ANEMIA (LOW HEMOGLOBIN) IN CHILDREN
Consultant Pediatrician – B.J.Wadia Hospital for Children
Editor - Pediatric Oncall
What is anemia?
Anemia means low hemoglobin. Hemoglobin is a protein present in the blood that carries oxygen from the lungs to different parts of the body. Low hemoglobin leads to decrease amount of oxygen reaching various tissues of the body. This leads to fatigue, tiredness, weakness and in severe cases even shortness of breath.
What are the causes of anemia?
The most important component of hemoglobin is iron. Thus iron deficiency is the commonest cause of anemia in the world. Other vitamins and minerals such as vitamin B12, folic acid, thiamine are also need to make hemoglobin. Thus deficiencies of these vitamins can also cause anemia. Infact vitamin B12 deficiency is seen in vegetarians who have very poor intake of green leafy vegetables.
Other causes of anemia could be genetic defects in hemoglobin that cause abnormal hemoglobin to be formed such as thalassemia, sickle cell anemia.
Since blood is formed in the bone marrow, any disease of the bone marrow can also cause anemia such as aplastic anemia (bone marrow stops producing blood), blood cancer (bone marrow is over crowded with cancer cells and hence cannot produce blood).
Just as body ages, the hemoglobin that is present in red cells in blood also age and these aging red cells are destroyed in the spleen to pave way for the new ones. Thus, increased destruction of red cells by the spleen can lead to decrease in hemoglobin. This increased destruction of red cell by spleen can occur when red cells are defective such as hereditary spherocytosis, elliptocytosis or destruction of infected red cells such as in malaria.
Some uncommon causes of anemia are enzyme defects such as G6PD deficiency pyruvate kinase deficiency.
Blood loss anywhere from the body can also lead to anemia.
What happens if a child has anemia?
Apart from symptoms of anemia such as increased tiredness, easy fatigability, shortness of breath, patients may have growth failure, poor cognitive development and even stunting. Since oxygen supply to various tissues of the body is affected, the heart tries to compensate by pumping out more blood in the body. However, the heart may sometimes be unable to cope up with this task and fail which may lead to severe breathlessness in the child and breathing difficulty which may also endanger the child’s life.
How is the diagnosis of anemia made?
Doctor may find that the child looks pale. There may be enlargement of liver and/or spleen. On blood tests, hemoglobin would be low. Certain indices on the blood test such as MCV, MCHC and MCH help your doctor to get a clue as to what is the cause of anemia. The doctor will look under the microscope to see the red cells and determine if they are small (small red cells are seen with iron deficiency, thalassemia), large (large red cells are seen with folic acid deficiency, vitamin B12 deficiency) or normal shaped or have abnormal shapes such as sickle (sickle cell anemia), spherical (hereditary spherocytosis). Depending on these tests, other tests may be done to confirm the test such as iron studies for iron deficiency, hemoglobin electrophoresis to look for thalessemia or sickle cell anemia, osmotic fragility to look for hereditary spherocytosis or bone marrow examination to look for bone marrow problems.
What is the treatment of anemia?
Treatment of anemia depends on the cause. Iron supplements and modification of diet (diet rich in iron such as green, leafy vegetables) is required in case of iron deficiency. In cases of vitamin B12 and folic acid deficiency, diet rich in them and supplements are required. For thalassemia, treatment consists of bone marrow transplantation or repeated blood transfusions. Treatment of bone marrow related anemia needs consultation with hematologists.
Last updated on 01-06-2005