What Is Iron Deficiency Anemia Treatment?

It is the most common type of anemia in infancy. The underlying cause of this is a small cell hypochromic anemia that occurs due to iron deficiency in the body, resulting in reduced hemoglobin synthesis. In addition to clinical anemia, it can also reduce the biological activity of many iron-containing enzymes due to iron deficiency, which in turn affects cell metabolism and causes the body to experience gastrointestinal dysfunction, circulatory dysfunction, low immune function, mental and neurological symptoms and skin Mucosal lesions and other non-hematological manifestations.

Basic Information

English name

Nutritional Iron Deficiency Anemia

Visiting department

Pediatrics, Hematology

Multiple groups

6 months to 3 years old

Common causes

Low body iron content at birth, iron deficiency in diet, rapid growth in children, small amount of long-term blood loss, etc.

Common symptoms

Pale skin and mucous membranes, loss of appetite, palpitations, inattention, etc.

Causes of iron deficiency anemia in children

1. Iron content in the body at birth

The content of iron in newborns is mainly determined by blood volume and hemoglobin concentration.

Influencing factors: Blood volume is directly proportional to body weight. Therefore, the amount of iron in children is proportional to their weight. Therefore, the lower the birth weight, the less the total amount of iron in the body, the greater the possibility of anemia; such factors can exist in premature and low birth weight infants. The fetus is transfused with the mother or another fetus in the twins. Whether placental rupture and umbilical cord ligation were delayed during delivery.

In addition, mothers have iron-deficiency anemia during pregnancy, which is not positively related to infant anemia.

2. Iron deficiency in diet

Human milk has a high iron content and iron absorption rate. If the baby is breast-fed within 6 months after birth, hemoglobin and iron storage can be maintained within normal ranges. When breastfeeding is not possible, iron-fortified formula should be fed and supplementary foods added in time.

3. The relationship between growth rate and anemia

Children grow rapidly and blood volume increases quickly. Normally, infants will use stored iron for maintenance, and no need to add iron to food. However, before the weight was doubled, obvious iron deficiency anemia occurred, which was generally not caused by iron deficiency in the diet. Premature babies need much more than normal babies and need extra iron in their food.

4. Long-term small amount of blood loss

Acute blood loss does not exceed one-third of the total blood, and no additional iron supplements can be used to prevent anemia. However, in chronic chronic blood loss, the consumption of iron is more than double the normal, which can cause anemia. In infants less than 1 year old, the stored iron is used to supplement the blood volume expansion caused by growth. A small amount of chronic blood loss can lead to anemia. In addition, children who drink more than 1L daily with uncooked fresh milk may experience chronic intestinal blood loss. Therefore, it is best not to consume more than 750ml of fresh milk daily, or use evaporated milk. In addition, gastrointestinal malformations, polyps, ulcers, hookworm disease, pulmonary hemosiderin, and excessive menstrual flow in adolescents can also cause iron deficiency anemia.

5. Other reasons

In acute and chronic infections, the child loses appetite and has poor gastrointestinal absorption. Long-term vomiting and diarrhea, enteritis, and fatty diarrhea affect the absorption of nutrients.

Clinical manifestations of iron deficiency anemia in children

The onset is mostly from 6 months to 3 years old, and most of them start slowly.

General performance

Appears irritable or debilitated, does not like activities, and loses appetite. The skin and mucous membranes are pale, most notably the lips, oral mucosa, nail bed and palms.

2. Performance of hematopoietic organs

Mild swelling of the liver, spleen, and lymph nodes often occurs. The younger the age, the more severe the anemia, and the longer the course of the disease, the more obvious this symptom, but rarely more than moderate swelling.

3. Neuropsychological changes

The mild person is irritable and uninterested in the surrounding environment. Inattention, reduced understanding and slow response. Apnea may occur in infants and young children. School-age children behave abnormally in the classroom, such as chaos and non-stop movements.

4. Impact on metabolism

Metabolic disorders, lack of cytochrome enzyme system, decreased activity of enzymes such as catalase, and affect DNA synthesis. Loss of appetite, slowed weight gain, decreased gastric acid secretion, dysfunction of the small intestinal mucosa, and atrophy of the tongue and nipples. Hemophilia is less common in children.

5. Changes in heart function

Hemoglobin is reduced below 70g / L, and heart enlargement and murmurs may appear, which is a common manifestation of anemia. Hemoglobin drops below 50g / L, and it can induce heart failure when combined with respiratory infections.

6. Prone to infection.

Pediatric iron deficiency anemia examination

Blood image

Both red blood cells and hemoglobin are reduced, especially hemoglobin. Hematocrit: The hematocrit decreases accordingly, the average volume (MCV) is less than 80fl, the average hemoglobin (MCH) is less than 26pg, and the average hemoglobin concentration (MCHC) is less than 0.30. In the smear, the red blood cells become smaller, the staining is lighter, and the translucent area in the middle is enlarged. In severe cases, red blood cells may be ring-shaped. Fragility is reduced and nucleated red blood cells are rarely seen in peripheral blood. The Price-Jones curve shifts to the left and the base widens. The reticulocyte percentage was normal, and the absolute value was lower than normal. In cases of severe anemia, the number of white blood cells can be reduced, and a relatively high number of lymphocytes can occur. Most platelet counts are normal. In some cases, platelet counts can increase, but they can be slightly reduced in severe cases, but rarely cause bleeding.

