Anemia

Patient Education

About Anemia

Anemia occurs when the level of healthy red blood cells (RBCs) in the body becomes low. This can lead to health problems and complications, including fatigue and stress on bodily organs because RBCs contain hemoglobin, which carries oxygen to the body's tissues.

The mechanisms that produce anemia are:

• excessive destruction of RBCs
• blood loss
• inadequate production of RBCs

Iron is essential to hemoglobin production. Poor dietary iron intake (or excessive loss of iron from the body) can lead to iron deficiency anemia, the most common cause of anemia in kids. Iron deficiency anemia can affect kids at any age but is most common in those younger than 2 years old. Young children who drink excessive amounts of milk are at increased risk for iron deficiency.

Girls going through puberty also have a particularly high risk for iron deficiency anemia because of the onset of menstruation; the monthly blood loss increases the amount of iron they need to consume in their diets.

Signs and Symptoms

• Pale skin
• Fatigue or weakness
• Slow cognitive and social development
• Inflammation of the tongue
• Increased likelihood of infections
• Unusual cravings for non-nutritive substances, such as ice, dirt or pure starch If the anemia is caused by excessive destruction of RBCs, symptoms also may include jaundice, a yellowing of the whites of the eyes, an enlarged spleen, and dark tea-colored urine.

Diagnosing Anemia

A complete blood count (CBC) may indicate that there are fewer RBCs than normal. Other diagnostic tests may include:

Blood smear examination: Blood is smeared on a glass slide for microscopic examination of RBCs, which can sometimes indicate the cause of the anemia.

Iron tests: These include total serum iron and ferritin tests, which can help to determine whether anemia is due to iron deficiency.

Hemoglobin electrophoresis: Used to identify various abnormal hemoglobins in the blood and to diagnose sickle cell anemia, the thalassemias, and other inherited forms of anemia.

Bone marrow aspiration and biopsy: This test can help determine whether cell production is happening normally in the bone marrow. It's the only way to diagnose aplastic anemia definitively and is also used if a disease affecting the bone marrow (such as leukemia) could be causing the anemia.

Reticulocyte count: A measure of young RBCs, this helps to determine if RBC production is at normal levels.

In addition to running these tests, your doctor may ask about a family history of anemia and your child's symptoms and medications.

Treatment

If your child has iron deficiency anemia, the doctor may prescribe medication as drops (for infants) or as a liquid or tablet (for older kids), which usually must be taken for as long as 3 months to rebuild the body's store of iron. The doctor also may recommend adding certain iron-rich foods to your child's diet or reducing milk intake.

Folic acid and vitamin B12 supplements may be prescribed if the anemia is traced to a deficiency of these nutrients, although this is rare in children.

Depending on the cause, treatment for more severe or chronic forms of anemia may include:

• transfusions of normal red blood cells taken from a donor
• removal of the spleen or treatment with medications to prevent blood cells from being removed from circulation or destroyed too rapidly
• medications to fight infection or stimulate the bone marrow to make more blood cells In some cases of sickle cell anemia, thalassemia, and aplastic anemia, bone marrow transplantation may be used.

Preventing Anemia

• Breast-feed or use iron-fortified formula. Breast-feeding until your child is age 1 is recommended. Iron from breast milk is more easily absorbed than is the iron found in formula. If you don't breast-feed, use iron-fortified infant formula. Cow's milk isn't a good source of iron for babies and isn't recommended for children younger than age 1.
• Encourage a balanced diet. When you begin serving your baby solids — typically between ages 4 months and 6 months — feed him or her foods with added iron, such as iron-fortified baby cereal. For older children, good sources of iron include red meat, chicken, fish, beans, and dark green leafy vegetables. Between ages 1 and 5, don't allow your child to drink more than 24 ounces (710 milliliters) of milk a day.
• Enhance absorption. Vitamin C helps promote the absorption of dietary iron. You can help your child absorb iron by offering foods rich in vitamin C — such as melon, strawberries, kiwi, broccoli, tomatoes, and potatoes.
• Consider iron supplements. If your baby was born prematurely or with low birth weight or you're breast-feeding a baby older than 4 months and he or she isn't eating two or more servings a day of iron-rich foods, talk to your child's doctor about oral iron supplements.

Should I have my child screened for iron deficiency?

Iron deficiency and iron-deficiency anemia are typically diagnosed through blood tests. The American Academy of Pediatrics recommends that all infants be tested for iron deficiency anemia starting between ages 9 months and 12 months and, for those who have risk factors for iron deficiency, again at later ages. Depending on the screening results, your child's doctor might recommend an oral iron supplement or a daily multivitamin or further testing.

Iron deficiency in children can be prevented. To keep your child's growth and development on track, pay attention to how much iron your child is getting through his or her diet and talk to your child's doctor about the need for screenings and iron supplements.