Anemia (Anemia) and Iron Deficiency Symptoms, Causes and How to Treat?
Anemia is a condition in which blood hemoglobin levels fall below 13 g / dL in adult men and 12 g / dL in women, and can cause many important health problems. Anemia less than 11 g / dL in children aged 6 months to 6 years and 12 g / dL in 6-14 years is considered anemia. Early detection of anemia in children is very important because it can cause many serious diseases, especially developmental delay.
Among the main symptoms of anemia;
Fatigue
Weakness
Dizziness
Quick fatigue
Reduction in working capacity
Frequent illness
Anorexia
Nausea
Paleness of skin on the inside of eyelids and palms
Palpitation
Shortness of breath
Overheating
Concentration disorder is a general symptom of anemia.
Anemia can cause significant problems when untreated or delayed treatment. In children; growth is adversely affected and slows down. Physical activity decreases. Diseases are more common. Perception, learning and interpretation functions are reduced, distraction, fatigue and apathy increase, school success decreases.
In the treatment of anemia primarily, the cause of iron deficiency is eliminated. The most common cause of iron deficiency anemia, especially in infancy and adolescence, is the lack of increased iron supply; In childhood and adolescence, it is recommended to investigate absorption disorders such as underlying bleeding, parasites or celiac disease.
Anemia due to vitamin B-12 deficiency
Vitamin B12 deficiency, which plays an important role in blood production, is mostly seen in vegetarian (meat-fed) diet and folic acid deficiency occurs in people who are fed a poor diet of green leafy vegetables. However, anemia due to deficiency of these two nutrients is not as common in children as iron-deficient anemia.
It is very important because it affects both the intelligence level and physical development of children with iron deficiency anemia. Two out of every five children (40%) in the world are bloodless, but many of them are unfortunately not aware of their condition. While the incidence of anemia in children aged 0-5 years is 4-20% in developed countries, this rate increases up to 80% in the same age group in less developed countries. In our country, this rate is quite high as 50% (one in two children).
Iron Deficiency and Anemia Symptoms
Iron deficiency does not show any symptoms in most cases. Diagnosis can be made as a result of blood tests. If the disease is advanced and severe, weakness, pallor, fatigue, loss of appetite, constipation occurs. Palpitations during a physical activity, difficulty breathing, fatigue occurs according to the severity of the disease. Patients want to eat non-food substances such as pica soil or clay, ice.
Other than these, the following symptoms may occur:
Dizziness, tinnitus,
Cracks in the mouth,
Spoon shape of the nails, formation of cracks,
Reddening of the tongue, crack and bubble formation,
Difficulty swallowing, painful swallowing,
Children with iron deficiency are delayed in walking, sitting or talking. Behavioral disorder occurs in these children and learning becomes difficult. The immune system weakens and the chance of developing the disease increases. Symptoms of iron deficiency in childhood are not original. It is difficult to define until significant anemia occurs. It tends to develop so slowly that it is often difficult to notice. Iron deficiency anemia may give different signs and symptoms according to age groups.
Anemia and iron deficiency symptoms in infants;
appetite, restless, cheerless, sluggish, slow movements, sleep disorders may be. In these babies, the physical examination of the eyelids, palms, soles of the feet, nail beds are pale. However, all these symptoms may remain faint.
Anemia and iron deficiency symptoms in children;
The main symptoms are fatigue, fatigue, loss of appetite, restlessness, palpitations, inability to exercise, fatigue quickly, in shorter breathing and difficulty in breathing. The most important finding in these children is paleness. In addition, iron deficiency affects physical growth, cognitive and psychomotor development, reduces resistance to infections and affects school success in this age group.
Kindergarten and school children appear tired, inadequate learning and perceptions at school, are reluctant, are very difficult to follow in the afternoon desriere, attention affects memory and learning and become inadequate, lack of attention, difficulty in learning, problem solving, reduced school achievement and more introverted and timid behavior is observed.
What Causes Iron Deficiency Anemia and Anemia?
Iron deficiency anemia occurs when the amount of iron in the body is insufficient and insufficient to allow hemoglobin to be made to the required extent. There are many causes of this deficiency in the body. The main reason of iron deficiency in children is the increase in need, inadequate intake, and rarely, iron loss due to bleeding. There is often an imbalance between iron intake and the need of the child. If the increased requirement is not met enough, it causes iron deficiency especially in infancy and childhood.
