Prevention of Nutritional Anemia's

Question 1

ID Risk Factors

Answer 1

Children living at or below the poverty level

Black and Hispanic children

Question 2

IDA Risk Factors

Answer 2

Childhood obesity
History of prematurity
Low-birth-weight
Immigrant groups

Question 3

Iron Requirements

Answer 3

Infants:
Full-term—if breast fed, begin iron supplementation at 4 months/premature start at 1 month
Formula fed use iron rich formula

Avoid feeding cow’s milk until age 12 m

Children age 1-5 yrs should consume no more then 20 oz of cow’s milk/d + adequate iron-containing foods

Question 4

Treatment For infants with confirmed IDA

Answer 4

Ferrous sulfate(3 to 4 mg/kg of elemental iron

In divided doses, between meals with juice) remains the standard therapy

Iron-fortified formulas and iron supplementation at these doses are infrequent causes of gastrointestinal symptoms

Larger doses rarely are necessary and may produce some degree of intolerance

Question 5

Adverse Reactions of Iron Supplements

Answer 5

GI: GI irritation, epigastric pain, nausea, diarrhea, dark stools, constipation

GU: black or dark urine

Misc: liquid preparations can temporarily stain teeth (brush or rinse immediately after giving!)

Question 6

Prevention of Iron Deficiency Anemia

Answer 6

Full-term infant  
  1 mg/kg (max 15 mg), start no later than 4 months in breastfed infants
Premature
  2 mg/kg (max 15 mg), start no later than 2 months in breastfed infants
1-10 y/o
  10 mg/day
11-adult (female)
  15 mg/day
11-adult (male)
  12 mg/day

Question 7

Increased folate in Pregnancy

Answer 7

For increased red cell mass

Prevention of neural tube defects in fetus

Question 8

Anemia in Pregnancy

Answer 8

There is a greater expansion of plasma volume, then there is an increase in Hgb mass = Physiological anemia
In the 1st and 3rd trimesters—Hgb < 11 g/dL is defined as anemia
In the 2nd trimester—Hgb < 10.5

To prevent too great a degree of anemia recommend—30 mg/day of iron

Question 9

Short Bowel Syndrome

Answer 9

Leads to B12 deficiency since there is no ileum to absorb the B12

Question 10

Gastric Bypass SurgeryPost Gastrectomy

Answer 10

Bypassing the duodenum and loosing most of the stomach

Part or all of the stomach is removed because of cancer or refractory ulcers

Question 11

Anemia in Alcoholics

Answer 11

Usually macrocytic although can be mixed if they have chronic blood loss and iron deficiency

Most common cause of folic acid deficiency in the U.S.