Prevention of Nutritional Anemias Flashcards
Risk factors for Iron Deficiency?
Children living at or below the poverty level
Black and Hispanic children
Risk factors for Iron deficiency Anemia?
Childhood obesity
History of prematurity
Low-birth-weight
Immigrant groups
How much of the daily iron need should come from diet in infants and children?
30%
The normal term infant is replete of iron the first how many months?
5-6 mo
What condiditons can lead to iron deficient anemia in infants?
5
- Prematurity:
- Fetal-maternal hemorrhage
- Twin-twin transfusion syndrome
- Other perinatal hemorrhagic events
- Insufficient dietary intake
What factors in prematurity lead to iron deficeint anemia?
3
- smaller total blood volume at birth
- increased loss through phlebotomy
- gastrointestinal absorption 4. despite decreased ferritin concentrations
Dietary factors leading to IDA?
4
- insufficient iron intake
- Poor iron absorption
- Early introduction to cows milk
- Meds: aspirin and NSAIDS
What type of malabsorption states lead to IDA?
4
Celiac disease
Crohn’s disease
Giardiasis
Resection of the proximal small intestine
Why does ealry introduction of cow’s milk lead to IDA?
2
- Occult blood loss secondary to cow’s milk intolerance
2. Whole cow’s milk increases intestinal blood loss in infants
If an infant is breast fed when should they recieve iron supplementation?
What if they are on formula?
at 4 months/premature start at 1 month
Formula fed use iron rich formula
When should we avoid feeding ababy cows milk?
until 12 months
No more than 20 oz a day until 5 yrs
What kind of anemia is IDA?
Microcytic, hypochromic,
What is the most common presentation for a child/infant with IDA?
Most common presentation is asymptomatic, well nourished child w/ mild microcytic, hypochromic anemia
What can IDA cause in infants?
3
- impaired psychomotor and/or
- mental development/
- cognitive impairment
What is the most important screening test for detecting IDA?
careful dietary history
What are the dietray risk factors that could cause IDA?
For infants:
For preschool aged kids:
- Infants: use of low iron formula, cow’s milk, goat’s milk or soy milk before 1 yr of age
- Pre-school age children: milk intake > 24 oz a day, fewer then 3 servings daily of iron rich foods (iron fortified cereal/meats)
When should risk assessment for iron deficiency be done in infants and children according to the AAP?
4, 18, and 24 months of age, and annually thereafter
What blood test is reccommended at 12 mo of age by the AAP?
What is an abnormal level for Hg?
Ferritan can be measured but why is it not an accurate idea of iron levels?
A hemoglobin or hematocrit is recommended at 12 months of age
Hg
In what conditions do you have a microcytic anemia?
3
thalasemmia, anemia of chronic disease, iron deficiency
In what conditions will you have a macrocytic anemia?
3
B12, folate, Myleplastic disorders
In children thought to be anemic what kind of testing should we do?
2
Complete blood count, with smear
Reticulocyte count
Once the diagnosis of IDA is established what should we do next?
3
- The child should have a careful dietary history
- Be screened for lead poisoning
- Have stools screened for occult blood three times
How should we approach a patient that is a young female who is found to be anemic?
3
- If they have a history of heavy menses
- They can be put on a trial of iron supplementation (if their dietary screen is satisfactory)
- If their Hgb does not normalize in 3 months then further studies need to be done
What is considered a low HgB that we need to check in on?
less than 7
What should we give infants presenting with IDA?
What should we give with it?
Ferrous sulfate
Take once or twice daily inbetween meals (not with food)
juice-better absorbed with acid
Biggest symptom with iron supplement?
2
DARK STOOLS
GI Upset
nausea, vomitting etc
What are the four types of iron supplements?
ferrous sulfate
ferrous gluconate
ferrous fumarate
Polysaccharide iron
GI adverse reactions of iron supplements?
6
- GI irritation,
- epigastric pain,
- nausea,
- diarrhea,
- dark stools,
- constipation
GU adverse reactions of iron supplements?
black or dark urine
What can liquid preparations of iron supplements do?
stain teeth
rinse them
How much iron should a full term infant get to prevent IDA?
1 mg/kg (max 15 mg), start no later than 4 months in breastfed infants
HOw much iron should a premature infant get to prevent IDA?
2 mg/kg (max 15 mg), start no later than 2 months in breastfed infants
How much should a 1-10yr get to prevent IDA?
10 mg/day
How much should an 11-adult female get to prevent IDA?
15mg/day
How much iron should 11-adult male get to prevent IDA?
12mg/day
What foods should be reccommended to parents to increase iron absorptions in babies over 6 months of age?
2
- foods rich in Vitamin C (citrus fruits, tomatoes, dark green vegetables—beware of juices!)
- The introduction of pureed meats—which increase absorption of nonheme iron
Physiological changes with pregnant include increased iron (2) and folate requirements (2). Why?
Maternal iron requirements average close to 1000 mg over the course of pregnancy:
- -300 mg for the fetus and placenta
- -500 mg for expansion of the maternal Hgb
For increased red cell mass
Prevention of neural tube defects in fetus
What causes anemia in pregnancy?
greater plasma volume and no increase in HgB.
In the 1st and 3rd trimester what value is defined as anemia?
IN the 2nd trimester what is defined as anemia?
Hgb
How much iron is recommended a day for pregnant women?
30 mg/day
What is the reccommended does of folic acid for pregnant women?
0.4 mg/day
Alcohol abuse anemia is multifactorial. In which ways does it cause anemia?
4
- actetaldehyde is a hematologic toxin
- Malnutrition can lead to b12 and folate deficiency
- Chronic GI bleeding (ulcers, esophygeal varices)
- Chronic illness from alcoholism leads to anemia of chronic disease
What is R factor?
R factor is in saliva and gastric juice. Takes to stomach and then hands it off to the IF in duodenum. Absorbed in ileum
What kind of anemia do alcoholics have usually?
macrocytic
What is the most common cause of folic acid deficiency?
alcoholism
Treatment and prevention of alcoholic anemia?
5
Stop alcohol!!!
Improve nutrition
Supplement folate & B12 as needed
Workup for GI bleeding
Workup for chronic disease
Why do pt that have gone through Gastric Bypass Surgery
Post Gastrectomy have anemia sometimes?
How should we treat this?
Absorption of dietary iron is reduced due to lower acid content in the gastric pouch and the bypass of its main sites of absorption (the duodenum and proximal jejunum)
Prophylactic iron supplementation
What kind of anemia does the short bowel syndrome lead to?
B12 deficiency, macrocytic anemia
No ileum to absorb B12
IN A patient with microcytic and hypochromic anemia what would the iron panal show?
3
serum iron ferritin-low
iron binding capacity-elevated
transferrin saturation-low