Inadequate intake of iron due to nutritional deficiencies such as insufficient consumption of iron-rich foods and iron-enriched foods, or dietary habits with less iron-containing foods, and nutrient factors such as cow's milk and cereals, which prevent absorption of iron from intestines, lead to iron deficiency. important reasons.
In addition, due to cow's milk sensitivity in childhood, hidden bleeding from intestines, puberty and menstrual bleeding in pregnant women through the increase in iron loss and this is another reason to be covered with food.
Continuous use of pain medications and irregular nutrition also increases the risk of anemia. Anemia is common in patients with low socio-economic status, vegetarians (those who eat meat), and chronic diseases such as ulcers and parasitic diseases.
Cases where iron absorption is impaired; prolonged diarrhea, chronic infections, disorders of the digestive system can cause anemia by disrupting the absorption of iron taken into the body. Lead poisoning; lead poisoning caused by the mixing of lead in the fuel, especially in the city centers where there is heavy vehicle traffic, can also cause anemia.
Problems Caused by Anemia
Anemia can have significant consequences if left untreated or delayed. In children; Growth is adversely affected and generally slows down. Physical activity decreases. Diseases are more common. Perception, learning and interpretation functions are reduced, distraction, fatigue and apathy increase (school achievement decreases). In adults; There is a constant feeling of fatigue, weakness occurs, labor is reduced. Diseases are more common.
What is Daily Iron Need and Loss?
Daily iron requirement is 1-3 mg. It is up. 5-10% of it is absorbed from the duedenum and proximal small intestine. Daily loss is 1 mgr. Sweat is lost with feces, urine, spilled cells.
What is the Importance of Iron for the Body?
The most important function of iron in the body is the production of oglo hemoglobin.. Hemoglobin is found in the red blood cells in our blood and carries out the process of carrying the oxygen necessary for all tissues to survive. In other words, the more important oxygen is for our lives, the more important it is for iron to be used. Although iron is present in the human body for a total of 4 grams, it is an important biological element and causes serious problems in its deficiency.
Iron Deficiency and Anemia Treatment
1. The cause of RIA is investigated: The most common cause of RIA, especially in infancy and adolescence, is the lack of increased iron supply; In childhood and adolescence, it is recommended to investigate absorption disorders such as underlying bleeding, parasitosis or celiac disease.
2. Firstly, the cause of iron deficiency is eliminated in the treatment.
3. Iron deficiency treatment:
Drugs containing the ferro (+2) salt form of iron (ferro sulphate) are used. If patients cannot tolerate this form orally, drugs containing the ferri (+3) form may also be used.
The drug dose is adjusted to include 3-6 mg / kg / day elementary iron according to the depth of the patient's anemia. The total daily dose is divided into two or three doses. Iron medications may also be given as a single dose in mild anemia. It is desirable to take the drugs on an empty stomach (2 hours after meals) for maximum absorption.
The patient / family is informed about the side effects of oral iron medications (nausea, vomiting, dyspepsia, constipation, diarrhea, flatulence, black stool, staining of teeth).
To minimize the staining of the teeth to black, the form of drops or syrup is directed towards the back of the tongue so as not to contact the teeth; administering the drug by dilution with fruit juice or water; It is recommended to administer the drug with a pipette.
Intolerance to oral iron medication is common. If this occurs, the drug is discontinued for 1-2 days. Then, starting from a low dose, increasing the dose as the patient tolerates, and reaching the ideal dose within 4-5 days.
Iron absorption is reduced by the combined use of certain drugs containing antacids, proton pump inhibitors, histamine 2 receptor antagonists, aluminum, magnesium, calcium or zinc. Iron reduces the absorption of drugs such as bisphosphonates, tetracycline, quinolone, levodopa, methyldopa, levothyroxine, penicilllamine. It is recommended to take at least 2 hours between these drugs and iron drugs. It is not recommended to give iron together with zinc.
As soon as iron deficiency is detected, iron treatment is initiated. The patient's hemoglobin increases 1-2 g / dl in 2-4 weeks. During this period, the patient is followed up with a complete blood count control as often as appropriate.
Anemia of the patient improves in 1-2 months with appropriate iron medications and treatment of the underlying disease. After anemia has been resolved, treatment is continued to fill the body's iron stores for another 2-3 months.
If an anemia or hypoxia is present (eg severe lung infection) at a depth that will cause heart failure, the patient may be given an erythrocyte suspension. After the patient's condition improves, iron treatment is started.
