Anemia during

Infancy
Etiology anemia
• Decreased red cell production (generally develops
gradually and causes chronic anemia)
– Marrow failure (aplastic anemia, malignancy)
– Impaired erythropoietin production( severe
malnourish, hypothyroid, renal disease)
– Defect in red cell maturation and ineffective
erythropoiesis ( iron/ folat acid/ B12 def, thalassemia)
• Increased red cell destruction (hemolysis)
– Extracellular causes (AIHA, HUS, infection)
– Intracellular causes ( membrane defects, enzyme
defects, hemoglobinopathies)
• Blood loss
IRON DEFICIENCY
ANEMIA
 Prevalence
• USA  decreasing ; 2.5% in healthy population.
• Developing nations : the prevalence of anemia is
extremely high. This is particularly true in preschool-
aged children, in whom the prevalence reached as high
as 90% of the sample population studied.
 Risk factors :
• Nutrition  inadekuat intake, malabsorpsi
• Infection
• Low sosio economic
• Malnutrition
• Prematuritas
• Anemia pada ibu hamil
Phatophysiology
• The main physiologic role of RBCs is to deliver oxygen to
the tissues.
• Certain physiologic adjustments can occur in an
individual with anemia to compensate for the lack of
oxygen delivery.
(1)Increased cardiac output
(2)Shunting of blood to vital organs
(3)Increased 2,3-diphosphoglycerate (DPG) in the RBCs,
which causes reduced oxygen affinity, shifting the
oxygen dissociation curve to the right and thereby
enhancing oxygen release to the tissues
(4)Increased erythropoietin to stimulate RBC production.
Clinic manifestation
• Iron-deficiency anemia is produce many systemic
abnormalities, among them blue sclerae, koilonychia,
impaired exercise capacity, and functional alterations in
the small bowel. The most important systemic
abnormality produced by iron deficiency in infancy is the
alteration in cognitive performance.
• In all these studies, the iron status of the subjects was
well defined both before and after therapy. Lower scores
on the Bayley mental-development index were observed
in the infants with iron-deficiency anemia.
• The study by Walter et al, reported that performance
scores were lower among infants who had had anemia for
at least three months than among those who had had
anemia for less than three months.
• In the study by Walter et al. and the studies by Lozoff et
al., the reversal of the anemic, iron-deficient state did not
produce an improvement in the test scores, suggesting
that iron-deficiency anemia at a critical period of brain
growth and differentiation may produce irreversible
abnormalities.
• Kilbride et al, Anaemia during pregnancy as a risk factor
for iron-deficiency anaemia in infancy The incidence of
iron-deficiency anaemia was very high in anemic
mothers during pregnancy
• Because iron-deficiency anemia can have damaging
long-term consequences, it should be prevented in every
child
Hematologic marker for identifying iron deficiency
Iron Needs during Infancy and Childhood
• In the normal infant born at term  iron stores
are adequate to maintain iron sufficiency for
approximately four months of postnatal growth.
• In the premature infant total-body iron is
lower than in the full-term newborn, although the
proportion of iron to body weight is similar.
Premature infants have a faster rate of postnatal
growth than infants born at term, so unless the
diet is supplemented with iron, they become
iron-depleted more rapidly than full-term infants.
Iron deficiency can develop by two to three
months of age in premature infants.
Therapy
• The most economical and effective medication in the
treatment of iron deficiency anemia is the oral
administration of ferrous iron salts.
• They should be continued for about 2 mo after correction
of the anemia and its etiological cause in order to
replenish body stores of iron. Ferrous sulfate is the most
common and cheapest form of iron utilized. Tablets
contain 50-60 mg of iron salt. 3-6 mg/kg/d PO divided tid
suggested, depending on severity of anemia
• Response to iron therapy can be documented by an
increase in reticulocytes 5-10 days after the initiation of
iron therapy. The hemoglobin concentration increases
about 1 g/dL weekly until normal values are restored.
• Diet
 The Committee on Nutrition of the American
Academy of Pediatrics recommends:
• Full-term infants be provided with iron (1 mg per kilogram
per day, to a maximum of 15 mg per day), starting at no
later than four months of age and continuing until three
years of age
• For low-birth-weight infants, the requirement is 2 mg per
kilogram per day, to a maximum of 15 mg per day,
starting at no later than two months of age
• Infants with birth weights of less than 1000 g should
receive 4 mg per kilogram per day, and infants with birth
weights between 1000 and 1500 g should receive 3 mg
per kilogram per day. For these infants, iron
supplementation at the higher dose should continue
throughout the first year of life
• After one year of age, the diet becomes more varied and
there is less information from studies on which to base
dietary recommendations. The recommended dietary
allowance decreases to 10 mg per day for children
between 4 and 10 years of age and then increases to 18
mg per day at the age of 11 to provide for the
accelerated growth that takes place during adolescence
Diet counseling to prevent iron
deficiency in children :
THANK YOU