Anemia
What is it?
Anemia is a low red blood cell count. Both
increased blood loss (from bleeding or excessive
blood cell breakdown, for example) and poor blood
cell production (such as iron deficiency) can
cause anemia. Anemic babies may have apnea, low
blood pressure, or a high heart rate, and they may
seem sleepy. A doctor can diagnose anemia with a
blood test.
Who gets it?
Anemia, the most common form of blood disorder,
limits the blood's ability to carry sufficient
oxygen throughout the body. In a healthy person,
disc-shaped red blood cells contain hemoglobin,
a red pigment that carries oxygen to the tissues
and carries away the waste material, carbon
dioxide. Anemia occurs when the overall number of
red blood cells decreases or when the amount of
hemoglobin available in those cells decreases.
What Cause it?
There are many different types of anemia, but
generally the condition can be traced to one of
three causes:
- environmental factors, such as deficiency of
a certain nutrient (most commonly iron) or the
side effect of certain medications
- external or internal blood loss or infection
- inherited or acquired problems with the
production and function of red blood cells or
hemoglobin
What are the symptoms?
The most common sign of iron deficiency and
other types of nutritional anemia is mild paleness
of the skin, which most apparent as a decreased
pinkness of the lips, the lining of the eyelids,
and the nail beds. A friend or relative who sees
your child only occasionally may be more likely to
notice this than you are because the changes
usually happen so gradually.
Your child may also be irritable and easily
fatigued.
Other symptoms can include dizziness,
lightheadedness, and a rapid heart rate, all a
result of the heart's effort to compensate for
lower hemoglobin levels by pumping more blood
throughout the body.
In addition to these symptoms, hemolytic anemia
may cause jaundice (yellow-tinged skin), dark
tea-colored urine, and enlargement of the spleen
or liver. Normally, the spleen and liver remove
old red cells from the blood at the end of their
life cycles. As cells are destroyed prematurely,
the organs become clogged with cells.
Sickle cell anemia often causes additional
symptoms, including unexplained fever, swelling of
the hands and feet, episodes of pain due to
blockages in the blood vessels by sickled red
blood cells, problems fighting infection, and eye
problems.
Children and young adults who have aplastic
anemia often experience easy bruising, nausea,
tiny areas of bleeding in the skin, and abnormal
bleeding from the gums, nose, vagina, or
gastrointestinal tract.
How is it diagnosed?
In many cases, doctors don't discover anemia
until they run blood tests as part of a routine
physical examination. A complete blood count
(CBC) may indicate that there are fewer red
blood cells than normal. Other diagnostic tests
may include:
- blood smear examination
: Microscopic
examination of red blood cells can help to
establish whether anemia is present and its
cause. Normal growth and hemoglobin production
are characterized by richly pigmented cells of
uniform shape and size. Cells that are extremely
large, abnormally pale or small, or misshapen may
be indicators of specific types of anemia.
- hemoglobin electrophoresis
: This test
identifies various abnormal hemoglobin in the
blood.
- 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.
In addition to running these tests, your
child's doctor may ask about a family history of
anemia and anemia symptoms and signs such as
jaundice and enlarged spleen, medications your
child takes, and previous and current infections.
What is the treatment?
Treatment for anemia cannot begin until the
underlying cause is identified. It's important not
to assume that any symptoms your child may be
having are due to iron deficiency ? be sure to
have her checked by a doctor, and don't attempt to
treat her yourself before doing so.
If your child does have iron deficiency anemia,
the doctor may prescribe medication in the form of
drops (for infants) or liquid or tablet form (for
older children). The doctor also may recommend
adding certain iron-rich foods to your child's
diet. In infants and preschool children, iron
deficiency anemia can result in developmental
delays and behavioral disturbances, such as
decreased motor activity, and problems with social
interaction and attention to tasks. Recent
research studies indicate that that behavioral
problems may persist into and beyond school age (5
years) if the iron deficiency is not properly
treated..