Oral iron therapy is always the first choice. Parenteral iron treatment is given if there is a non-compliance or tolerance of oral iron treatment, if there is a problem with iron absorption, if there is continuous blood loss.
Parenteral treatment of iron sucrose, iron gluconate (not in Turkey) or iron dextran given.
Side effects of parenteral iron therapy; anaphylaxis, arthralgia, myalgia, fever, flushing, hypotension. Since 0.5 to 1% of the patient may have anaphylaxis, it is recommended to administer the drug after a small test dose of 30 minutes. The daily dose is given as IV infusion by dividing the total dose to not exceed 100 mg / day. Since the muscle mass in children is not high, absorption by IM injection is variable, because it causes pain and discoloration of the skin, IM injection is generally not preferred, but it can be applied carefully in mandatory situations. The response to parenteral treatment is not faster than the response to oral treatment.
If there is no response to oral iron treatment;
It is questioned whether the family gives the medicine regularly and appropriately.
Check the adequacy of the dose and the use of the recommended drug.
Factors affecting iron usage and absorption are reviewed.
Drug intake that disrupts iron absorption is questioned.
Vitamin B12, folic acid deficiency, such as coexistence conditions are investigated.
The bleeding focus is investigated.
The possibility of misdiagnosis is reviewed. Differential diagnosis should be made with all hypochromic microcytic anemias: Hemoglobinopathies (especially thalassemia minor), copper deficiency, zinc deficiency, chronic disease anemia, lead intoxication, sideroblastic anemias, etc. Final control is recommended 1 week after the end of treatment. Complete blood count and serum ferritin level (with CRP and ESR) are checked for this control. The patient is also evaluated once again after 3-6 months
What can you do to prevent iron deficiency anemia and anemia?
Iron deficiency, because it is still the most common cause of anemia in Turkey, is a major problem affecting the public health. Therefore, prevention of the development of iron deficiency in children has priority.
For this purpose:
Breastfeeding should be encouraged. Breast milk is sufficient for the first 4-6 months after birth.
After six months, it is recommended to be fed with nutrients rich in iron, as well as breast milk. It is recommended that babies who cannot get breast milk at this age should be fed with iron-rich formulas as well as supplementary food.
After 4 months, 1 mg / kg / day dose was given to babies born at term; Premature babies born below 2500 g should be given 2 mg / kg / day drops of elementary iron after 2 months and iron prophylaxis should be continued until 1 year of age.
Daily cow's milk consumption should be limited to 2 cups.
Premature and low birth weight babies, cow's milk started before 1 year of age and daily milk consumption of more than 500 ml, children with a history of low iron-rich foods, children with chronic disease are at risk for iron deficiency.
Foods Good for Iron Deficiency and Anemia
Red offal from animal foods is the richest source of iron. Other useful foods; red meat, chicken, eggs, shellfish and fish (the richest salmon). Among plants, wheat, corn and oats are richer than iron when granular. Like many other vitamins and minerals, it is found in iron, especially on the outside of grain grains; For example, when milling wheat, 75% of the iron contained in the bran remains, ie wheat flour contains only 25% iron than grain wheat. Although spinach is known to be rich in iron content, this information is not accurate because iron contained in the structure of many vegetables such as spinach and black cabbage is not as useful as the body.
Nuts such as raisins, dried apricots, prunes, almonds, pistachios, walnuts and kernels are not very rich in iron, but they contain sufficient iron. One tablespoon of molasses contains about 3 mg of iron. Drinking one glass of orange juice a day increases the absorption of iron from plants, while consumption of tea and coffee reduces iron absorption by 75%.
What are the points to consider while using the drug?
Although the best iron absorption is on an empty stomach, many people cannot bear it and like to take it with food. Milk and milk products should not be taken together with the drug as it will prevent the absorption of iron. Vitamin C increases the absorption of iron.
Measures to be taken against anemia
Iron deficiency anemia is a preventable disease. Blood tests should be performed at 12 months for diagnosis in infants. For the prevention of iron deficiency anemia;
1. Giving Adequate and Usable Iron with Nutrients - Breast Milk Nutrition:
Preservation, maintenance and dissemination of breastfeeding are the most important measures. Iron deficiency anemia has been shown to be lower in infants who received breast milk alone in the first 6 months of life compared to those who did not. The iron store the baby bought from the mother in the first 6 months! it is sufficient and is easy to use because iron in breast milk is more easily absorbed. Therefore, it is difficult to develop iron deficiency in the first 6 months.