2. Biochemical inspection

When iron is deficient, the levels of ferritin and hemosiderin in the liver and bone marrow are reduced. After that, serum ferritin decreases, and below 10 ng / ml, biochemical or clinical iron deficiency may occur. Since then, serum iron has fallen below 50 g / dl, serum iron binding capacity has increased above 350 g / dl, transferrin saturation has fallen below 15%, hemoglobin synthesis has decreased, and the accumulation of free protoporphyrins in red blood cells can be as high as 60 g / dl blood. The increase in the ratio of free protoporphyrin to hemoglobin (FEP / Hgb) in infants and young children is more meaningful for diagnosing iron deficiency anemia than reducing transferrin satiety. If the ratio is greater than 3 g / g, it is considered abnormal. If it is between 5.5 and 17.5 g / g, iron deficiency anemia can be diagnosed after excluding lead poisoning.

3. Myeloid

Bone marrow showed hyperplasia, the bone marrow cell count increased slightly, and the number of megakaryocytes was normal. The proportion of granulocytes and nucleated red blood cells is reduced, and red blood cells proliferate vigorously. Both juvenile red blood cells and juvenile red blood cells increased, especially juvenile red blood cells increased more significantly. The red blood cell line showed a decrease in cytoplasm, a decrease in hemoglobin content, and a cytoplasmic maturity lagging behind the nucleus. Bone marrow iron staining showed decreased iron granulocytes and hemosiderin.

4. Other inspections

B ultrasound can find hepatosplenomegaly and enlarged heart. Chronic intestinal blood loss and positive fecal occult blood. When a pulmonary infection is present, an inflammatory shadow can be seen on the chest X-ray and the heart can enlarge. With severe disease and long course of disease, radiation-like streaks of hemoglobin disease can be seen on the skull X-ray.

Pediatric Iron Deficiency Anemia Treatment

Take iron supplements and remove the cause of disease.

Iron treatment

Note that vitamin B ₁₂ and folic acid are not effective in treating iron deficiency anemia and should not be abused. Oral iron, oral inorganic salt is the most economical, convenient, and effective; iron injection is suitable for children who cannot tolerate oral iron, severe diarrhea, and anemia and severe illness.

2. Causative treatment

Improper diet must improve diet and feed reasonably. Surgery or deworming should be performed on intestinal malformations and hookworm disease after anemia is corrected. Fresh milk allergy can be changed to milk powder, evaporated milk, hydrolyzed protein milk powder, etc.

3. blood transfusion

Indications: Hemoglobin is below 30g / L in patients with severe anemia or with severe infection or urgent surgery.

Principle: Take a small number of times or input concentrated red blood cells, 2 ~ 3ml / kg each time.

Severe heart failure uses a blood exchange method to replace whole blood with concentrated red blood cells.

Prognosis of iron deficiency anemia in children

The prognosis is good. After treatment with iron, it can usually be cured. If the diet can be improved and the cause can be eliminated, there will be very little recurrence. For severely ill patients, due to severe infection and indigestion, timely rescue may result in death. For the later treated children, although the anemia is completely recovered, physical development and intellectual development will be affected.

Prevention of iron deficiency anemia in children

1. Can take ferrous sulfate, ferrous gluconate, plus vitamin C, can promote iron absorption.

2. Patients should eat more foods such as various lean meat, animal liver, animal blood, egg yolk and so on. Green leafy vegetables, soybeans and their products, fungus and mushrooms, sesame sauce, etc.

3. Don't drink iron with iron supplement diet: Many of the ingredients in tea can be combined with iron, which affects the efficacy of the drug. Do not take iron before meals: This is because iron has irritation to the gastric mucosa. Take it before meals, which makes it difficult for people to tolerate. It should be taken after meals. In addition, do not take iron with milk, because milk contains more phosphorus, which will affect the absorption of iron and reduce the efficacy.

4. Make good baby feeding instructions. Iron is well absorbed in breast milk, and breastfeeding is best. If breastfeeding is not available, use fortified iron formula.

5. Add iron-fortified diet. Full-term infants start from 4 to 6 months (no later than 6 months), and premature babies and low-weight infants start from 3 months to strengthen the iron content in the diet. The easiest way is to add ferrous sulfate to the milk formula or complementary foods, such as eating iron-containing cereals or using ferrous sulfate drops alternately. Ferrous sulfate drops should not be used for more than one month at home to avoid iron poisoning. In addition, after 6 months of artificial feeding, the amount of milk without iron should not exceed 750ml. Children and adults are advised to add 13 to 16 mg of iron per kilogram of flour. At the same time, care should be taken to increase the animal diet as much as possible.

6. Do a good job of health check-ups and conduct regular anemia screening to achieve early detection and early treatment.