8.1 Anemia

Question 1

Anemia

Answer 1

• Low Hemoglobin, Hematocrit and RBC
• This diminishes oxygen carrying capacity of the blood and causes reduction in the amount of oxygen available to tissue
• MOST COMMON DISORDER

Signs and Symptoms
- Heart murmur
- Cardiac failure
- Cyanosis
- Birth retardation
- Anorexia

• CBC is important for diagnosis.
• MCV (Mean Corpuscular Volume) - Indicates size of RBC’s

Macrocytic - >95
- Folate/B12 Deficiency
- Aplastic Anemia
- Immune Hemolytic Anemia

Microcytic - <75
- Iron deficiency Anemia
- Lead Poisoning
- Thalassemia

• MCH (Mean Corpuscular Hemoglobin) - Indicates Color (Concentration of hemoglobin)
  Normochromic, Hyperchromic, Hypochromic

Reticulocytes - Immature RBCs

Increased (Reticulocytosis)
- Acute Anemia
- Chronic Hemolytic Anemia

Decreased (Reticulocytopenia)
- Iron deficiency Anemia
- Folic deficiency Anemia
- B12 deficiency Anemia
- Bone Marrow Failure Syndrome
- Infectious Bone Marrow Suppression

Question 2

Iron Deficiency Anemia Causes

Answer 2

• Inadequate supply of iron (deficient in diet)
• MILK IS NOT A GOOD SOURCE OF IRON, IT CAN ACTUALLY INHIBIT IRON ABSORPTION
• Excessive milk intake or exclusive breast feeding after 6 months without supplements and delayed introduction of solid foods can cause inadequate supply
• Inadequate iron stores at birth
• LBW, premature, anemic mothers, fetal blood loss
• Impaired iron absorption
• Iron inhibitors such as phytates (grains, nuts, legumes, maize), phosphates (poultry, fish, nuts, beans, dairy), Oxalates (spinach, bran flakes, beets, potato chips, french fries, nuts, nut butters)
• Gastric Alkalinity
• Malabsorption disorder
• Lactose intolerance, inflammatory bowel disease or chronic diarrhea
• Blood loss (acute/chronic hemorrhage)
• Excessive demands for growth (prematurity, adolescents, pregnancy)
• Not able to keep up with iron demands during growth

Question 3

Symptoms of Iron Deficiency Anemia

Answer 3

• Pallor (Skin, mucous membranes, conjunctiva of eyes)
• Pica (Eating inedible foods)
• Fatigue (Common. Children like to exert themselves so fatigue is a sign)
• Tachycardia (Attempt to circulate more oxygen)
• Tachypnea (Attempt to circulate more oxygen)
• Lethargy
• Irritability

Question 4

Iron Studies

Answer 4

• SIC (Serum Iron Concentration)
• Amount of circulating iron in the body
• TIBC (Total Iron-Binding Capacity)
• Total amount of transferrin that is necessary for the transport of iron in the bloodstream. (Transferrin is the protein that binds iron and transports it to plasma)
• Usually elevated in Iron Deficient Anemia
• Ferratin - A blood cell that contains protein
• Indicates how much iron is stored in the body
• Low ferratin indicates iron deficient anemia

Question 5

Management Of Iron Deficient Anemia

Answer 5

• 3-6mg of iron per kg per day (usually divided into mourning and evening dose 2-3 doses)
• Vitamin C food or juice helps with iron absorption
• Reticulocyte levels should increase in 5-10 days
• Hematocrit and RBC should increase in 1 month
• Infants can be given iron supplements (liquid version in syringe) or (iron fortified cereal starting at 4-6 months). Infant cereal is a powder that can be added to formula or breast milk. Typical in breastfed patients because formula is already iron fortified. Add it to the bottle for breast feeding.

WARNING SIGNS OF IRON SUPPLEMENTS
- Can cause black tarry school
- Iron can stain children teeth (place syringe towards back of mouth to avoid teeth)
- Overdose is fatal (keep out of reach of children)

Question 6

Infant General Facts

Answer 6

• Most at risk is Infants and children from 6 months to 2 years old
• MEAT IS THE BEST SOURCE OF IRON. Sweet potatoes can help as well

Question 7

Clinical Manifestations of Anemia

Answer 7

• Dizziness/Fainting
• Cardiac Murmurs
• Tachycardia
• SOB
• Pale Skin (Pallor)
• Abdominal Pain