Anemia in children

Anemia in children is a hematological syndrome characterized by a decrease in the concentration of hemoglobin and the number of red blood cells per unit volume of blood. With various forms of anemia, children have general weakness, fatigue, pallor of the skin and mucous membranes, dizziness, palpitations. Anemia in children is diagnosed according to clinical and laboratory data (general blood test, determination of bilirubin, serum iron, total iron binding capacity of serum, bone marrow punctate examination, etc.). The general principles of the treatment of anemia in children include the organization of rational nutrition, timely introduction of complementary foods, vitamin therapy, iron supplementation, FTL (gymnastics, massage, UFO), according to indications – carrying out blood transfusions.

General information
Anemia in children (anemia) is a pathological condition accompanied by a decrease in the level of hemoglobin and red blood cells in the child’s blood. Anemia in children is an extremely common disease in modern pediatrics. About 40% of cases of anemia are diagnosed in children under the age of 3 years; 30% – in the puberty period; the rest – in various age periods of the child’s development.

Reasons
Factors contributing to the development of anemia in children are divided into antenatal, intranatal and postnatal.

Antenatal factors act during intrauterine development. For the normal course of hematopoiesis processes in a child during pregnancy, his body must receive from the mother and accumulate a sufficient amount of iron (about 300 mg). The most intensive transfer of iron from the pregnant woman and its deposition in the fetus occurs at 28-32 weeks of gestation. Violation of the normal course of pregnancy during this period (gestosis, fetoplacental insufficiency, the threat of miscarriage, premature placental abruption, bleeding, infectious diseases of the mother, exacerbation of chronic processes) leads to a violation of iron metabolism and its insufficient accumulation in the child’s body. Anemia in children occurs if a woman also suffered from anemia during pregnancy. Multiple pregnancies contribute to the development of anemia in newborns.
Intranatal factors of anemia in children are mainly associated with blood loss during childbirth. Blood loss is possible in the case of premature placental abruption during childbirth, early or late ligation of the umbilical cord, the outflow of blood from the umbilical cord residue when it is improperly processed, the use of traumatic obstetric aids. Premature birth leads to the fact that anemia is detected in all premature babies from birth or approximately from the 3rd month of life.
Postnatal factors of anemia in children are included after birth and can be endogenous or exogenous. The causes of endogenous anemia in children can be damage to red blood cells due to hemolytic disease of newborns, abnormalities of hemoglobin synthesis, primary constitutional insufficiency of the bone marrow.
Anemia in children is most often caused by:

Alimentary reasons. In this case, anemia develops mainly in children of the first year of life who are on monotonous breastfeeding. Anemia in young children can occur with insufficient iron content in breast milk; early and unjustified transfer of the child to artificial or mixed feeding; use of unadapted mixtures, cow’s or goat’s milk for feeding; late introduction of complementary foods into the child’s diet. Premature babies and children born with an increased body weight need a higher intake of iron into the body. Therefore, the discrepancy between the intake and consumption of iron can also cause anemia in children of the first year of life.
Regular blood loss: with private nosebleeds, blood diseases (hemophilia, Willebrand’s disease), menorrhagia, gastrointestinal bleeding, after surgical interventions. In children with food allergies, exudative diathesis, neurodermatitis, there is an increased loss of iron through the epithelium of the skin, therefore, such children are at risk for the development of iron deficiency anemia.
Insufficient absorption of iron. In addition to the loss of iron, the development of anemia in children can lead to a violation of its absorption and metabolism. Such disorders are usually found in malabsorption syndrome (hypotrophy, rickets, lactase deficiency, celiac disease, intestinal form of cystic fibrosis, etc.). Anemia in children can be a consequence of any infectious or chronic somatic disease (tuberculosis, bacterial endocarditis, bronchiectasis, pyelonephritis, etc.), leukemia, mycosis, worm infestation, collagenosis (SLE, rheumatoid arthritis, etc.).
Vitamin deficiency. In the development of anemia in children, a deficiency of B vitamins, trace elements (magnesium, copper, cobalt), unfavorable hygienic conditions, depletion of endogenous iron reserves, which occurs in an infant by 5-6 months, has a certain importance.
Pathogenesis
The frequent occurrence of anemia in children is due to their intensive growth, the activity of the erythropoiesis process, a progressive increase in the number of shaped elements and BCC. At the same time, the hematopoiesis apparatus in children is functionally immature and very vulnerable in the face of various influences. The normal course of hematopoiesis in children requires a large amount of iron, protein, vitamins and trace elements, so any feeding errors, infections, toxic effects on the bone marrow can cause the development of anemia in a child. Especially sensitive in this regard are children of the second half of life, whose neonatal iron reserves are depleted.

