Iron deficiency anemia in children: symptoms, causes and treatment. Causes, symptoms and methods of treating anemia in children Prevention of anemia

Anemia (anemia) is a condition in which there is a low level of hemoglobin in the blood. This pathology affects both adults and children. However, in childhood, anemia poses an increased danger. That is why timely detection of anemia and its proper treatment are important.

Mechanism of anemia development

Hemoglobin is a protein found in the most important blood cells - red blood cells. The function of hemoglobin is to deliver oxygen to tissues. If there are fewer red blood cells than normal or if the red blood cells contain insufficient hemoglobin, the person will experience signs of anemia. Consequently, the main danger of anemia is a lack of oxygen in the body, oxygen starvation of tissues.

Anemia is a symptom, evidence of pathological processes in the body, and not the disease itself. Therefore, anemia is always caused by some extraneous reasons:

• Blood loss;
• Deficiency of iron, vitamin B12, folic acid;
• Violation of red blood cell synthesis;
• Accelerated destruction of red blood cells;
• Chronic infectious diseases;

The most common type of anemia is iron deficiency (IDA). It occurs in 90% of cases. Iron is a key element that allows hemoglobin to take up oxygen, so a decrease in iron intake or loss leads to the immediate development of oxygen starvation.

Anemia in children

Anemia is more common in childhood than in adults. There are two main reasons for this. Firstly, in childhood the mechanism of hematopoiesis is not so well developed. The second reason is rapid growth babies, due to which their body requires a lot of iron.

Hemoglobin norms in childhood

Newborns usually have very high hemoglobin levels. This is explained by the fact that in order to form red blood cells, the child’s body takes iron from the mother. However, once these iron stores are depleted, hemoglobin begins to fall.

Causes of anemia in childhood:

• Unbalanced diet;
• Regular bleeding;
• Diathesis, allergies;
• Infectious diseases;
• Helminthic infestations.

Children under 3 years of age are most susceptible to anemia. This is explained by the fact that it is during this period that the body grows most intensively.

Prevalence of anemia in children of different ages

The most common causes of pathology in newborns and infants are:

• Low maternal hemoglobin levels
• Prematurity,
• Deviations in the course of pregnancy.

Iron deficiency anemia is especially common in childhood, as in adults. A child's body requires an increased amount of iron, and iron can only be supplied to the body through food.

Iron intake standards depending on age

Infants receive iron from their mother's milk. Consequently, the longer breastfeeding continues and the later the child switches to artificial feeding, the less likely it is that anemia will occur in an infant.

Why is anemia dangerous for children?

The consequences of this syndrome are especially dangerous in childhood. Indeed, at this time, the body’s protective resources to fight pathology are limited.

Hypoxia, characteristic of anemia, attacks all organs and tissues. But first of all, the consequences of a lack of hemoglobin affect the brain. The heart and kidneys are less affected.

The consequences of pathology should not be underestimated. Although it is usually not fatal, this condition requires increased attention and timely treatment.

Anemia occurs in children:

• Light weight,
• Slow growth
• Delayed mental and mental development,
• Deterioration of memory and attention,
• Reduced immunity,
• Increased morbidity
• Low activity
• Fatigue quickly
• Frequent allergic reactions.

Interruptions in the functioning of the heart, heart failure, inflammatory diseases of the heart muscle (myocarditis) may occur.

Anemic children are usually whinier and more irritable than their peers. They suffer from insomnia or drowsiness and have no appetite.

Symptoms specific to IDA:

• Pale, dry skin;
• Brittle nails;
• Ulcers in the corners of the mouth;
• Disorders of the gastrointestinal tract;
• Low blood pressure;
• Tachycardia;
• Headache, dizziness, tinnitus;
• Paleness of the skin (primarily lips and eyelids), mucous membranes;
• Change in taste, tendency to eat earth, clay, lime, etc.

Blood tests show a low hemoglobin content. This is the main diagnostic sign. They also have diagnostic value:

• number of red blood cells and reticulocytes,
• blood color index,
• serum iron (transferrin) and ferritin levels,
• transferrin binding capacity.

All these indicators, with the exception of the binding capacity of blood serum, are reduced in IDA.

The severity of symptoms depends on the degree of anemia. There are three degrees of pathology.

Degrees of anemia

If you suspect a lack of hemoglobin, you should immediately consult a doctor. Only in this case can unpleasant consequences for the patient’s health be avoided. For successful treatment it is necessary to identify the causes of the syndrome. If this is a lack of iron from food, then it is necessary to balance the baby’s diet. Most iron is found in liver meat products, nuts and fruits. Tea and milk reduce iron absorption. And vitamin C, citric acid, fructose enhance its absorption. Infants can be given iron-fortified formula.

If improving your diet is not enough, your doctor may prescribe. It should be remembered that self-treatment with iron supplements is dangerous, as it can lead to poisoning. Iron-containing preparations are available in the form of syrups, which are convenient to give to children. Among such drugs we can mention Actiferrin, Ferrum Lek, Ferronal.

The drugs are taken until the level of hemoglobin in the blood stabilizes, and then for some more time so that a reserve of iron is formed in the liver.

Contrary to popular belief, anemia in children these days is not such a rare disease. And it is not at all necessary that anemia occurs in the so-called dysfunctional families or due to poor nutrition, both for the mother herself during pregnancy or breastfeeding, and for the baby herself.

Causes of anemia in children

Anemia means: pathological condition, in which there is a decrease in the content of hemoglobin and red blood cells in the blood. So, normal indicator, within the physiological norm for a child under 7 years old, a hemoglobin level is considered to be within the range of 125 – 135 grams per liter. Any deviation towards a decrease in the amount of hemoglobin is pathological and requires mandatory therapeutic treatment from a specialist.

The main causes of anemia in children are age-related characteristics of the hematopoietic apparatus.

Experts distinguish 2 types of anemia:

• exogenous (in other words, external) origin;
• endogenous (internal) origin.