Breast milk is the most important food of the baby for the first 6 months. Nowadays, it is recommended that babies should be fed only breast milk in the first 6 months, supplementary foods should be started after 6 months and breastfeeding should be continued until the age of 2 years. This form of nutrition is defined as natural nutrition. In our country where breastfeeding is a tradition, almost every baby is fed with breast milk in the first month after birth.
However, the rate of breastfeeding decreases in the following months. According to the National Nutrition and Health survey, the overall rate of breastfeeding is 95%. The first hour of breastfeeding was 52.8% and the first day of breastfeeding was 84.8%. It was found that breastfeeding and breastfeeding rates decreased in the following days. In the first 3 months, the rate of infants receiving only breast milk decreases to 10.4%. On the other hand, when the babies are 2-3 months old, the rate of onset of cereal based nutrients as an additional nutrient increases with increasing iron absorption and it is seen that it reaches 55%. In addition, one out of every five babies under 3 months is given ready food.
However, breastfeeding with breast milk has three main components of healthy nutrition; It fuses food, health and care perfectly. In researches, it was found that the intelligence level of breastfed children in infancy was about 8 points higher than those fed with formula. Therefore, breastfeeding and breastfeeding should be the first step in the prevention of iron deficiency in infants.
Only cow's milk should not be given without additional nutrients during infancy:
Foods made with cow's milk cause intestinal hemorrhage as a result of reactions to cow's milk due to poor intestinal absorption of iron in cow's milk and lead to iron deficiency. However, if it is necessary to give cow milk instead of ready foods for economic reasons, it can be prepared by boiling and diluting cow's milk and given with other foods suitable for baby's month. It is recommended not to take more than 500cc of milk per day in the first year.
Increasing the nutrients of iron with high bioavailability in diet and giving them enough (meat, egg yolk, chicken, fish, grape molasses)
Consumption of plant-based nutrients (citrus fruits, green plants, etc.) containing vitamin C that increase absorption of iron with low bioavailability
Low consumption of cereal products (phytate, tannan, oxalate) which reduce iron absorption
Iron Enrichment of Nutrients
2. Giving Iron Support:
One of the important steps in the prevention of iron deficiency anemia is the administration of prophylaxis to meet the increased need. In babies born in time, iron stores in the body after 4 months cannot meet the increased requirement due to rapid development. Hemoglobin is required to build more iron. In our country, since the consumption of iron-enriched food and other nutrients is insufficient, the iron sulfate is given to infants at the Ministry of Health from 4 and 6 months as I mg / kg / day and used until the age of 3 years. Since iron stores are less and develop faster in premature babies, iron storage is emptied more quickly, therefore 2 mg / kg / day iron sulfate drop is continued to babies with low birth weight after 2 months until 3 years of age. Positive correlations were found between hemoglobin levels and iron stores in pregnancy. For this reason, giving iron support before conception in women of childbearing age prevents the development of iron deficiency in the newborn.
Anemia and Iron Deficiency
Deficiency usually occurs during childhood and adolescence during pregnancy, where growth is very rapid. Again, over-consumption of foods with low iron content and also the difficulty in absorbing iron taken through food are factors that facilitate the emergence of anemia. In infants and children, there is a need for more iron to maintain a healthy growth since it has a rapid growth rate. However, iron supplemented with nutrients alone may not be sufficient to meet this need.
Why iron deficiency is common in children?
The newborn has 0.5 g of iron in the body. In adults, it is 4-5 g. To compensate for this deficit, an average of 0.8 g of iron absorption per day should be achieved in the first 15 years. This means that 30% of children's daily iron requirement must be fed with food. This is achieved by daily iron absorption of I mg. Since the need for infants and children also increases due to rapid development and growth, iron deficiency develops excessively as a result of this being not adequately met with food.
Endogenous iron is sufficient in infants during the first 6 months and nutrients and iron should be taken sufficiently after that. As a result of rapid development and growth in infants, the need has increased and iron deficiency develops, especially in cereals fed because there will not be enough iron intake. In addition to the rapid growth and growth spurt in adolescence, the need for iron increases even more in young adolescent girls as menstrual bleeding increases.
The need increased during pregnancy. In our country, feeding of mothers is not enough. Especially in childhood, girls who are not fed enough in terms of iron and generally fed with cereals and therefore short stay have high risk during pregnancy and childbirth. If the prospective mother has mild anemia, the unborn baby is unaffected but there is a relationship between maternal anemia and preterm birth.
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