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Anemia

Anemia is a condition of a person characterized by a decrease in the number of red blood cells and / or hemoglobin per unit volume of blood (anemization), which causes insufficient supply of oxygen to tissues.

The intensity of metabolic processes (water, salt) in children is higher than in adults, therefore, the tissue needs for oxygen are high, and a slight degree of decrease in the level of red blood cells can lead to a number of undesirable consequences. In addition, the possibilities of tissue metabolism in children are less perfect than in adults.

Anemias vary in their causes, nature of the changes and signs of the disease.

Anemia associated with blood loss can be of various origins.

Acute post-hemorrhagic anemia. In newborns, acute blood loss is associated with damage to the placenta, rupture of the umbilical cord blood vessels, and hemorrhages due to birth injuries. Umbilical, intestinal and other bleedings may occur as a result of hereditary or post-birth diseases. Bleeding can occur with the development of infections in the perinatal period, which starts from the 28th week of pregnancy, includes childbirth and 7 days after them. At an older age, bleeding is associated with external injuries or injuries of internal organs, accompanied by damage to blood vessels. Abundant gastrointestinal bleeding can be the result of gastric ulcer and duodenal ulcer, varicose veins of the esophagus and stomach against the background of high blood pressure. Posthemorrhagic anemia is often observed in children suffering from malignant neoplastic diseases. Manifestations of the disease in acute post-hemorrhagic anemia are due to the intensity, duration of bleeding and the total volume of blood lost. Small blood loss in older children does not cause pronounced changes in the general condition and are tolerated relatively well. Significant blood loss in children is worse than in adults. Acute hemorrhage is especially bad in newborns. The loss of 10-15% of blood in newborns causes symptoms of shock: the child is unconscious, the skin is pale, cold to the touch, the lips and nails are bluish in color, the pulse is weak, the body temperature and blood pressure decrease, whereas in adults the loss of 10% of blood is replaced independently, without pronounced disorders. In older children, a reduction in blood volume by 30–40% leads to a dangerous state of shock. A sudden decrease in total blood volume by 50% is incompatible with life.

The development of signs of the disease in acute post-hemorrhagic anemia consists of a sharp decrease in blood pressure and anemic condition, manifested by a decrease in the number of red blood cells and hemoglobin. Children become lethargic, sedentary, some have a restless, anxious look. There are dizziness, tinnitus, cold sweat, a drop in blood pressure, shortness of breath. An increase in the number of heart contractions is also noted, systolic murmur is heard above the apex of the heart. In severe cases, there are bluish color of the skin and mucous membranes, convulsions, visual impairment. In newborns with acute blood loss, severe pallor, muscle weakness, retraction of the abdomen, rapid breathing, and palpitations can be noted.

Characteristic changes in the blood in acute post-hemorrhagic anemia depend on the period during which the study was conducted. In the early period of blood loss, the quantitative indicators of hemoglobin and red blood cells are within the normal range. The early signs of blood loss are an increase in the number of platelets - cells that are involved in the process of blood coagulation, and an increase in the level of leukocytes - cells involved in the body's defense reactions. Severe anemization is characterized by the so-called wateriness of blood, characterized by the flow of tissue fluid into the bloodstream, which fills the intercellular spaces in the tissues, from which cells receive nutrients. During this period, the amount of hemoglobin and erythrocytes significantly decreases without reducing the color index, which expresses the quantitative content of hemoglobin in one erythrocyte. Four to five days after blood loss, blood volume is replaced by enhanced functioning of the hematopoietic tissue of the bone marrow. It is characterized by the presence in the blood of a large number of modified underdeveloped erythrocytes, and in infants, young cells can appear - myelocytes, from which the body's protective cells are formed. The outcome of the disease in acute blood loss depends on the underlying disease that caused the bleeding, the massiveness and rapidity of blood loss, the age and individual characteristics of the child’s body. Treatment begins with urgent measures - to stop bleeding and eliminate the symptoms of shock, increase blood pressure and replace lost blood. If these measures fail, internal bleeding is an indication for surgery. In the fight against shock, the main role is played by the restoration of the volume of circulating blood with the help of blood substitutes (polyglucin, albumin, gelatinol). Erythromass is introduced — erythrocytes obtained from the blood by removing its liquid portion, and plasma — the liquid portion of blood containing proteins. At the same time, the correction of violations caused by the lack of substances and energy necessary for growth and vital activity is carried out. The patient should receive a high-calorie diet enriched with proteins, microelements, vitamins. Also, the patient is warmed, give plenty of drink. Given the depletion of iron reserves, going to the production of hemoglobin, it is necessary to prescribe iron-containing drugs (conferenceon, ferroplex).