The causes of anemia in children of exogenous origin are usually:

• monotonous, meager food. Occurs in children when breastfeeding, especially if the nursing mother herself has a deficiency of iron in the blood. This anemia is also called nutritional anemia. With a monotonous diet, the diet lacks a number of amino acids that are involved in the synthesis of hemoglobin;
• infectious diseases, most often pyogenic infections, which lead to the development of hypochromic anemia. Hypochromic anemia is also caused by helminthic infestations;
• irregularities in work gastrointestinal tract, which lead to poor absorption of nutrients necessary for the production of hemoglobin. Such disorders include gastritis with low acidity, or achylia, ulcerative lesions of the stomach, pancreas, intestines, various enzymatic disorders, including those of a hereditary nature, enterocolitis, etc.

The causes of anemia in children of endogenous origin are primarily associated with:

• hemolysis, that is, damage to red blood cells. This phenomenon often occurs in newborns with Rh conflict (when the blood of the mother and fetus are incompatible according to the Rh factor);
• hereditary diseases of the hematopoietic organs, for example, anemia of the Minkowski-Choffard, Lederer type, etc.;
• abnormalities of hemoglobin synthesis (thalassemia and sickle cell anemia);
• insufficient development of the bone marrow responsible for hematopoiesis (aplastic and aregenerative anemia). This anemia is typical for premature babies.

Main signs of anemia in children

Any disease of the hematopoietic organs is characterized by gradually increasing symptoms and it is impossible not to notice changes both in the child’s behavior and in his appearance.

The main signs of anemia in children of any age are, first of all:

• increasing weakness and lethargy of the child;
• restless sleep, sleep dysfunction;
• pallor of the skin and mucous membranes;
• swelling and puffiness of the face, especially pronounced after sleep;
• tearfulness, moodiness, emotional instability, increased lability, restlessness, very low concentration, memory impairment, and even motor coordination;
• headaches, palpitations and shortness of breath that occur with the slightest physical exertion, fainting is possible;
• delay in physical and mental development, which is especially dangerous for children under one year old;
• dryness and hyperkeratosis (thickening and roughening of the skin on the elbows and knees) of the skin, seizures in the corners of the lips, brittle nails and hair loss, even alopecia;
• darkening and tarnishing of tooth enamel, late teething;
• from the gastrointestinal tract there is a tendency to functional failure, that is, to slow and sluggish digestion, lack of appetite, taste distortion, sudden weight loss, constipation, even intestinal atony;
• significant general decrease in immunity (frequent recurrent acute respiratory viral infections and acute respiratory infections that are difficult to treat).

Any of the above signs of anemia in children should be a reason to contact a specialist. Diagnosis of anemia is carried out using general analysis blood, after which the type and type of anemia is determined and symptomatic treatment is prescribed. It should be noted that such treatment, as a rule, is very long-term and one should not neglect the recommendations of a hematologist, otherwise the disease may become chronic.

Prevention of anemia in children

Along with taking special medications and proper symptomatic treatment, the prevention of anemia is very important. This concept includes the following factors:

• normalization of diet;
• normalization of work and rest regimes;
• hardening of the body.

Prevention of anemia in children is mainly related to nutrition. The more varied the baby’s food, the more essential vitamins, minerals and microelements will be supplied to the body. The better the hematopoietic apparatus will function, producing the necessary hemoglobin and saturating the child’s blood with oxygen. And this contributes not only to its healthy development, but also to high mental and physical activity, and the full growth of tissues and cells of the body.

The diet of a healthy child, and even more so of a child suffering from anemia, must contain vitamins C, E, group B, microelements - iodine, manganese, iron, copper, potassium, magnesium, etc.

The diet of a child with anemia should be varied and include not only fruits, vegetables, cereals, but also meat products. For preventive purposes, children are prescribed fish oil. But by itself proper nutrition for an anemic child will not have the desired effect if he has concomitant diseases of the gastrointestinal tract.

Prevention of anemia in children also includes massages, mandatory feasible physical activity, sports, exposure to ultraviolet rays, hardening and water procedures. It is with this integrated approach that one can achieve either complete cure from anemia, or reduce the risks to the child’s health and thereby improve his quality of life in case of hereditary diseases.

Blood carries large number nutrients that a child’s body needs for growth and development. Red blood cells or erythrocytes are responsible for this process. When their number decreases, children develop anemia.

What is it?

Anemia is a condition in which there is an insufficient amount of hemoglobin or red blood cells. It is quite common in children's practice. According to world statistics, this disease is registered in every fourth child born.

Red blood cells normally must transport hemoglobin to tissues throughout the body. It contains protein structures and iron. This special chemical structure allows red blood cells to perform a transport function. They deliver oxygen to all cells of the body.

Hemoglobin levels change significantly with age. During breastfeeding, the baby receives a sufficient amount of iron through breast milk. After stopping such feedings, the baby's hemoglobin reserves last for several months.

If, after stopping breastfeeding, the child’s diet is poor and does not contain sufficient amounts of all nutrients and microelements, this quite often leads to the development of anemia.

The average normal hemoglobin level in a child by the age of seven is about 120 g/liter. A decrease in this indicator below 110 already indicates the presence of an anemic process.

As you get older, hemoglobin and red blood cell levels change. This is due to the development of functional changes in the hematopoietic organs.

The peak incidence occurs between 3 and 10 years of age. Every child can get anemia, regardless of age, gender and place of residence. There is a huge amount various types anemia. Different diseases and provoking circumstances lead to the development of each specific form.

Reasons

For the development of a persistent decrease in the total number of red blood cells or hemoglobin, prolonged influence of some factor is necessary. This contributes to disruption of tissue metabolism in the child’s body and leads to the development of anemia.

Among the most common reasons:

• Poor nutrition. Insufficient intake of foods containing iron or folic acid leads to the development of anemia.
• Low intake of vitamin C or ascorbic acid from food. This biologically active substance is involved in tissue metabolism and helps maintain a normal number of red blood cells.
• Chronic diseases digestive system. Gastritis, enteritis or inflammatory diseases of the gastrointestinal tract often cause metabolic disorders, which leads to anemia.
• Diseases of the hematopoietic organs. Pathological conditions that arise in bone marrow or spleen, often lead to disruption of the formation of a new generation of red blood cells.
• Prematurity. Premature birth leads to the formation of anatomical developmental defects. The organs of the hematopoietic system have developmental abnormalities, which inevitably lead to the development of anemia in the future.
• Exposure to adverse environmental factors. Polluted air from high content toxic substances leads to disruption of tissue metabolism, and subsequently to persistent anemia.

