract diseases
  • impaired absorption
  • infectious or oncological diseases
  • puberty
  • period of active growth of the body
  • with hormonal changes
  • after operation

The children’s organs of blood formation are not yet fully anatomically and physiologically mature, therefore they are easily amenable to the action of all negative environmental factors. Babies who are breastfed suffer from anemia less often than babies who are breastfed. The process of blood formation is hampered if there is a lack of protein and other trace elements in the child’s food: nickel, cobalt, manganese, copper, iron.

Causes of megaloblastic anemia in children:

  • vitamin B12 deficiency in a breastfeeding mother
  • the content in the child’s diet of vitamin B12 <2 mg/day

Folic acid deficiency anemia can be caused by:

  • impaired folate absorption in the small intestine
  • insufficient folate intake from food
  • increased folate loss
  • increased need for folates
  • medication (sulfalazin, biseptol, etc.)

Pathogenesis during Anemia in Children

The development of anemia occurs in three stages:

  1. Prelaptive iron deficiency. At this time, depleted iron stores in the body. The level of hemoglobin in the peripheral blood continues to be normal. However, in the tissues the amount of iron is constantly decreasing, and its absorption from food does not increase, but constantly decreases. This is due to the fact that intestinal enzymes reduce their activity.
  2. Latent (hidden) iron deficiency. At this stage, the deposited reserves of iron are significantly reduced (the so-called reserve fund, which is about 1/3 of the total iron in the human body). In addition, the amount of iron in the serum is also reduced.
  3. The last stage of iron deficiency in the body. At this time, hemoglobin decreases markedly. For the most part in the blood decreases the number of red blood cells. This is iron deficiency anemia. Regardless of the causes of sideroblastic anemia (a group of diseases associated with impaired activity of enzymes that are involved in the synthesis of porphyrins and hemma – the non-protein portion of hemoglobin), worsening heme production necessarily leads to iron retention in mitochondria.

Morphologically, this is manifested as follows – nuclear erythrocytes with iron granules (iron aggregates in mitochondria), which are located near the nucleus, appear in the bone marrow. These abnormal cells, called ring sideroblasts, can only be found in pathological conditions. They differ from sideroblasts present in the bone marrow of a healthy person. (Sideroblasts are precursors of red blood cells that contain ferritin granules that are common in the cytoplasm). Sideroblastic anemia is most often diagnosed in adults, but there are cases of childhood diseases. Their causes may be the following factors: medication, alcohol abuse. But they can also develop as a result of myelodysplastic disorders (groups of diseases that are characterized by impaired blood formation in the myeloid lineage). Some types of sideroblastic anemia can be detected in children.

Megaloblastic anemia is a group of hereditary and acquired anemia. Their common feature is the presence of megaloblasts in the bone marrow (Megaloblast is the parent cell of erythropoiesis, characterized by an abnormal shape and unusually large size).

Regardless of the causes of the pathology, patients with children are diagnosed with hyperchromic anemia with characteristic changes in the erythrocyte morphology. In this case, the red blood cells are oval, they are large (12-14 microns and more). Red blood cells with basophilic cytoplasm are found (pathological precipitate of the substance of ribosomes, manifested in the form of small blue spots). In many erythrocytes, remains of the nucleus are found (Weidenreich specks – remnants of nuclear matter; Kebot rings – remnants of the nuclear envelope, which have a ring shape; Jolly calf – remnants of nuclear chromatin).

Folic Anemia

All of the above etiological factors lead to the fact that the formation of the active form of folic acid (5,10-methylenetetrahydrofolic acid) decreases in the child’s body. As a result, DNA synthesis is disrupted in hematopoietic cells, and megaloblastic anemia begins to develop.

The causes of hereditary microspherocytic hemolytic anemia in children:

  1. Violation of sodium equilibrium in erythrocytes (in erythrocytes the amount of water accumulation increases).
  2. Loss of lipids by the erythrocyte membrane.
  3. Compaction of the cytoplasm (this reduces the ability of erythrocytes to deform when passing through the splenic sinuses) and reducing the area of the erythrocyte.

Red blood cells with lesions are absorbed by spleen macrophages.

Symptoms of Anemia in Children

Epithelial syndrome

Manifested in the skin and mucous membranes. dryness and peeling of the skin, pigmentation, dystrophy of hair and nail plates are also observed. The appetite of the child decreases, there are violations in the digestive tract.

Astheno-neurotic syndrome

The child becomes emotionally unstable, over-excitable, irritable. Parents may notice that the child is lagging behind in development physically, as well as his psychomotor development and speech. May show apathy or fatigue.

Cardiovascular syndrome

It is manifested by symptoms such as shortness of breath and palpitations, the child has a tendency to reduced pressure. ECG shows functional systological noise.

Muscle Syndrome

There is a weakness of the sphincter of the bladder, delayed physical development, can be enuresis.

Enlarged liver and spleen

Syndrome of reduced local immune protection

The degree of development of anemia in children is determined by the degree of manifestation and the number of symptoms listed above. In the mild form, the level of hemoglobin in the blood is 110-91 g/l, with moderate it drops to 90-71 g/l, and with severe it is less than 70 g/l. There is also a rare extra-heavy form in which hemoglobin in the blood is 50 g/l or less.

