Anaemia in Children

Anaemia is a condition where there is a decrease in the number of Red Blood Cells (RBC) and the amount of haemoglobin present in these cells,thereby the blood is not able to carry the required amount of oxygen to the body cells to enable their function and growth.

Causes

Two main causes for the condition of anaemia to develop in the body are:

• Inadequate production of red blood cells
• Destruction of too many red blood cells

Inadequate production of red blood cells

Causes for inadequate production of RBCs are deficiency of iron, folic acid or folate and vitamins like Vitamin B12 and Vitamin C. Other causes include slowing down of the production of red blood cells by the bone marrow due to specific causes like illnesses or specific medications, and low production of hemoglobin due to lead poisoning.

Iron Deficiency

Production of red blood cells in the body needs proper amounts of iron, folate, and Vitamin B12. Breast milk and formula provide the necessary amounts of folate and Vitamin B12. Regarding iron supply, lot of iron is passed on from the mother's body to the infant during the last few months of pregnancy. This iron is sufficient for the baby only for the first six months. After that, the baby has to take more of iron fortified cereals and vegetables in puree form along with breast milk or formula, to improve upon the iron content in the body. If food taken by the infant does not contain sufficient iron, production of red blood cells becomes inadequate, leading to anaemia. Breast milk helps in increased absorption of iron from the intestine, compared to formula or cow's milk. Infants fed with cow's milk before they are one year old are most affected by iron deficiency. Iron deficiency is the main cause for slowing down of production of red blood cells.

Video on Anemia Symptoms and Treatments

Temporary Malfunction of Bone Marrow

Red blood cells are produced in the bone marrow. This production slows down if the baby is attacked by any viral illness. The virus causes a temporary decrease in the production of the RBCs. Once the baby gets cured from the illness, bone marrow continues its function normally. Certain medications too hamper the production of RBCs. This is also temporary. Once the medication is stopped or the dose is reduced, bone marrow functions normally. Diseases affecting the bone marrow like leukaemia decreases the RBC production, and rare inherited disorders of the bone marrow completely stops the production of RBCs, in which case, bone marrow needs to be transplanted.

Lead Poisoning

Children are exposed to lead dust when parents bring it home on their clothes or skin from their work place. The lead paints that peel off from older buildings create lead dust in the surrounding and the child may be exposed to it. Lead is in drinking water getting in from sources like plumbing and fixtures made of lead. When lead thus enters the body, most of it goes into the RBCs and hampers the production of haemoglobin. This decreased production of haemoglobin can cause anaemia.

Destruction of too many red blood cells

• Hemolytic anaemia - Normally the life-span of red blood cells is 90 to 120 days. In new-born babies, due to blood group incompatibility, mother's antibodies may attack the red blood cells of the babies, and cause their destruction. Sometimes, red blood cells are destroyed quicker than the normal period of time due to occurrence of diseases in babies. Such premature destruction of red blood cells is called hemolytic anaemia. Here the normal life-span of red blood cells is shortened. This increased rate of destruction of red blood cells is compensated with production of new cells by the bone marrow. When new cells cannot compensate for the destructed number of cells, and the number of red blood cells in the baby's body is lower than normal, it results in hemolytic anaemia.
• Autoimmune hemolytic anaemia - Sometimes, the immune system of the baby mistakes red blood cells for foreign bodies and begins to destroy them. Thus, the number of red blood cells decreases resulting in an anaemic condition called Autoimmune hemolytic anaemia.
• Other kinds of hemolytic anaemia which are caused by inherited defects are:
  • Sickle cell anaemia - It is an inherited disorder in which red blood cells change shape to that of a sickle, and get stuck in capillaries and have chances of getting destroyed prematurely. Therefore, amount of haemoglobin goes down to a very low level resulting in anaemia. The sickle shaped cells also get stuck together in abnormal fashion and block the blood vessels and cause serious damage to internal organs. It is commonly found among people of various origins including Indians.
  • G6PD Deficiency - G6PD is an enzyme, the deficiency of which causes red blood cells to be destroyed prematurely. This premature destruction of red blood cells occurs when the child suffers any infection, takes any medicine or when exposed to some specific substances. It is common in some parts of India – especially the West and Northwest.
  • Hereditary spherocytosis - It is an inherited disorder, in which red blood cells change into abnormal shapes and have a smaller surface area than the normal red blood cells. The cells are fragile due to the problem with a protein in the RBC structure. Because the cells are fragile, they are easily destroyed. It is common among people of northern Europe, but can affect people of all origins.
  • Thalassemia - It is a condition in which RBCs are abnormal and have a short life-span. The condition can be severe, known by the name Cooley's anaemia, in which RBCs get destructed quite rapidly and iron gets deposited on the skin and other vital organs like liver, spleen and heart causing enlargement of these organs. It can also be mild without much changes in the RBCs. It is common among people of Mediterranean, African and South East Asian origins.