• Frequent infectious diseases. Excessive viral or bacterial load leads to rapid depletion of the immune system. Fighting infections requires a huge amount of energy. It is taken from hemoglobin. With frequent infectious diseases, the amount of this substance decreases, which leads to the development of anemia.
• Congenital forms. They arise due to underdevelopment of the hematopoietic organs. This pathology usually develops in the first trimester of pregnancy. After birth, the baby experiences a decreased level of hemoglobin or red blood cells.
• Oncological diseases. Even when tumors are localized in different organs, anemia can develop. Tumor growth also requires increased amounts of nutrients, just like normal healthy cells. Increased consumption of nutrients and hemoglobin leads to the development of persistent anemia.

• Bleeding or consequences of injury. Large blood loss causes a general decrease in the level of hemoglobin and red blood cells. Such forms are called posthemorrhagic. They can also occur due to tuberculosis or the disintegration of a large tumor.
• Hereditary. They have a pronounced genetic predisposition. Thus, with Fanconi anemia, the formation of new red blood cells is impaired due to insufficient bone marrow function. Such forms are quite rare in children.
• Long-term use of various medications. Cytotoxic drugs, sulfonamides, benzene compounds, as well as some antibacterial drugs can cause anemia.
• Incorrectly provided surgical assistance during childbirth. Untimely separation of the placenta, poor-quality ligation of the umbilical cord or other errors during childbirth can cause the development of anemia in the child in the future.
• Rheumatological diseases. Systemic lupus erythematosus or rheumatoid arthritis are often the causes that lead to the appearance of anemic signs in babies. The first symptoms are registered as early as 2 years.
• Autoimmune diseases. Lead to a decrease general content hemoglobin in red blood cells, which leads to the development of anemia.

Classification by disease mechanism

Currently, there are a huge variety of different anemic conditions. Modern classifications make it possible to distribute pathologies similar in reasons of development into certain groups. This allows doctors to accurately determine the cause of the disease and verify the diagnosis.

All anemic conditions can be divided into several groups:

• Hemolytic. Characterized by increased destruction of red blood cells. Often occur as hereditary diseases or as a result of long-term use of medications.
• Posthemorrhagic. Occur after massive bleeding, leading to a pronounced loss of circulating blood volume. They can occur at any age. They are characterized by both a decrease in the total number of red blood cells and hemoglobin.
• Iron deficiency. Characterized by low iron levels. Such deficiency forms of anemia occur mainly due to poor nutrition, as well as chronic intestinal diseases. They can also become the only manifestation of a growing tumor. They can be hyper- and hypochromic.
• Folate deficient. Occurs with reduced folic acid levels. Most often they begin to develop during the period of intrauterine development. They can occur in babies and after birth as a result of insufficient intake of folic acid from the outside, as well as in chronic diseases of the stomach and intestines.

• B12-deficient. Characterized by low levels of vitamin B12 in the body. They develop in diseases of the gastrointestinal tract, as well as during helminthic infestations. They are often combined with folate deficiency anemia.
• Hereditary. As a result of Minkowski-Choffard disease, rapid and pathological destruction of altered red blood cells occurs. Hereditary forms of the disease are quite rare. Every three out of ten thousand babies born have this disease. The disease manifests itself already in the 1st year of a child’s life, having a genetic predisposition.
• Hypoplastic or aplastic. Occur due to impaired bone marrow function. As a result of this condition, virtually no new red blood cells are formed. The accelerated destruction of red blood cells only worsens the anemic condition.

Classification by severity

During the development of anemia, the level of hemoglobin decreases. The lower it is, the more adverse anemic symptoms can develop. This classification makes it possible to establish the severity of the disease, taking into account the quantitative determination of the level of hemoglobin in the blood.

According to the level of reduction of this indicator, all anemias are divided into:

• Lungs. The hemoglobin level is more than 90 g/liter. The severity of clinical symptoms is insignificant. Often this condition is detected accidentally during screening or when taking a general blood test due to other diseases.
• Medium heavy. Hemoglobin levels range from 70 to 90 g/liter. Symptoms are more pronounced. Strong changes in tissue respiration are observed. The condition requires mandatory treatment and prescription of medications for a course.
• Heavy. Occur when hemoglobin decreases below 70 g/liter. Accompanied by severe disturbance general condition. They require immediate identification of the cause of the disease and immediate prescription of medications.

Symptoms

The first signs of an anemic condition can appear even in young children. They are often non-specific. This significantly complicates the possibility of establishing a diagnosis in the early stages. Typically, the symptoms of anemia begin to manifest themselves quite clearly when hemoglobin drops below 70-80 g/liter.

The most common manifestations of anemia are:

• Change in general condition. Babies become more lethargic. Even after their usual activities, they get tired faster. Teenagers experience rapid development of fatigue even after 2-3 lessons at school. Habitual daily activity can lead to increased general weakness.
• Pale skin. In some cases, the skin even takes on a somewhat earthy color. With a pronounced decrease in hemoglobin levels, you may notice blue lips and blanching of visible mucous membranes.
• Quick change of mood. Children are more likely to be capricious. Even the calmest child can become capricious and very whiny.
• Increased feeling of anxiety. The child becomes more nervous. Some babies have sleep disturbances.
• Persistent increase in body temperature to subfebrile levels. Usually it increases to 37 degrees and lasts for a long time. In this case, the baby does not have a runny nose, cough or any other catarrhal symptoms.
• Changing eating habits. Disturbances in tissue metabolic processes lead to the development of abnormal or uncharacteristic taste desires for the child. For example, some children begin to chew chalk. The child's appetite may decrease and taste preferences may change.

• Marked chilliness. Typically, children complain that their hands and feet are very cold.
• Instability of blood pressure. Some babies often experience hypotension.
• Rapid pulse. The lower the level of hemoglobin in a child’s body, the higher the tachycardia. With an excessively low amount of hemoglobin, a decrease in oxygen in the tissues is observed. This leads to the development of tissue hypoxia and starvation of cardiac muscle cells.
• Weak immunity. Insufficient nutrients resulting from decreased hemoglobin levels lead to poor functioning of immune system cells. With such a long-term condition, secondary immunodeficiencies develop.
• Disorders of the digestive system. Babies may experience diarrhea or constipation and may experience difficulty swallowing while eating.
• Secondary nonspecific signs: excessive hair loss, frequent dental caries, severe dry skin, formation of small ulcers around the lips, increased brittleness of nails.

