Prevention of Nutritional Anemia

Question 1

What is the most common nutritional deficiency in children in the world?

Answer 1

Iron Deficiency

Question 2

What is ID? What is IDA?

Answer 2

ID- Iron deficiency

IDA- Iron deficiency anemia

Question 3

Risk factors of ID

Answer 3

children living at or below the poverty level

black and hispanic children

Question 4

Risk factors of IDA

Answer 4

• childhood obesity
• history of prematurity
• low-birth-weight
• immigrant groups

Question 5

neonates of mothers with iron deficiency are at increased risk of IDA in early infancy. True or false?

Answer 5

True, yo.

Question 6

What percent of daily iron needs must come from diet in infants and children?

Answer 6

30%

Question 7

Examples of conditions that can lead to early development of IDA

Answer 7

• prematurity
• fetal-maternal hemorrhage
• twin-twin transfusion syndrome
• other perinatal hemorrhagic events
• insufficient dietary intake

Question 8

Dietary factors leading to IDA (reasons you might get IDA)

Answer 8

• 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)

Question 9

When do you begin iron supplementation for infants?

Answer 9

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!

Question 10

What is the most common presentation of IDA?

Answer 10

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

Question 11

How to screen for IDA?

Answer 11

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

Question 12

When do we screen for iron deficiency?

Answer 12

in normal, healthy infants
4, 18, and 24, annually thereafter

hgb/hct is recommended at 12 months, hgb

Question 13

What test would you order for a child you suspect might be anemic?

Answer 13

CBC with smear

retic count

Question 14

What do you do once the dx of IDA is established?

Answer 14

• careful dietary history
• screen for lead poisioning
• have stools screened for occult blood three times

Question 15

How do you treat female adolescents who are found to be anemic?

Answer 15

• if they have heavy menses
• put on trail iron supplementation
• if hgb doesnt normalize in 3 months, do further studies

Question 16

Treatment for infants with mild microcytic anemia and a presumptive dx of IDA

Answer 16

theraputic trail of iron
ferrous sulfate 3mg/kg
once or twice daily between meals for 4 weeks
juice helps absorption

Question 17

Treatment for infants with confirmed IDA

Answer 17

ferrous sulfate 3mg/kg
once or twice daily between meals
juice helps absorption

Question 18

Types of iron supplements

Answer 18

ferrous sulfate (most cost-effective)
ferrous gluconate
ferroud fumarate
polysaccharide iron

Question 19

Adverse Rxn to iron supplement

Answer 19

GI- irritation, epigastric pain, nausea, diarrhea, dark stools, constipation
GU-black or dark urine
Misc- liquid preps can stain teeth (brush or rinse)

Question 20

How to prevent IDA

Answer 20

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

Question 21

dietary changes that will increase iron absorption

Answer 21

citrus fruits, tomatoes, dark leafy greens, MEAT

Question 22

Physiologic changes that occur with pregnancy

Answer 22

• 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

Question 23

When should women be taking folic acid?

Answer 23

prior to conception!!!!!!!!!!!!!!!!!!!!!!!!!

0.4 mg.day

Question 24

What is the most common cause of folic acid deficiency in the US?

Answer 24

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

Question 25

What are regular features on a peripheral blood smear of an alcoholic?

Answer 25

macrocytosis and stomatocytosis

Question 26

Treatment for alcoholic anemia

Answer 26

STOP ALCOHOL
Improve nutrition
supplement folate and B12
Workup GI for bleeding
Work up for chronic disease

Question 27

Gastric bypass surgery can lead to ID. true or false?

Answer 27

True. absorption is lower due to lower acid content in the gastric pouch and bypass of main absorption sites

Question 28

Short bowel syndrome leads to what?

Answer 28

B12 definiency since there is no ileum to absorb the B12