Laboratory findings in iron deficiency anaemia Essay

II. Inadequate dietary iron intake
- Faulty feeding consumption of large amounts of milk and carybohydrates,
exclusively on milk diet after 6 months.
III. Impaired iron absorption
- Pica, achlorhydria
IV. Increased iron requirements
- Preterm/Low birth weight infants
- Feto maternal haemorrhage/early clamping of cord
V. Decreased total body iron
- Low birth weight, prematurity, twins.
DISTRIBUTION OF TOTAL IRON IN BODY8
60% iron is in Hb
25% is storage iron (ferritin) and
15% is tissue iron (myoglobin & cytochromes)
CLINICAL FEATURES
The iron deficiency anemia is commonly found in children aged 6 months to 60 months, very high incidence is found in two age groups, one between 6 months and 3 yrs and other between 11 and 17 years of age12. This is so, because there is rapid growth and expanding red cell mass in both these age groups.
Clinical findings generally do not become apparent until hemoglobin falls below 7g/dl. Clinical features include pallor, sleepiness, irritability, and decreased exercise tolerance. All these manifestations of iron deficiency anemia reflect the underlying disease process as well as of deficiency state. Pallor is one of the most important clinical sign, is seen over skin, conjunctiva, tongue and nails. Sometimes children appear with the desire to ingest unusual substances such as ice or dirt called as Pagophagia, another manifestation of IDA.13. Ultimately, weakness, tachypnea, shortness of breath on exertion, tachycardia, cardiac dilatation, and eventually liver failure ensues in cases of severe anemia. Children having severe anemia, have irritability and anorexia as most prominent features. At this point tachycardia and cardiac dilatation occur, and systolic murmurs may also be appreciated.13
Initial stages of iron deficiency anemia, having only iron deficiency and no effect on hemoglobin as yet, affects attention span, alertness, and learning in both infants and adolescents.Adolescent girls with serum ferritin levels <12ng/dl but without having any change on hemoglobin, have demonstrated improved verbal learning and memory after taking iron for 8weeks13. Many neurological changes that occur due to iron deficiency may be long term or even irreversible14 Many steps of immunogenic mechanisms are influenced by iron deficiency anaemia, including humoral, cell mediated and nonspecific immunity and the activity of cytokines 15.
Walter et al16 suggests that children suffering from iron deficiency have a significant effect on their mental development, having a lower mental developmental index. Oski17 and web18 also have reported similar observation in their studies on children with iron deficiency anemia.
Other physical findings include, Platynychia, Koilonychia, glossitis, angular cheilosis.19
In chronic cases of anemia, skull bone changes have also been observed, like in chronic haemolytic anaemia20.
LABORATORY FINDINGS IN IRON DEFICIENCY ANAEMIA
Initial laboratory investigations should include hemoglobin, hematocrit and red cell indices, also white blood cells, differential count, platelet count, reticulocyte count, and examination of peripheral blood film. The laboratory diagnosis in children requires special attention to the use of age specific reference standards. Since all parameters vary with different ages, the normal values for the various haemotological indices, must be considered age-wise when interpreting results