Features of iron deficiency anemia in children

This type of anemic condition is most common in pediatric practice. It occurs as a result of insufficient intake of iron from food, and also in some cases due to the active destruction of red blood cells present in the body. This is caused by various diseases of the gastrointestinal tract.

Iron deficiency anemia is common throughout the world. According to European studies, every second child with anemic syndrome has iron deficiency. Normally, the content of this microelement in the body is about four grams. This amount is quite enough to perform basic functions.

Almost 80% of iron is contained in hemoglobin. There it is in an active state, since red blood cells constantly carry out the transport function of transporting oxygen and nutrients throughout the body.

There is also a safety stock. It is found in the liver and macrophages. This iron is in an inactive state. The body makes such a strategic reserve in case of severe blood loss or possible injury, which will be accompanied by severe bleeding. The share of reserve iron is 20%.

Iron enters the body with food. For the proper functioning of the hematopoietic organs, 2 grams of this substance is usually sufficient. However, if the child has chronic diseases of the stomach or intestines, then the amount of incoming iron should be greater. This is also facilitated by the concomitant rapid loss of red blood cells as a result of erosions or ulcers, which occur in diseases of the gastrointestinal tract.

To treat iron deficiency anemia in children, a special diet is required. It takes quite a long time to maintain such a diet until the condition completely stabilizes.

Typically, it may take 6 months or more to normalize the level of iron in the body and permanently consolidate the result.

In severe cases of the disease, the prescription of special iron-containing drugs is required. Such medications help replenish iron deficiency in the child’s body and lead to normalization of the condition. They are usually prescribed for long-term use. During treatment, mandatory monitoring of hemoglobin levels in the blood is carried out.

Diagnostics

To determine the presence of anemia, you should first perform a routine blood test. A decrease in the level of hemoglobin or red blood cells below the age norm indicates the presence of signs of anemic syndrome.

To determine the type of anemia, the color index is also often assessed. Normally it should be 0.85. If this value is exceeded, they speak of hyperchromic anemia, and if it decreases, they speak of hypochromic anemia. Such a simple diagnosis helps doctors establish the correct diagnosis and identify the cause that contributed to the development of the anemic condition.

In case of iron deficiency anemia, they resort to determining the total amount of iron in the body, as well as transferrin indicators. It shows how well the red blood cell is filled with iron from the inside. Ferritin levels help clarify the nature and cause of iron deficiency anemia.

To determine hypoplastic anemia, you will need to determine the level of bilirubin. Analysis of the content of vitamin B12 and folic acid in the body will help in clarifying the diagnoses of anemic conditions that arise from their deficiency.

In difficult diagnostic cases, the pediatrician will recommend contacting a gastroenterologist, cardiologist, rheumatologist, or nephrologist. These specialists will help clarify the presence of various chronic diseases internal organs which could cause the development of anemic syndrome in a child.

Ultrasound examination of the liver and spleen makes it possible to clarify the presence of pathology in these organs responsible for hematopoiesis. Aplastic anemia may require a bone marrow biopsy. Only with such a study can it be determined as a result of which the anemic syndrome developed.

Complications

If not diagnosed promptly, an anemic condition can be very dangerous. Prolonged oxygen starvation of body tissues leads to the development of persistent abnormalities in the functioning of internal organs. The longer hypoxia develops, the greater the likelihood of complications.

Most often, anemic syndrome leads to:

• Development of immunodeficiency states. An insufficiently active immune system makes the baby more susceptible to various infectious diseases. Even a common cold can last quite a long time and require higher doses of medications.
• Development of cardiovascular pathologies. An anemic state contributes to the development of oxygen starvation. Particularly dangerous this process for the heart muscle and brain. With prolonged hypoxia, which develops as a result of anemia, myocarditis can occur. This condition is manifested by a violation of the contractile function of the heart and leads to heart rhythm disturbances.
• The appearance of persistent disorders of the nervous system. Severe dizziness, a feeling of pulsation in the temples, a diffuse severe headache - all these signs can be manifestations of complications of an anemic condition.
• Development of pathological conditions of the gastrointestinal tract. Long-term stool disorders can lead to the development of dysbiosis and irritable bowel syndrome in children.
• Memory impairment and difficulty remembering new material. This manifestation of the disease is most dangerous at school age. The inability to concentrate for long periods of time and decreased memory contribute to a child’s decline in school performance.
• Asthenization. In severe cases of the disease, children experience severe general weakness. With prolonged development of the disease, even some malnutrition and even muscle atrophy are observed. The child appears excessively tired and exhausted.

Treatment

Therapy for anemia begins with identifying the cause that led to its development. It makes no sense to replenish lost hemoglobin if it is regularly lost in the body.

In order to establish the cause, additional examinations and tests are required. With their help, it is possible to conduct a qualitative differential diagnosis and prescribe the necessary therapy.

Treatment of anemia is complex. It includes not only the prescription of medications, but also recommendations for normalizing the daily routine and nutrition. Medicines are prescribed only when there is a marked decrease in the level of hemoglobin in the body. For mild forms of the disease, treatment begins with a special diet.

Basic principles of anemia therapy:

• Complete nutrition, enriched with all necessary vitamins and microelements. Particular emphasis in the children's diet is placed on foods high in iron, vitamin B12, folic acid, copper, as well as all the necessary microelements involved in hematopoiesis.
• Prescribing medications. They are prescribed by the attending physician. Appointed for a course appointment. After 1-3 months from the date of starting medication, regular monitoring of hemoglobin and red blood cell levels is carried out. Such monitoring allows you to evaluate the effectiveness of selected drugs.
• Normalization of the daily routine. A child needs adequate sleep, rest during the day, as well as a reduction in intense physical and psycho-emotional stress to improve the therapy process.
• Surgical treatment. It is used when the culprit of the disease is a tumor or pathological processes in the spleen. Splenectomy in most cases improves the course of the disease in this form of the disease.
• Treatment of secondary chronic diseases which could cause anemia. Without eliminating the primary source of inflammation, it is impossible to cope with the normalization of hemoglobin levels. If there is a bleeding ulcer or erosion in some organ, then even despite regular medications, it is not possible to achieve complete stabilization of well-being. First, it is necessary to eliminate all the causes that caused the anemic syndrome.