Chronic post-hemorrhagic anemia develops as a result of frequently repeated small bleeding. It is rare in children, more often it can be observed in adults - it is the main cause of iron deficiency in the body. Chronic post-hemorrhagic anemia in children can be caused by diseases of the digestive tract, such as peptic ulcer and duodenal ulcer, ulcerative colitis (inflammation of the large intestine), intestinal parasites, esophageal varices. This anemia is characterized by slow development. Children are relatively easy to tolerate permanent blood loss. The development of various signs of the disease depends on the severity of anemia. In mild cases, anemia may go unnoticed for a long time. Many children feel well with a hemoglobin level of 90–100 g / l or less. With severe anemia, general weakness, dizziness, tinnitus appear, physical and mental activity decreases, appetite worsens. Pale skin with a waxy tinge, mucous membranes of the lips, bloodless conjunctiva, sclera - bluish. Above the apex of the heart is heard the noise, rapid heartbeat, reduced blood pressure. In the blood, the number of red blood cells and the content of hemoglobin in them decreases. Anisocytosis is observed - the appearance of red blood cells of various sizes in the blood. The level of iron in the blood is reduced on the background of increased serum iron-binding ability. The number of leukocytes is normal.

Principles of treatment. Treatment is primarily aimed at eliminating the source of bleeding and restoring the amount of iron. To do this, prescribe iron supplements, vitamins, nutrition, enriched with proteins, fruits, vegetables and other foods containing iron in sufficient quantities. In severe anemia, you can resort to red blood cell transfusions.

Anemia associated with impaired blood formation

Iron deficiency anemia. There are two forms of iron deficiency - latent iron deficiency, i.e. iron deficiency in tissues without anemia, and iron deficiency anemia. Iron deficiency anemia is a very common disease in both children and adults. In childhood, during the first two years of life, iron deficiency anemia is recorded in 40% of cases, and in adolescence, 1/3 of children experience anemia. The role of iron in the body is as follows: it is part of various body proteins, including hemoglobin. Hemoglobin consists of globin protein and iron-containing heme. In the final form, heme is a strong compound of porphyrin with iron. In the non-heme form, iron is contained in a number of enzymes (substances that accelerate biochemical reactions in the body).
The fetus receives iron from the mother. The accumulation of iron in the body of the fetus begins in the early stages of pregnancy, but it is most intense in the last months before childbirth. After birth, the body receives iron from food. The main amount of iron is absorbed in the duodenum and small intestine. The regulating mechanism of absorption is the total amount of iron in the body.

The next stage is the transition of iron into the blood. This is followed by the transfer of iron into the bone marrow. It is carried out by transport protein - transferrin. In bone marrow cells, iron is involved in the formation of heme. Ferritin, which is one of the main iron preservers in the body, is also produced from annoferritin protein and excess iron, which is not part of hemoglobin. With the death of red blood cells, iron is captured by special cells that purify the human body from decomposition products, resulting in a complex - hemosiderin.

The body has the following iron foundations:

1) hemoglobin, or erythrocyte, fund represented by hemoglobin iron (basic);

2) the reserve fund is iron, which is part of ferritin and hemosiderin, which accumulate in the liver, spleen, muscles, bone marrow;

3) a transport fund represented by transferrin-related iron;

4) tissue fund is iron, which is part of tissue proteins (myoglobin) and iron-containing enzymes (cytochrome, catalase, peroxidase) in tissues.

Iron losses in normal conditions in adults are about 1 mg, in young children - 0.1—0.15 mg / day. Iron is lost with feces, urine, and sweat. Iron loss may also be due to bleeding.

The causes of iron deficiency anemia in children are diverse. 1. Insufficient iron stores. A healthy, full-term baby is born with a total iron supply of 250 mg (70–75 mg / kg) obtained from the mother. These reserves of iron satisfy the needs for 3-5 months. The mechanism of transmission from mother to baby through the placenta is stable and does not depend on the concentration of iron in the mother. However, this transfer of iron to the fetus is impaired with severe toxicosis in pregnant women, blood loss, and lack of oxygen in the mother’s tissues. The initial level of iron in the body of the fetus is reduced in chronic maternal bleeding, and it can be born with iron deficiency anemia.

2. Increased body's need for iron. This reason works with intensive growth in premature babies and in children from multiple pregnancies, when even the normal intake of iron from food does not meet the needs of a rapidly growing organism.