Symptoms

The child will display no symptoms if the anaemia is mild and it can be found only during a medical examination, which includes a blood test. Symptoms could be severe in severe conditions of anaemia. Feeling unusually weak and tired is the main symptom of anaemia. More of the other common symptoms include paleness of the skin, more clearly shown out as a decreased pinkness of the lips, the lining of the eyelids and the usual pink portion of the nails. Dizziness, head ache, lack of concentration and difficulty in sleeping may also be shown. Severity of symptoms include breathlessness, rapid heart beat and swelling of hands and feet. If anaemia continues for an extended period, it affects the normal growth of infants and children.

Diagnosis

Anaemia can be diagnosed by the symptoms shown by the child and by blood tests. With the help of a blood test, blood cell count and the level of hemoglobin in the blood cells can be measured. The diagnosis of the type and cause of anaemia is possible by looking at the blood under a microscope (peripheral smear). Other tests like a bone marrow study or specific tests done on the RBCs (like spectrometry) or tests like measurement of iron levels can help to make specific diagnoses.

Treatment

Since anaemia is of many types, identification of the cause for the anemic condition is important before deciding on the treatment. Without the physician's direction, do not try to treat your child with iron, vitamins or other nutrients, or over the counter medications. This will make the diagnosis of the cause for anaemia difficult.

If anaemia is due to iron deficiency, the doctor will recommend iron-rich foods or iron tablets. Foods rich in iron are liver, fish, meat, dark green leafy vegetables, eggs, cereals, peas, beans, and dried fruits. If anaemia is due to deficiency of vitamins like Vitamin B12 and Vitamin C, foods rich in these vitamins should be supplemented. Liver, fish, egg and dairy products are rich sources of vitamin B12. Vitamin B12 injections are also being used for treating this vitamin deficiency. Vitamin C helps the body absorb iron. Vegetables and fruits, especially citrus fruits are good sources of Vitamin C. Folic acid is an important component useful in the production of red blood cells. The deficiency in folic acid can be treated with foods rich in folic acid like meat, milk, egg, liver, green leafy vegetables and raw fruits. Folic acid tablets help in quick recovery from anaemia.

To increase the red blood cell count, medicines may be prescribed by your doctor. Some of the medicines are:

Antibiotics - to treat infections which lead to a decrease in the rate of production of red blood cells and

Medicines - to prevent destruction of red blood cells by the body's own immune system. Chelation therapy is used to treat children who are affected by lead poisoning.

For severe forms of anaemia, treatment with medications, blood transfusions, and removal of spleen to prevent rapid destruction of red blood cells are some of the treatments in practice. In some cases of severe sickle cell anaemia and thalassemia, bone marrow transplantation is the ultimate treatment. Sickle cell anaemia in babies is currently treated by giving liquid hydroxyurea which increases the level of hemoglobin and prevents the blood cells from becoming sickle cells. Liquid hydroxyurea may be given in increased dosage to children between 2 to 5 years.

Prevention

A healthy diet which contains foods rich in iron and vitamin B complex is necessary to prevent occurrence of anaemia. Iron and vitamins will help to maintain a normal blood count and normal level of hemoglobin.