Iron supplements

In the treatment of iron deficiency anemia, the appointment drug treatment required in the vast majority of cases. Often, following a diet alone is not enough.

If, within three months, against the background of regular consumption of foods rich in iron, hemoglobin has not returned to normal, you should show the baby to a pediatrician. To completely stabilize the condition, the doctor will prescribe iron supplements.

Several types of drugs can be used to treat iron deficiency conditions. They may contain ferrous and trivalent iron in different chemical combinations. The effectiveness of these funds varies. Dosages are selected individually, taking into account the severity of the condition, the initial well-being of the child, as well as his age.

For children under three years of age, the physiological iron requirement of 3 mg/kg per day is used to calculate the dose. For older children - 50 mg/kg. IN adolescence 100 mg/kg will already be required. This calculation formula is used for drugs containing divalent iron. If ferric iron is used, then the dosage is on average 4 mg/kg.

The effectiveness of the selected drugs is monitored using a general blood test. The effect of treatment does not come quickly. Typically, it takes at least 2-3 months for hemoglobin levels to normalize. First, young blood cells - reticulocytes - appear in the blood. Subsequently, an increase in the level of hemoglobin and red blood cells is observed.

Most often, iron supplements are prescribed in the form of tablets or sweet syrups. However, the use of these dosage forms may not always be acceptable. If a child has ulcerative processes in the stomach or intestines, he is prescribed iron-containing drugs in the form of injections. These agents have excellent absorption and reach the hematopoietic organs well.

Most often used to normalize iron levels: Ferrum lek, Hemofer, Conferon, Ferroplex and many others. The selection of the drug is chosen by the attending physician, taking into account the child’s existing chronic diseases. When taking iron-containing medications, remember that they turn stool black.

Nutrition

The organization of children's menus for anemia should be given due attention. Only good nutrition will help normalize hemoglobin levels and quickly bring the child’s body back to normal.

Your baby's diet should include foods with a maximum iron content. These include: beef, veal, rabbit, chicken and poultry drumsticks, offal (especially liver). In the diet of a child suffering from anemia, such products should occupy more than 50%. Each meal should include at least one iron-containing product.

If the baby is still too small and is breastfed, then it is better to give preference to special artificial formulas that contain a high iron content. They are also perfectly balanced in their nutritional components and contain additional amounts of microelements necessary for optimal hematopoiesis.

To ensure sufficient intake of folic acid into the body, a variety of vegetables and greens should be added to the baby’s diet. All green foods contain large amounts of folate. These substances are needed for good hematopoiesis, especially for children with folate deficiency anemia.

For infants, you can add a variety of juices and purees made from green apples and pears. Such products provide great variety to children's diets and will also help normalize the level of folic acid in the body.

In order to compensate for the reduced level of vitamin B12, you should not forget to include porridges made from various grains in your child’s diet. Buckwheat or barley porridge will be an excellent choice when creating a menu for a baby suffering from B12-deficiency anemia. To achieve the best effect, it is better to alternate cereals.

The diet of a baby with anemia should be balanced and varied. Active hematopoiesis requires a regular supply of all types of animal and plant products. Fresh fruits and vegetables, quality meat and fish products, as well as poultry and grains contribute to the high-quality formation of new red blood cells.

Prevention

Compliance with preventive measures will help reduce the possible risk of developing anemic conditions. Every pediatrician should suspect anemia during regular examinations and examinations of the child. Even the simplest laboratory tests can help identify signs of anemia.

To prevent anemia, use the following recommendations:

• Visit your child's doctor regularly. Carrying out a general blood test as a screening will allow timely detection of the first manifestations of anemic syndrome.
• Try to carefully plan your baby's diet. Be sure to include all age-appropriate animal and plant foods. Meat, poultry and fish must be present in the baby’s diet every day.
• If you have a hereditary predisposition to anemia, consult a hematologist. He will be able to give accurate recommendations and prescribe appropriate treatment.
• If you have multiple pregnancies, get plenty of rest and be more careful about your diet. Give preference to iron-containing foods, as well as fresh vegetables and herbs. Such nutrition will contribute to the proper formation of hematopoietic organs in future babies and will not contribute to the development of anemia.
• Develop your child's love for healthy image life. Try to keep your baby regularly fresh air.
• Take iron supplements in prophylactic dosages for premature babies. They will help prevent the development of anemic syndrome in the future. Such preventive courses are prescribed by a pediatrician.

Normalizing hemoglobin levels leads to improved well-being. After achieving a lasting therapeutic result, children begin to feel much better, become more active and mobile. Regular monitoring of hemoglobin levels is necessary at any age to prevent anemia.

You can watch more about anemia in children in the following video.

Anemia in children is a pathological condition of the body, characterized by a decrease in the content of red blood cells and hemoglobin per unit volume of blood. The causes of anemia are varied, but can be combined into three large groups.

Causes of anemia in children

I. Anemia caused by increased destruction of red blood cells (hemolytic). Hemolysis can be caused by:

• intraerythrocyte causes - an internal defect of erythrocytes, which, as a rule, is hereditary. Some of them are associated with hemoglobin abnormalities (hemoglobinopathies), others with disturbances in the shape of erythrocytes (hereditary spherocytosis, ovalocytosis, etc.), others with enzymatic abnormalities of erythrocytes, which manifest themselves mainly under the influence of certain drugs or other substances;
• extra-erythrocyte causes. Usually these are acquired anemias that occur when factors aggressive to red blood cells appear in the blood. There are isoimmune anemias caused by antibodies received by the fetus from the mother (Rh-conflicts, etc.) or by the recipient from a donor (during blood transfusion), and autoimmune anemia, in which the body produces antibodies directed against the patient’s red blood cells.

