Prevention of Nutritional Anemia Flashcards
What is the most common nutritional deficiency in children in the world?
Iron Deficiency
What is ID? What is IDA?
ID- Iron deficiency
IDA- Iron deficiency anemia
Risk factors of ID
children living at or below the poverty level
black and hispanic children
Risk factors of IDA
- childhood obesity
- history of prematurity
- low-birth-weight
- immigrant groups
neonates of mothers with iron deficiency are at increased risk of IDA in early infancy. True or false?
True, yo.
What percent of daily iron needs must come from diet in infants and children?
30%
Examples of conditions that can lead to early development of IDA
- prematurity
- fetal-maternal hemorrhage
- twin-twin transfusion syndrome
- other perinatal hemorrhagic events
- insufficient dietary intake
Dietary factors leading to IDA (reasons you might get IDA)
- insufficient iron intake
- decreased absorption d/t poor dietary sources of iron
- early introduction of whole cows milk
- medications (ASA, NSAIDs)
- malabsorption states (celiac disease, chrons disease, giardiasis, resection of the proximal small intestine)
When do you begin iron supplementation for infants?
breast fed full term- start at 4 months
breast fed premature- start at 1 month
formula fed- use iron rich formula
*Avoid cows milk until age 12 m!
What is the most common presentation of IDA?
asymptomatic, well nourished child w/ mild microcytic, hypochromic anemia
- in IDA infants the is impaired psychomotor and/or mental development/cognitive impairment can even occur in adolescents
How to screen for IDA?
Take a careful dietary history (more useful than hgb levels)
risk factors:
-infants that use a low iron formula before 1 year
-pre-school age children that have a milk intake of >24oz/day
When do we screen for iron deficiency?
in normal, healthy infants
4, 18, and 24, annually thereafter
hgb/hct is recommended at 12 months, hgb
What test would you order for a child you suspect might be anemic?
CBC with smear
retic count
What do you do once the dx of IDA is established?
- careful dietary history
- screen for lead poisioning
- have stools screened for occult blood three times
How do you treat female adolescents who are found to be anemic?
- if they have heavy menses
- put on trail iron supplementation
- if hgb doesnt normalize in 3 months, do further studies
Treatment for infants with mild microcytic anemia and a presumptive dx of IDA
theraputic trail of iron
ferrous sulfate 3mg/kg
once or twice daily between meals for 4 weeks
juice helps absorption
Treatment for infants with confirmed IDA
ferrous sulfate 3mg/kg
once or twice daily between meals
juice helps absorption
Types of iron supplements
ferrous sulfate (most cost-effective)
ferrous gluconate
ferroud fumarate
polysaccharide iron
Adverse Rxn to iron supplement
GI- irritation, epigastric pain, nausea, diarrhea, dark stools, constipation
GU-black or dark urine
Misc- liquid preps can stain teeth (brush or rinse)
How to prevent IDA
Full term infant- 1mg/kg, start no later tha 4 months in breastfed infants
Premature- 2mg/kg, start no later than 2 months on breastfed infants
1-10yo- 10mg/day
11-adult female-15 mg/day
11-adult male- 12 mg/day
dietary changes that will increase iron absorption
citrus fruits, tomatoes, dark leafy greens, MEAT
Physiologic changes that occur with pregnancy
- increased iron requirements
- increased folate (for increased red cell mass and prevention of neural tube defects)
- there is a greater expansion of plasma volume, then there is an increase in Hgb mass=physiologic anemia
- recommend 30mg/day
When should women be taking folic acid?
prior to conception!!!!!!!!!!!!!!!!!!!!!!!!!
0.4 mg.day
What is the most common cause of folic acid deficiency in the US?
Alcoholic anemia
usually macrocytic although can be mixed if they have chronic blood loss or ID
alcohol directly interferes with erythropoiesis and blocks the response to folate in subjects who are folate deficient
What are regular features on a peripheral blood smear of an alcoholic?
macrocytosis and stomatocytosis
Treatment for alcoholic anemia
STOP ALCOHOL Improve nutrition supplement folate and B12 Workup GI for bleeding Work up for chronic disease
Gastric bypass surgery can lead to ID. true or false?
True. absorption is lower due to lower acid content in the gastric pouch and bypass of main absorption sites
Short bowel syndrome leads to what?
B12 definiency since there is no ileum to absorb the B12