If your teenage daughter is anemic and has
heavy menstrual periods, her doctor may prescribe
a birth control pill to moderate the bleeding.
Folic acid and vitamin B12 supplements may be
prescribed if the anemia is traced back to a
deficiency of these nutrients.
If a certain medication appears to be the
cause, your child's doctor may discontinue it or
replace it with something else - unless the
benefit of the drug outweighs this side effect.
If an infection is the cause, curing the
infection will usually cure the anemia as well.
Treatment for more severe, chronic forms of
anemia may include:
- a transfusion of normal red blood
cells to help replenish the supply of normal
blood cells
- a splenectomy, removal of the spleen,
to allow more red blood cells to remain in
circulation
- corticosteroids
(hormones that control
key bodily processes) such as prednisone
to counter the process of premature destruction
of red blood cells by the immune system
- other drugs to suppress the immune system and
stimulate red blood cell production
- infection-fighting drugs or vaccines
- bone marrow transplantation to treat
severe cases of sickle cell anemia, thalassemia,
and aplastic anemia (This high-risk procedure
involves taking marrow from a donor and
injecting it into the child's vein; the donated
marrow then travels through the bloodstream to
the bone marrow, where it begins producing new
blood cells. The chance of success is usually
greatest when there is a histocompatible
- someone with a closely genetically matching
mix of body proteins - sibling donor.)
- extra fluids and pain medication (especially
for children with sickle cell anemia)
Self Care Tips
Whether anemia can be prevented depends on the
underlying cause. Presently, there is no way to
prevent anemia that is caused by genetic defects
of the red blood cell or hemoglobin.
However, there are steps you can take to help
prevent iron deficiency - the most common form of
anemia. Before following any of these suggestions,
be sure to talk them over with your child's
doctor. Each child's needs are different, and iron
overdose can cause serious health problems. In
fact, the American Academy of Pediatrics (AAP)
points out that iron is actually a significant
cause of poisoning in children younger than
5.
- cow's milk consumption
: Cow's milk given
too early (before 6 months of age) or in too
great quantities has been associated with cases
of anemia. Infants under 6 months fed regular
cow's milk may experience irritation of the
bowel, which can lead to small amounts of blood
loss. Furthermore, babies and toddlers who drink
too much cow's milk may become less interested in
foods with higher iron content. Parents also tend
to associate milk with good nutrition and may not
realize that the child needs better sources of
iron. In general, your child should not drink
more than 24 to 32 ounces of milk each day. If
you still can't get her to eat more iron-rich
foods, speak with your child's doctor about
adding an iron supplement to her diet.
- iron-fortified cereal and formula
: These
products can help ensure that your baby is
getting enough iron, especially as she makes the
transition from breast milk or formula to solid
foods.
- well-balanced diet
: Make sure that your
child or teen regularly eats foods that contain
iron. Good choices include iron-fortified grains
and cereals, red meat, egg yolks, leafy green and
yellow vegetables, yellow fruits, potato skins,
tomatoes, molasses, and raisins. If your child is
a vegetarian, you'll need to make an extra effort
to ensure that she gets sufficient iron. That's
because iron found in meat, poultry, and fish is
more easily absorbed than iron found in
plant-based and iron-fortified foods. Also, be
aware that certain food combinations can inhibit
or promote absorption of iron. For example,
drinking coffee or tea (including iced tea)
with a meal can significantly lower the amount of
iron absorbed. On the other hand, vitamin C helps
the body absorb iron.
- side effects of medications
: Numerous
medications can cause anemia. In most cases, the
benefit of the drug your child's doctor
prescribes outweighs the risk, but your child may
need to be monitored for signs of anemia.
This information has been designed as a comprehensive and quick reference
guide written by our health care reviewers. The health information written
by our authors is intended to be a supplement to the care provided by your
physician. It is not intended nor implied to be a substitute for
professional medical advice.
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