II. Anemia resulting from a decrease in the intensity of erythropoiesis. They develop when there is a deficiency of substances; necessary for the formation of red blood cells (iron, vitamin B 12, folic acid, proteins, less often with copper deficiency, cobalt).

Erythropoiesis is especially severely disrupted during hypoplasia and aplasia of the bone marrow, which are based on the loss of the ability of bone marrow cells to proliferate and differentiate. These disorders can be hereditary or acquired, caused by exposure to drugs, chemicals, or radiation.

III. Anemia caused by the release of red blood cells from the circulation during acute and chronic blood loss. A feature of these anemias is the loss of iron by the body along with red blood cells.

Degrees of anemia in children

1. Mild anemia. For grade 1 anemia in a child, the number of red blood cells in the blood is at least 3-10 12 /l, hemoglobin 90-110 g/l.
2. Moderate weight. For grade 2 anemia in a child, the number of red blood cells in the blood is in the range of 2.5-10 12 / l - 3-10 12 / l, hemoglobin is in the range of 70-90 g / l.
3. Severe anemia. Anemia of the 3rd degree in a child is diagnosed when the erythrocyte content is less than 2.5-10 12 / l, hemoglobin is less than 70 g / l.

The functional state of erythropoiesis can be assessed by the number of reticulocytes, according to which anemia is divided into:

• regenerative - the number of reticulocytes is over 5%o;
• hyperregenerative - reticulocytosis more than 50%o;
• c) hypo- and aregenerative - the number of reticulocytes is below 5% or reticulocytes are completely absent in the peripheral blood.

Depending on the value of the color index, all anemias are divided into three groups:

1. normochromic, in which the color index is in the range of 0.8-1.0;
2. hypochromic - color index below 0.8;
3. hyperchromic - color index higher - 1.0.

Iron deficiency anemia in children

Among the various forms of anemia in young children, the most common are iron deficiency anemia, which is characterized by a decrease in the number of red blood cells hemoglobin, a decrease in the average concentration of hemoglobin in one red blood cell, a decrease in serum iron content and an increase in the iron-binding capacity of serum.

A healthy full-term child in the first months of life uses the iron reserves available in the body, but already from 3-4 months of age these reserves become insufficient and for normal iron metabolism he must receive 8 mg daily from food, and from 3 years 12-15 mg iron.

Only about 10% of iron is absorbed from food, and the absorption of iron is affected not only by its content in food, but also by the type of food (iron is best absorbed from fish, chicken meat, soybeans - up to 20-22%). The absorption of iron is improved by the presence of vitamin C in food, a sufficient content of animal protein, microelements (copper, cobalt, fluorine, etc.), worsened by calcium salts, phosphorus, phytin, tetracyclines. Complexes of divalent ferrous iron with amino acids and peptides are well absorbed. Ferric salts are almost not absorbed.

Iron absorption occurs mainly in the duodenum and in the upper part of the small intestine. First, ferrous iron is actively captured by enzymes in the intestinal mucosa and transported inside the cell, and then the iron enters the blood.

Iron deficiency in a child’s body occurs when there is insufficient accumulation of iron in the “depot”, which is created during the period of intrauterine development and is then replenished by iron supplied with food. In premature babies, in children whose mothers had anemia during pregnancy, iron reserves in the body are reduced.

Impaired absorption of iron in the intestine is observed when receiving food poor in iron, an unfavorable combination of food ingredients, and diseases of the gastrointestinal tract.

Iron deficiency can also occur with increased iron requirements and excessive losses.

Symptoms of iron deficiency anemia in children

The clinical picture of anemia is characterized by the appearance of pallor of the skin and mucous membranes, irritability, increased fatigue, weakness, and loss of appetite. There may be a slight enlargement of the liver and spleen. Tachycardia, 1st flapping sound and functional systolic murmur at the apex, at Botkin's point.

Diagnosing iron deficiency anemia in a child

The diagnosis of iron deficiency anemia is made taking into account the following laboratory data: a decrease in hemoglobin levels to 110 g/l or lower. A decrease in serum iron levels below 14.3 µmol/l, an increase in the iron-binding capacity of serum above 78 µmol/l.

Treatment of iron deficiency anemia

Treatment of iron deficiency anemia in children involves organizing the correct regimen, sufficient exposure of the child to fresh air, massage, gymnastics, rational, balanced diet including foods rich in vitamins and iron.

Drug therapy includes the prescription of iron supplements and a number of vitamins. For mild and moderate forms of anemia, iron supplements are given orally; for severe forms, they can be prescribed parenterally.

To ensure that iron supplements are better absorbed and less irritating to the mucous membrane of the gastrointestinal tract, they are recommended to be taken an hour after meals.

The course of treatment with iron preparations should be long (3-4 weeks) until a clear therapeutic effect is achieved. After the elimination of iron deficiency anemia, young children are prescribed prophylactic doses of iron supplements for 2-3 months.

For better absorption of iron, it is recommended to take it in combination with ascorbic acid, copper preparations, sorbitol, etc. You should not wash down your iron intake with milk, coffee, undiluted fruit juices, since these products contain calcium, phosphorus, which form complexes with iron that precipitate into sediment.

If the drug is poorly tolerated, it is advisable to replace it with another and start taking it with small doses, gradually increasing them.

In the treatment of severe iron deficiency anemia, iron supplements are sometimes prescribed parenterally. The indication for such a prescription is the inability to take iron supplements orally (peptic ulcer, intolerance, malabsorption syndrome, etc.) or the lack of sufficient effect.

Nutrition for anemia in children

Depending on iron content food products divided into “rich”, containing 5 mg of iron per 100 g of product (liver, oatmeal, yolk), “moderately rich” - 1-4.5 mg (chicken meat, beef, chum salmon caviar, oatmeal, wheat, buckwheat, apples ) and “poor” - less than 1 mg (carrots, strawberries, milk). The absorption of iron largely depends on its form (ionic, colloidal, dissociated) and on other food ingredients. Iron is best absorbed from chicken, fish, and soy.

B 12 - folate deficiency anemia

Folic acid is a necessary factor for the normal process of hematopoiesis. With its deficiency, erythro-, granulo- and thrombopoiesis, protein synthesis are disrupted, normal cell maturation is delayed and megaloblastic anemia can develop.