3. Increased iron loss from the body. In children, the normal loss of iron in the first year of life is 0.07–0.1 mg, in 1–4 years - 0.15 mg, in 5–8 years - 0.2 mg, in 9–12 years - 0.3 mg; in puberty in boys - 0.5 mg, in girls - 1-3 mg per day. In various diseases, iron is lost with blood. Blood loss is the most common cause of the development of iron deficiency in adults, but this cause does not play a leading role. Its greatest significance is manifested in older girls after the establishment of menstruation.

4. Violation of the absorption and transport of iron. This is due to diseases of the digestive tract - occurs when inflammation of the small intestine, stomach. In children, iron absorption is reduced in diseases that cause insufficient absorption of iron and other substances (malabsorption syndrome).

5. Violation of the regulation of iron metabolism due to the influence of internal factors (hormones). Observed in children during puberty, which is associated with the release of hormones.

6. Insufficient intake of iron from food is the most common cause of anemia in children during the first years of life. Nutritional conditions, feeding characteristics play an important role in the formation of iron deficiency anemia in children. The daily need of children in the 1-2 years of life is 7-8 mg of dietary iron (0.5-1 mg / kg of body weight per day). In breast milk, the iron content, despite its maximum absorption, is low — 1.5 mg / l; in cow's milk, less than 0.5 mg / l. The first half of the life of the child compensates for the lack of iron from the internal reserves received from the mother. In the second half of the year, food becomes the main supplier of iron, and it is during this period that iron deficiency anemia can develop during unbalanced feeding. Improper feeding plays a role in the development of iron deficiency in children, not only younger but also older.

Signs of the disease. Iron deficiency anemia is characterized by signs due to insufficient supply of oxygen to tissues, as well as specific signs of iron deficiency. With a prolonged course of iron deficiency anemia, functional impairment due to lack of oxygen, pass into irreversible changes in organs and tissues. Signs of anemia do not appear immediately and grow gradually over a long time. A characteristic manifestation is pallor of the skin. With severe anemia, pallor has a waxy hue, there is blueness of the skin and mucous membranes, sometimes acrocyanosis (blue fingertips), aggravated by anxiety of the child. Children with anemia often have a reduced appetite, as a result of which they don’t gain weight. Many children have such asthenovegetative disorders as increased sweating, sleep disturbances, increased nervous irritability, dizziness, and dry mouth. Small children become restless, capricious. Behavior changes, the child becomes inactive, marked fatigue, muscle weakness. Pallor of the skin and asthenovegetative symptoms reflect the degree of anemia and are expressed in almost all children suffering from severe anemia. A number of children have dry skin, it feels rough to the touch, it is possible to detect the centers of hyperpigmentation, i.e. intensely darker colored skin. Trophic disorders of hair are characterized by their dryness, increased fragility, abundant loss. The nails acquire a dull shade, thin, marked fragility, sometimes the bulge of the nails is replaced by their thickening or concavity. The nails are spoon-shaped. A number of children can be noted inflammation of the oral mucosa. Shifts of the cardiovascular system are characterized by an increase in heart rate, the appearance of systolic murmur above the apex of the heart. With iron deficiency changes in the functions of the digestive tract are noted, the intestinal absorption of the main food ingredients (proteins, fats, carbohydrates, vitamins) is disturbed. Often there are distortions of taste, the child begins to eat chalk, sand. Children may have stool disorders, and sometimes they are prone to constipation. Children may also experience an increase in body temperature up to 38 ° C, the cause of which is not clear. In the analysis of blood in case of iron deficiency anemia, a number of characteristic signs are noted. They detect a decrease in the amount of hemoglobin and a decrease in the size of red blood cells. Anemia is diagnosed at a hemoglobin level of 110 g / l and below. According to the World Health Organization, children up to 6 years old have a lower limit of hemoglobin rate of 110 g / l, over 6 years old - 115 g / l. With iron deficiency anemia, the number of erythrocytes decreases to a lesser extent than the amount of hemoglobin, the color index is below 0.8. The number of leukocytes and the number of platelets are not significantly changed.

The treatment can be carried out under the supervision of the clinics at home, depending on the severity of the disease and the age of the child. Important is the proper organization of the regime and power. This is especially true of younger children. An effective treatment and preventive measure is a long stay in the fresh air. It is important to carry out water procedures, massage, gymnastics. Of great importance is nutrition. The diet should include fruit and apple juices, grated apples.

Iron preparations, which have found wide application, are the following: maltofer, ferrumlek.

If necessary, use erythrocyte mass. Prophylactic vaccinations in young children suffering from iron deficiency anemia can be given no earlier than 6 months after stable normalization of red blood counts.

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Anemia

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