In the outpatient clinic you may encounter anemia children every day, most people know that anemia must be tonic, even if some children are not anemia, parents themselves feel anemia, will consciously go to the pharmacy to buy some blood supplements for children to arrange, so what is anemia?
Anemia is when the specific volume of red blood cells, hemoglobin, or red blood cells in a unit volume of peripheral blood is lower than normal. Due to the large individual differences between infants and children, according to the World Health Organization, the low limit value of HB is 110 g/l for 6 months to 6 years old, 120 g/l for 6-14 years old, the altitude increase is 1000 m, the hb rises by 4%, and those below this value are anemia. Anemia in children is divided into 1.mild HB from the lower normal limit to 90 g/l; Moderate 90-60g/l, severe 60-30g/l; Very severe anemia: hb<30g/l. Neonatal HB144-120g/l is mild; 120-90g/l is moderate; 90-60g/l is severe; <60g/l is extremely severe.
Everyone's impression knows that anemia must be replenished by blood, especially bone soup, chicken soup supplements, parents are more anxious when they hear anemia, what iron can be supplemented, and always feel that the child's anemia is caused by improper care.
In fact, there are many types of anemia, not all anemia iron supplements are effective, anemia can be divided into iron deficiency anemia, megaloblastic anemia, thalassemia, hemolytic anemia, aplastic anemia, autoimmune anemia and many others. Today we are mainly talking about the most common nutritional iron deficiency anemia.
Nutritional iron deficiency anemia is the body iron deficiency leads to a decrease in hemoglobin synthesis, clinically characterized by small cell hypochromic anemia, serum ferritin reduction and iron treatment effectively, this disease is most mainly in 6 months to 24 months within the infant incidence will be relatively high, is one of the more common anemia diseases in China. Why are infants and young children under 6 months to 24 months most likely to develop iron deficiency anemia? This is because of the daily intake of iron for growth and development, relative to adults will be more, after 4 months to three years of age, about 0.5 to 1.5 mg of iron per day, premature babies need more iron will be about two milligrams, the total daily intake of children of all ages should not exceed 15 mg, but the fetus through the placenta from the mother's body is relatively small, early and second iron deficiency is relatively small, the amount of iron obtained in the third trimester of pregnancy is the most. Usually can get 4 mg of iron from the mother, so the iron obtained by the term child from the mother is enough for the baby to use within 4 to 5 months, but the relatively small amount of iron obtained by the premature baby from the mother is very prone to iron deficiency anemia, and if the pregnant mother is seriously iron deficiency, due to the increase in the compensatory nature of maternal iron and the decrease in the iron ingestion capacity of the placenta, it is possible to seriously affect the total amount of iron intake in the full-term newborn body is about 75 mg per kilogram, of which 25% is stored iron, due to physiological hemolysis released more iron, Subsequently, the hematopoietic period of physiological anemia is relatively low, and the iron obtained from the mother is generally able to meet the needs of 4 months, so iron deficiency is not easy to occur in early infancy. However, premature babies will receive less iron from the mother, and growth and development will be faster, and iron deficiency may occur earlier. After about 4 months, the iron obtained from the mother is depleted, coupled with rapid growth and development during this period, hematopoiesis is active, so the demand for dietary iron will be greater. However, the iron content of infant staple food, human milk and cow's milk is too low to meet the needs of the body, and iron deficiency is easy to occur after the depletion of iron storage, and the incidence of iron deficiency anemia in children from 6 months to two years old is high.
The occurrence of iron deficiency anemia, the most important reasons are the following: 1. Insufficient iron storage, premature children with multiple fetuses and pregnant mothers with severe iron deficiency are all able to reduce the iron content obtained by the fetus from the mother, resulting in a decrease in fetal iron storage. 2. Insufficient iron intake, which is the most critical cause of iron deficiency anemia. The content of breast milk and cow's milk is relatively low, but the iron absorption rate of breast milk is 5 times higher than that of cow's milk, but because parents do not add complementary foods with more iron in time, iron deficiency anemia is also prone to occur. 3. Growth and development factors, due to the rapid growth and development of the baby, failed to add iron-rich foods in time, so it is prone to iron deficiency. 4. Malabsorption of iron, unreasonable food mixing or chronic diarrhea or severe gastrointestinal allergies, resulting in iron malabsorption. 5. Excessive loss of iron, if the child has long-term chronic blood loss, such as intestinal polyps or hookworm disease in the stomach, can lead to chronic blood loss, long-term feeding infants and young children unheated milk caused by intestinal bleeding.