Erythropoiesis is the process of formation of erythrocytes (red blood cells).
Granulopoiesis is the process of formation of granulocytes (leukocytes, white blood cells).
Thrombopoiesis – the process of platelet formation
All of the above processes occur in the hematopoietic tissue of the red bone marrow.

Into the body folic acid comes with food and is also synthesized by intestinal microflora.

There is a close interaction between vitamins B 6, B 12 and folic acid. Vitamin B 12 enters the body with food and is synthesized by intestinal flora. For absorption from food, it must be separated from proteins, which occurs under the influence of hydrochloric acid of gastric juice or the alkaline environment of the intestine. To be absorbed in the intestine, vitamin B 12 must combine with the intrinsic factor of Castle, which is formed in the stomach. Once absorbed, it is transported into tissues in the form of a compound with special plasma proteins - transcobalamins. Deposited in the liver.

With a deficiency of vitamin B 12, DNA synthesis is disrupted, the maturation of hematopoietic cells slows down, which also results in the megaloblastic type of hematopoiesis.

Lack of folic acid occurs in gastrointestinal diseases, celiac disease, severe infectious diseases (sepsis, pneumonia, etc.).

Vitamin B 12 deficiency in a child’s body occurs either due to a lack of internal factor (leading to the development of pernicious anemia), or as a result of malabsorption due to prolonged intestinal infections, helminthic infestation (diphyllobothriasis), or due to a deficiency of transcobalamin II, which results in vitamin B 12 after absorption in the intestine can be transported by the blood to organs and tissues.

Symptoms of B 12 folate deficiency anemia

The clinical picture is characterized by pale skin with an icteric tint, glossitis, and moderate hepatomegaly. Blood tests show hyperchromic, megaloblastic anemia.

Treatment of B 12 folate deficiency anemias

Treatment includes eliminating the cause that caused the deficiency of vitamin B 12 and folic acid (treatment of gastrointestinal diseases, deworming, etc.), prescribing folic acid and vitamin B 12.

Hypoplastic and aplastic anemia in children

There are idiopathic anemias and anemias with a known etiology that developed as a result harmful effects various factors (physical - ionizing radiation; chemical - drugs; nutritional-toxic, etc.).

Symptoms of hypoplastic and aplastic anemia

Clinical picture: pallor of the skin, increasing asthenia, the appearance of symptoms of bleeding. Hepatomegaly is possible.

Anemia is normochromic, hyporegenerative or aregenerative in nature. Accompanied by the development of leukopenia, thrombocytopenia.

Treatment of anemia in children

Complex therapy, including steroid hormonal drugs, transfusions of blood and its components, vitamin complexes (C, B2, B6, B12, folic acid), anabolic hormones.

Glucocorticoid drugs have a positive effect on bone marrow hematopoiesis, reduce bleeding, and suppress the production of antibodies.

Posthemorrhagic anemia

Posthemorrhagic anemia(anemia due to blood loss) can be acute or chronic and can be caused by various reasons (trauma, peptic ulcer, polyposis, hemorrhagic diathesis, etc.).

The clinical picture of posthemorrhagic anemia depends on the amount and rate of blood loss, the age of the patient, and the etiological factor. With massive bleeding, shock may develop. In acute posthemorrhagic anemia, the reflex-vascular phase of compensation, the hydremic phase of compensation and the phase of bone marrow compensation are distinguished. Anemia due to blood loss is not immediately detected. The earliest hematological sign of the disease is an increase in platelet count and neutrophilic leukocytosis. Symptoms of progressive anemia (a uniform decrease in the number of red blood cells and hemoglobin) occur on the 2-3rd day after blood loss in the hydremic phase. On the 5th-7th day, in the phase of bone marrow compensation, reticulocytosis develops, indicating increased erythropoietic activity of the bone marrow.

The blood picture in chronic posthemorrhagic anemia is of an iron deficiency nature and occurs with a decrease in the color index, microcytosis, hypochromia of erythrocytes, and a decrease in serum iron levels. The number of leukocytes and platelets is within normal limits.

Treatment of posthemorrhagic anemia consists of stopping bleeding, eliminating symptoms of shock (blood transfusion, plasma, blood replacement fluids). The use of iron supplements is indicated.

Acquired hemolytic anemia

Majority acquired hemolytic anemia is autoimmune in nature. The cause of immunization can be previous infectious diseases (influenza, pneumonia, mononucleosis, etc.), as a result of which autoantibodies are formed that have specific agglutinating properties in relation to red blood cells.

Secondarily, the erythrophagocytic activity of the reticulo-histiocytic system (especially the spleen) increases. Acquired hemolytic anemias are often combined with other forms of autoimmune pathology: collagenosis, thrombocytopenic purpura, etc. In addition, they develop in diseases such as lymphogranulomatosis, liver cirrhosis, dermoid cysts, ovarian teratomas, etc.

Symptoms of acquired hemolytic anemia

Autoimmune hemolytic anemia can be detected at any age (more often in older children). The course of the disease varies. There is a decrease in appetite, agitation or drowsiness, low-grade fever, shortness of breath, palpitations, and headache. Jaundice and an increase in the amount of bilirubin are less significant than with congenital hemolytic anemia. Sometimes the only symptom of the disease is pale skin. The spleen and liver are usually slightly enlarged.

The blood picture gives great fluctuations. During increased hemolysis, severe anemia (up to 1 million red blood cells), anisocytoe, polychromatophilia, reticulocytosis, and erythronormoblastosis develop. The platelet count is not constant. Osmotic resistance is normal, slightly reduced or increased. For the diagnosis of acquired anemia, the detection of anti-erythrocyte antibodies using Coombs tests is important. Bone marrow punctate shows a picture of an intense erythroblastic reaction.

The prognosis of the disease has recently improved significantly due to the use of hormonal drugs.

Treatment. Corticosteroid hormones are prescribed (prednisolone in an initial daily dose of 1.5-2.5 mg per 1 kg of weight). A condition for the effectiveness of hormonal therapy, in addition to a sufficient dosage, is its duration. Hemotherapy requires great care and careful selection of blood (packed red blood cells) based on the indirect Coombs test. The effectiveness of splenectomy is questionable.