Long-term anemia in children is accompanied by the development of hypoxia, deep tissue and organ changes. Children with anemia lag behind in physical and mental development from healthy peers, more often suffer from intercurrent diseases, are prone to the development of chronic pathological processes and various kinds of complications.

Classification
In accordance with etiopathogenesis , the following groups of anemia are distinguished:

I. Posthemorrhagic anemia in children due to acute or chronic blood loss.

II. Anemia in children caused by a violation of hematopoiesis:

iron-deficient (hypochromic)
hereditary and acquired iron-saturated (sideroachrestic – associated with defects in porphyrin synthesis)
megaloblastic (B12-deficient and folic-deficient)
hereditary and acquired dyserythropoietic
hereditary and acquired hypoplastic and aplastic (associated with hematopoiesis inhibition)
III. Hereditary and acquired hemolytic anemia in children caused by increased destruction of erythrocytes and the predominance of the process of blood destruction over the process of blood formation (membranopathy, fermentopathy, hemoglobinopathy, autoimmune anemia, hemolytic disease of newborns, etc.).

Symptoms of anemia in children
The norm of blood hemoglobin in children under 6 years of age is 125-135 g / l; anemia in a child is said if this indicator falls below 110 g / l (in children under 5 years of age) and below 120 g / l (in children over 5 years of age).

Visible changes in anemia in children are observed from the skin and its appendages: the skin becomes pale, dry, flaky; nails deform and become brittle; hair loses its healthy shine. A characteristic sign of anemia in children is Filatov’s symptom – pallor of the earlobes when examined in passing light. In severe forms of anemia, cracks appear on the palms and soles of children, in the corners of the mouth; aphthous stomatitis, glossitis develops. Children with anemia are weakened, asthenic, often suffer from acute respiratory infections, bronchitis and pneumonia, acute intestinal infections.

On the part of the nervous system experiencing hypoxia, there is lethargy, tearfulness, rapid exhaustion, dizziness, superficial sleep, enuresis. There is a decrease in muscle tone, the child does not tolerate physical exertion, gets tired quickly. Hypotrophy is noted in children of the first year of life, there is a regression of psychomotor development.

Anemia in children reveals disorders of the cardiovascular system in the form of arterial hypotension, orthostatic collapses, fainting, tachycardia, systolic noise. On the part of the digestive system, children with anemia experience frequent regurgitation and vomiting after feeding, flatulence, diarrhea or constipation, decreased appetite, possibly an increase in the spleen and liver.

Diagnostics
Laboratory tests form the basis for the diagnosis of anemia in children. In the general blood test for anemia in children, a decrease in hemoglobin (Hb less than 120-110 g / l), a decrease in Er (<3.8 x 1012 / l), a decrease in CP <0.85 are detected. Biochemical blood testing includes the determination of serum iron, transferrin saturation with iron, serum ferritin concentration, bilirubin, vitamins. In some cases, a puncture and bone marrow examination are required.

In the process of diagnosis, the form and severity of anemia in children is determined. The latter is estimated by the content of erythrocytes and hemoglobin:

anemia of mild degree – Hb 110-90 g/l, Er – up to 3.5 x1012/l;
anemia of moderate degree – Hb 90-70 g/l, Er – up to 2.5 x1012/l;
severe anemia – Hb less than 70g/l, Er – less than 2.5 x1012/l.
According to indications, children with anemia may need consultations of narrow specialists (pediatric gastroenterologist, pediatric rheumatologist, pediatric nephrologist, pediatric gynecologist, etc.), examination of the gastrointestinal tract (EGDS, ultrasound of the abdominal cavity) and kidneys (ultrasound of the kidneys).

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