Preventin of nutritional anemias

Question 1

Iron deficiency in Infants and children

Answer 1

Iron deficiency most common NUTRITIONAL deficiency in children in the world (25%)
risk factors- children living at or below poverty level, black and hispanic kids, low birth weight, childhood obesity

Question 2

Dietary factors leading to Iron deficiency anemia

Answer 2

Early introduction of whole cows milk, insuffiecient iron intake, decreased absorption due to poor dietary sources or iron, meds (aspirin, nsaids) malabsorption states (celiac, crohns, giardia)

Question 3

When can you start feeding infants cows milk

Answer 3

1 year

Question 4

clinical manifestations of IDA

Answer 4

microcytic, hypochromic, hypoproductive
most common presentation is asymptomatic, well nourished child w/ mild micrcytic hypochrmoic anemia
In IDA infants there is impaired psychomotor and/or mental development/ cognitive impairment

Question 5

screening recommendations for IDA

Answer 5

A careful dietary history is currently the most important screening test and is more useful than hemoglobin levels for detecting IDA
In healthy infants assesment should be at 4, 18, and 24 months of age, and annually after. a HgB or hematocrit is recommended at 1 year
children w/ health needs (chronic infection, IBD, restricted diets)
children 2 to 5 w/ increased risk factors of IDA
HgB<11 is abnormal
risk factors-infants- use of low iron formula, cows mild, goat milk or soy before 1 year
preschool children-milk intake greater than 24oz a day, fewer then 3 servings daily of iron rich foods

Question 6

Treatment of IDA

Answer 6

Ferrous sulfate 3mg/kg of elemental iron

give between meals and w/ juice

Question 7

Types of Iron supplements

Answer 7

Ferrous sulfate-cheapest form, well absorbed (20% elemental iron)
Ferrous gluconate- slightly more expensive than ferrous, but fewer side effects (11.6%)
Ferrous fumarate- similar to ferrous gluconate (33%)
Polysaccharide Iron-may cause less nausea and constipation than other oral preparations. take w/ vitamin C

Question 8

what is most cost effective iron supplement

Answer 8

ferrous sulfate

Question 9

Requirements w/ Pregnancy (important)

Answer 9

Increased Iron requirements- maternal iron requirements avg close to 1000mg over course of pregnancy (300 mg for fetus and placenta and 500 mg for expansion of maternal HgB)
Increased Folate- for increased red cell mass and prevention of neural tube defects in fetus

Question 10

anemia during pregnancy

Answer 10

Pregnant women should take 30 mg/day of elemental iron
To prevent neural tube defects the ideal is for the woman to be taking folic acid PRIOR TO CONCEPTION. recommended dose prior and during is .4mg/day, but can increase to .6 mg or .8mg to get to 1mg/day requires prescription