Folic Anemia

This disease is typical for children, adolescents, as well as for pregnant women. Non-specific anemic syndrome is fixed, but there are no complaints that would be caused by damage to the nervous system. For this form, a symptom such as pale skin is also typical. The spleen may be enlarged, but for a short time. As for the heart, with this form of anemia, the following symptoms are observed:

  • low systolic noise at the top
  • muffled heart tones
  • violation of the phase of repolarization of the myocardium of the left ventricle

Hereditary microspherocytic hemolytic anemia

The disease has an undulating course. After hemolytic crisis comes remission, lasting from 2-3 months to 2 years. Hemolytic crisis may occur after psycho-emotional stress, infection, change of climatic zone.

Features of microspherocytosis in young children:

  • pronounced violation of bilirubin metabolism
  • gradual onset of the disease
  • in most cases severe
  • in children of the first 3 months, microspherocytosis and reticulocytosis are slightly pronounced and appear at a later age
  • frequent development of parenchymal hepatitis
  • typical appearance of normoblasts, especially during the crisis
  • increase the maximum osmotic resistance of erythrocytes along with a decrease in the minimum osmotic resistance of erythrocytes
  • way out of the crisis is slow

Complications of anemia in children

Newborns may develop nuclear jaundice, in children from 1 month – chronic hepatitis, cholelithiasis, cirrhosis of the liver. With frequent hemotransfusions, hemosiderosis may appear in individuals with severe disease.

Diagnosis of Anemia in Children

Anemia in children is diagnosed by the content of red blood cells and hemoglobin in the blood. Hemoglobin in arterial blood should normally be less than in venous blood. The study mainly takes blood from a vein. Also take into account the average concentration in one erythrocyte of hemoglobin, the volume of erythrocyte, color index, the capacity of serum iron. The child is prescribed medications with iron and see what the result is.

Parents can conduct one test at home. Give the child to eat dishes from beets. If his urine turns red, then there is a lack of iron in the body. This is due to the fact that the liver with a normal amount of iron in the body discolor the beet dye.

Diagnosis of folic deficiency anemia

  • general blood analysis
  • blood chemistry
  • histidine test
  • myelogram

When folic deficiency anemia in the general blood test, red blood cell macrocytosis, hyperchromic anemia, leukopenia, neutrophil hypersegmentation, thrombocytopenia are detected. On myelogram reveal hypersegmented neutrophils, megaloblasts. In the blood, the normal content of B12 is found.

Diagnosis of hereditary microspherocytic hemolytic anemia

Laboratory methods allow the child to detect pronounced reticulocytosis, anemia of varying severity; single microspherocytes in blood smears, normal number of leukocytes and platelets (increased after splenectomy). A decrease in the osmotic stability of erythrocytes and an increased concentration of bilirubin in the blood serum are also recorded.

Diagnosis of isoimmune hemolytic anemia in children

Conduct direct and indirect Coombs test. A blood test reveals a moderate or severe anemia, reticulocytosis. If the onset is acute, leukocytosis can be detected, as well as neutrophilia with a shift to the left. A characteristic violation of bilirubin metabolism.

Treatment of Anemia in Children

Treatment of anemia in children should begin with the appointment of iron-containing drugs in the form of ferrous salts, which are given to children inside. The nutrition of the child should be balanced, taking into account the physiological needs of the child in fats, carbohydrates and proteins, as well as trace elements and vitamins. After normalization of hemoglobin level, treatment should be continued.

Elements of complex treatment of anemia in a child:

  • proper nutrition
  • herbal remedies
  • antioxidant action products

Treatment of sideroachrestric anemia in children

  • Desferal
  • Vitamin B6 in high doses

Treatment of acquired forms of megaloblastic anemia is to eliminate the cause, which caused a lack of vitamin B12 or folic acid: worms irrational feeding, infection, medication, etc. When a vitamin B12 deficiency is prescribed, his drugs – cyanocobalamin or oxycobalamin. The dose is calculated as follows: 5 μg/kg per day in children up to 12 months; 100-200 mcg per day – after the year, 200-400 mcg per day – in adolescence.

Folic Anemia

Treatment is prescribed only after myelogram. These may be intramuscular injections of vitamin B12. The duration of the course of treatment is 4-6 weeks, then reinforcing therapy with cyanocobalamin is carried out. Treatment of B12-deficient anemia is carried out for life, and regular follow-up is carried out.

Hereditary microspherocytic hemolytic anemia

Treatment for anemia of Minkowski-Chauffard – splenectomy. If the child has no symptoms, then this method of treatment does not apply. In hemolytic crisis, replacement blood transfusion for life reasons at a dose of 8-10 mg/kg, detoxification therapy, correction of water and electrolyte balance, cardiovascular drugs for indications.

Isoimmune hemolytic anemia in children

Mainly mainly idiopathic autoimmune HA of thermal type are treated. The main method of treatment is monotherapy with steroids – prednisone at a daily dose of 2 mg/kg, divided into 2-3 doses. The course lasts from 4 weeks, the abolition of drugs is gradual.

Preventing Anemia in Children

  1. Regular examination by a pediatrician
  2. Regular laboratory tests
  3. Special attention is given to children from risk groups: newborns with a small body weight, children with a mother who has anemia, children from pregnancy with two or more fetuses, babies with high growth rates, and babies with artificial feeding.
  4. Preterm infants are prescribed iron supplements for prophylaxis – the dose is ½ therapeutic.
  5. Full nutrition.
  6. Walking in the fresh air.
  7. The correct sleep and wakefulness.
  8. Hardening, gymnastics, massages.

Prevention of sideroblastic anemia

In order to avoid child poisoning with lead, it is necessary to relocate children during the reconstruction of old houses. It is necessary to avoid burning and burying lead paints in the ground, scrape them off or remove them with chemical means.

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