Congenital (familial) spherocytic hemolytic anemia(abbreviated as spherocytosis, microspherocytosis). Anemic conditions in which the processes of blood destruction (hemolysis) prevail over the processes of hematopoiesis are called hemolytic anemia.

The average lifespan of red blood cells in hemolytic anemia is shorter than normal (that is, less than 100-120 days). There are: 1) congenital (hereditary) and 2) acquired hemolytic symptom complexes.

Congenital (familial) spherocytic hemolytic anemia(Minkowski-Choffard disease, microspherocytosis) refers to erythrocytopathies inherited in an autosomal dominant manner. The disease is based on a little-studied enzyme deficiency of erythrocytes, leading to a disorder in the intracellular metabolism of carbohydrates, lipids, electrolytes, and impaired ATP regeneration. In spherocytes-erythrocytes the content of hydrophilic colloids, potassium salts, and lipoid phosphorus is reduced. Congenital inferiority of erythrocytes is accompanied by a decrease in their osmotic resistance, leading through the stage of spherocytosis to accelerated destruction of erythrocytes in the spleen.

Clinic. The disease can be detected in children of different ages, starting from the neonatal period. There are cases with a latent course that are diagnosed later in life. The clinical symptoms of the disease are very diverse. The course of the disease is cyclical and is characterized by alternating crises and remissions. An exacerbation is usually preceded by various exogenous factors: intercurrent infections, injuries, etc.

The earliest and most characteristic sign of microspherocytosis is jaundice. It changes in its intensity, intensifying during periods of hemolytic crises. Anemia and splenomegaly subsequently appear. The liver enlarges to a lesser extent. Jaundice, anemia, splenomegaly are the classic clinical triad for spherocytic anemia. With the early onset of the disease, there is a delay in the general development of the child (splenogenic infantilism). Symptoms associated with anemia of the patient may occur: adynamia, lethargy, dizziness, palpitations, etc. Sometimes hemolytic anemia is complicated by cholelithiasis with the clinical picture of angiocholecystitis and parenchymal hepatitis. Some patients exhibit dysplastic features in the skeletal structure: tower skull, hypertelorism, Gothic palate, polydactyly, etc. Rare symptoms in children include trophic ulcers of the legs.

The blood picture is characterized by the following triad: 1) microspherocytosis; 2) reticulocytosis; 3) a decrease in the osmotic resistance of erythrocytes (min. 0.60 0.70 instead of 0.48 normal, max. 0.40 versus 0.32% NaCI normal). The question of true microcytosis in spherocytic anemia has recently been disputed by some hematologists. With an asymptomatic course of the disease, the number of red blood cells and hemoglobin remains normal. In cases of chronicity, anemia is benign, normocytic in nature. During hemolytic crises, the number of red blood cells can fall catastrophically (to 2 million and below).

In bone marrow punctate with microsphorocytosis, an intense reaction of the erythronormoblastic type is detected. With frequent crises, there may be temporary aplasia or hypoplasia of the bone marrow. The content of indirect bilirubin is increased in the blood serum, and urobilinogen in the urine with a negative reaction to bilirubin. In the neonatal period, with a high level of indirect bilirubin, there may be a threat of developing kernicterus.

X-ray examination of the skull reveals expansion of the spongy layer of bone. In some cases, a striped pattern of the bony plates of the cranial vault is visible.

Treatment of congenital spherocytosis depends on the age of the patient and the severity of the symptoms of the disease. In newborns with a threat of kernicterus, replacement blood transfusion is indicated. For hemolytic crises in older children, blood transfusions and hormonal drugs are prescribed. Only effective method treatment of congenital spherocytosis - splenectomy, indications for which are chronic anemia, frequent hemolytic and aplastic crises, and the appearance of complications of the disease.

Iron-refractory sideroachrestic anemias- diseases in which the utilization of iron for heme synthesis is impaired due to certain defects in the enzymatic systems of erythrocytes. With this disease, there is a decrease in the level of enzymes,

participating in the synthesis of delta-aminolevulinic acid, porphyrins, as well as in the synthesis of hemoglobin at the stage of incorporation of iron into the heme molecule. There are congenital (hereditary) and acquired anemias (with endo- and exogenous intoxications, systemic blood diseases, etc.).

Clinic. An important role in the diagnosis of the disease is played by the combination of hypochromic anemia with high level iron in plasma. An increase in the content of sideroblasts in the bone marrow and refractoriness to treatment with iron supplements are also characteristic. The degree of anemia is usually low, the number of reticulocytes is usually within normal limits.

In the treatment of patients, large doses of vitamin B6 are used (intramuscularly and orally) in combination with vitamin B12, since there is an opinion that pyridoxal phosphate is involved as a coenzyme in the synthesis of porphyrins (in phase I). As a result of combined treatment, serum iron levels decrease and red blood counts improve. For anemia complicated by hemosiderosis, desferrioxyamine is effective, increasing the removal of iron from tissues.

Acquired hypo-, aplastic anemia in children

Acquired hypo-, aplastic anemia children can develop due to various general diseases of the body, endogenous intoxications, under the influence of physical factors (ionizing radiation), drugs and chemical compounds.

Medicinal substances that have a sporadic depressive effect on hematopoiesis include chlormycetin (chloramphenicol), streptomycin, sulfonamides, arsenic, gold preparations, some antihistamines, etc. Hypo-, aplastic states of hematopoiesis of medicinal origin are caused by either an overdose of the substance or the special sensitivity of the patient to the usual doses of the drug. Some dyes, varnishes, paint solvents, pest control agents, etc. have a toxic effect on hematopoiesis. A hypo-, aplastic symptom complex can develop due to autoimmune mechanisms. Pancytopenia has been described in influenza, pneumonia, rheumatism, disseminated tuberculosis, in newborns - with congenital syphilis, toxoplasmosis, generalized megalocytosis, etc. In some cases, the etiological factor of aplasia remains unclear (genuine, idiopathic aplasia).

Symptoms of the disease

The disease begins unnoticed. Early symptoms include increasing weakness, fatigue, anorexia, and pale skin. Signs of hemorrhagic diathesis (nose, gastrointestinal bleeding, hemorrhages under the skin) appear quite early. Less commonly, septic and necrotic complications occur in connection with granulocytopenia.