When the child has anemia, there will be the following related manifestations, the skin, mucous membrane pallor is the most prominent, the skin (ear surface palm and other parts), mucous membranes (blephagus conjunctiva and oral mucosa) and nail bed are pale, severe anemia, the skin is often sallow yellow foreign body turned to mild jaundice, on the contrary, accompanied by jaundice cyanosis or skin pigment changes can cover up the manifestations of anemia. Severe anemia, older children will be accompanied by dizziness, black tinnitus in front of the eyes and other discomfort. The performance of anemia in the digestive system is mainly for loss of appetite, anorexia, and a small number of pica, such as liking to eat soil, eating wall skin, eating hair, eating iron nails, etc. Some children may experience vomiting, diarrhea, and even stomatitis, glossitis, or atrophy of the papillae. In the nervous system, it is manifested as irritability or lack of concentration in learning, memory loss, sluggishness, most of the intelligence is lower than that of peers, and even affects the interaction between children, imitation ability, learning ability decline, and performance regression. In terms of cardiovascular aspects, the most important manifestations are increased heart rate, severe syncope, heart enlargement, and even heart failure, anemia shock and so on. Finally, children with anemia are very susceptible to reduced immune function, often with infection, and even anti-nail phenomenon.
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So how is iron deficiency anemia diagnosed? Iron deficiency anemia is a disease characterized by small cell hypochromic anemia, peripheral blood smear is to see red blood cells of varying size, with small cells as multicenters, the light stained area expands MCV less than 80fl, MCH < 26 pg, MCHC < 0.31, RDW is elevated, generally platelets and white blood cells are not affected. Secondly, bone marrow puncture examination can be done, the bone marrow phase is more than indicative of hyperplasia, mainly in the middle and late young erythrocyte hyperplasia, the red blood cells in each stage are small, the cytoplasm is small, the staining is blue, showing that the maturity of the cytoplasm lags behind the nucleus. In addition, the examination of iron metabolism can also help in the diagnosis of the disease.
So how do we treat it? The principle of treatment of this disease is to remove the cause and supplement with iron. 1. Conventional treatment is to strengthen nursing care, ensure adequate sleep, improve the body's immunity, and avoid infection. For severe anemia, the function of the heart is protected first, and if necessary, blood transfusion is treated. According to the child's digestive capacity, appropriate addition of iron-rich and easily digestible food, to ensure the absorption of iron, remove the cause: for those who eat improperly should correct unreasonable eating habits and food composition in time, such as parents fail to add complementary foods in time, should be according to the nutritional needs of the child in time to add iron-rich food (lean meat, pig blood, pig liver, internal organs are iron-rich food), if there is chronic blood loss, should be timely medical treatment to determine the cause. 3. Oral iron therapy, iron is a special drug for the treatment of iron deficiency anemia, as far as possible to use oral administration.
Of course, there are more varieties of oral iron, but at present, ferrous gluconate is still the most commonly used on the market, and the taking of iron is selected as much as possible between meals, which can reduce the stimulation of the gastric mucosa and facilitate absorption, which can reduce gastrointestinal side reactions, and at the same time can supplement appropriate vitamin C to promote the absorption of iron. During the period of taking iron, tea, milk, and coffee are not suitable for taking iron at the same time. Of course, oral iron also has many side effects, common is nausea, diarrhea, vomiting, constipation, loss of appetite, black stool and other discomfort, some children even have allergic reactions, if there is an uncomfortable reaction during the use of iron, you should see a doctor in time.
The main cause of iron deficiency anemia is that parents cannot detect anemia in time and fail to add iron-rich foods on time. So how do we prevent iron deficiency anemia? 1. The iron absorption rate of breast milk will be higher than that of artificially fed dairy products, so breastfeeding is routinely recommended. 2. Timely add foods rich in iron, such as high-speed rail milk powder, high-speed rail rice paste, red foods, such as pork liver, pig blood, lean meat, etc. 3. Pay attention to the combination of food nutrition, infants and young children who take fresh milk should be heated in time to reduce intestinal blood loss caused by milk allergy. 4. If there is blood in the stool, you should seek medical attention in time to determine whether it needs to be treated. Regular physical examination to the hospital, for premature babies, especially low-weight infants, iron should be added in time.