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By ULY CLINIC staff

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Iron Deficiency Anemia in Children

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This is the type of anaemia which is caused by lack of Iron leading to microcytic and hypochromic RBCs.
 

Dignostic Criteria

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  • Palmar pallor

  • Koilonychia and/or glossitis in Iron deficiency anaemia

  • Hb less than cut off value for age

  • Microcytic and hypochromic RBCs
     

Investigations

 

  • FBP

  • Reticulocyte count

  • Iron Studies (Serum Iron, Ferritin, Total Iron Binding Capacity

  • RBC Folate and Vitamin B12

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Note:

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Investigate for the cause of Iron deficiency as appropriately.

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Treatment

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Non Pharmacological treatment

 

  • Ensure adequate dietary intake rich in iron content.

  • Give packed RBC 10 ml/kg over 3 hours.

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Pharmacological treatment

 

  • Give iron PO 6mg/kg of elemental iron inform of Ferrous Sulphate OR Iron syrup/drops once a day for young infants for 3 months.

  • If the child is one year or older and has not received mebendazole in the previous 6 months, give one dose of Mebendazole 500mg PO for possible hookworm or whip worm infestation

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Indications for blood transfusion

Note:

 

Consider transfusion in normalvolemic patients ONLY if they have symptomatic anaemia. These symptoms include:

  • Heart failure

  • Difficulty breathing or Shortness of breath for no other reason,

  • Tachycardia for no other reason

  • ST depression on ECG

  • Clinically detectable dehydration or shock

  • Impaired consciousness

  • Very high malaria parasitaemia (>10% of red cells with parasites).

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Giving a blood transfusion

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Before transfusion, check the following:

 

  • The blood is the correct group and the patient’s name and number are on both the label and the form (in an emergency, cross-match group-specific blood or give Onegative blood if available)

  • The blood transfusion bag has no leaks. Do not inject into the blood pack.

  • The blood pack has not been out of the refrigerator for more than 2 hours, blood is not pink or has large clots, and the red cells do not look purple or black

  • Any signs of heart failure. If present, give furosemide as above.

  • Do a baseline recording of temperature, respiratory rate and pulse rate. The volume transfused should in itially be 10 ml/kg body weight of packed red blood cells, given over 3 hours.

    • Amount of blood to be transfused

    • Formula for calculating amount of P RBC needed (in ml):

    • 3 x weights in kg x (desired Hb–current

Example. The desired Hb is 10gm/dL, therefore a 20 kg Child with a Hb of 6gm/dl, the required amount of blood is 3 x 20 x 4 =240 mls of packed (PRBC).

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  • A standard blood infusion set with an in-line filter must be used to infuse all RBC transfusions.

  • The transfusion time per unit is 2 to 4hours, with a maximum time of 5 hours from the time the blood is removed from the refrigerator to the completion of transfusion.

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Last updated on 01.10.2020

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References

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  1. ​Tanzanian Standard treatment guideline for children 2017 edition page 113-114

  2. NHIS. Iron Deficiency anemia. https://www.nhs.uk/conditions/iron-deficiency-anaemia/. Accessed 01.10.2020

  3. MSD manual. Iron deficiency anemia. https://www.msdmanuals.com/professional/hematology-and-oncology/anemias-caused-by-deficient-erythropoiesis/iron-deficiency-anemia. Accessed 01.10.2020

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