Although people’s standard of living has improved significantly, especially for urban children, who have long been free from food and clothing, iron deficiency anemia is still relatively common because of the lack of knowledge about feeding. When the imbalance between the body’s demand and supply of iron is not improved, iron reduction, iron deficiency in red blood cells and iron deficiency anemia will appear one after another.
The causes of iron deficiency anemia include.
1. Insufficient iron storage at birth: all the iron in the fetus comes from the mother, and the last trimester of pregnancy gets the most iron, so premature babies are most likely to have iron deficiency due to insufficient congenital iron acquisition.
2. Insufficient intake: The diet contains too little iron, resulting in insufficient iron intake. The most common is exclusive breastfeeding, the mother’s own iron deficiency, the mother’s diet iron sources are not enough, the child did not add iron-rich food in time, resulting in iron deficiency anemia.
Since the fetus gets its iron from the mother, if the mother is deficient in iron, is the fetus necessarily deficient in iron stores? It depends. Previous studies have suggested that no matter how iron-deficient the mother is, the full-term fetus will not be iron-deficient, so “mother’s love is selfless”, but my supervisor, Prof. Qingkui Liao, has shown that when the mother is severely iron-deficient, the fetus’ iron supply will also be affected, so “limited and selfless”.
3, too fast growth, iron needs too much, did not add iron-rich food in time.
4, absorption disorders: intestinal diseases or food mix is not reasonable can lead to iron malabsorption and excretion increased.
5, too much loss: some diseases can lead to iron deficiency due to long-term chronic blood loss, such as: intestinal polyps, hookworm disease, milk protein allergy, etc..
As the former belongs, iron deficiency anemia is divided into three periods, what is the basis for the division and what are the corresponding laboratory test indicators? How is it diagnosed?
Iron-depleted stage: It can be diagnosed by meeting the following terms (1), plus any one of (2) or (3)
(1) There is a clear cause and clinical manifestation of iron deficiency.
(2) Serum ferritin <12 μg/L.
(3) Bone marrow iron staining: iron granulocytes <15% or absent, extracellular iron deficiency.
Although the percentage of iron granulocytes in bone marrow is a sensitive and specific indicator of the early stage of iron storage, bone marrow aspiration is after all more damaging than venous blood sampling, and its application is not common, so the most useful indicator is serum ferritin. Therefore, serum ferritin is the most valuable indicator to reflect the status of iron storage.
Erythropoietic iron deficiency: erythrocyte free protoporphyrin >0.9 μmol/L or >4.5 g/gHb indicates iron deficiency in erythrocytes, and a decrease in serum ferritin with an increase in erythrocyte free protoporphyrin and normal hemoglobin is typical of the erythropoietic iron deficiency phase.
Iron deficiency anemia stage: a decrease in serum iron <10.7 μmol/L, a decrease in transferrin saturation <15%, and a total iron binding capacity >64.4 μmol/L suggest the iron deficiency anemia stage.
In fact, the clinical detection of iron deficiency is already in the last stage – the iron deficiency anemia stage.
There is a normal physiological phenomenon in childhood called “physiological anemia”. After birth, with the resumption of autonomic respiration, the oxygen content of blood increases, erythropoietin decreases, and bone marrow hematopoiesis is temporarily reduced; secondly, the life span of fetal red blood cells is short; thirdly, the rapid growth of infants and the increase in circulating blood volume reduce the number of red blood cells and the amount of hemoglobin to about 100g/L at 2-3 months of age. Physiological anemia does not require treatment and gradually recovers after 3 months.
I once saw a case of iron deficiency anemia in a boy, exclusively breastfed, without complementary foods at 10 months, with a poor growth trend in height and weight, weighing 9 kg at 10 months, P25-50, length 69.5 cm, P3-5, and hemoglobin only 61 g/L. According to the standard, hemoglobin below 61 g/L is considered severe anemia.
Figure 1: A boy, 10 months old, with routine blood results indicating microcytic hypochromic anemia
Figure 2 A boy, 10 months Iron deficiency complete set: all indicators of iron deficiency anemia were abnormal
Figure 3. A boy, 10 months. Hemoglobin electrophoresis results: thalassemia was detected.
Iron deficiency prevention is especially needed in the following cases: preterm birth, multiple births, exclusive breastfeeding, maternal iron deficiency, excessive growth, chronic intestinal diseases, milk protein allergy.
How to treat for iron deficiency anemia?
1. supplementation with elemental iron 4-6mg/kg/day, divided into three doses, while taking vitamin C orally to help iron absorption, note that taking iron with milk, coffee, tea, etc. at the same time will affect iron absorption; /2. full course of supplementation, should be supplemented until the anemia is corrected and continue to supplement for 6-8 weeks, do not stop when the hemoglobin is normal, because the hemoglobin is normal and still needs to continue to supplement stored iron.
3. Therapeutic reactions after iron supplementation.
(1) Increased appetite and reduced irritability 12-24h after oral administration.
(2) 48-72h after oral administration, reticulocytes begin to rise, reaching a peak in 5-7 days, and then gradually decline, falling to normal in 2-3 weeks.
(3) After 1-2 weeks after oral administration, Hb begins to rise, and the anemia is usually corrected after 3-4 weeks, after which supplementation continues for 6-8 weeks.
Regarding the diagnosis and treatment of nutritional iron deficiency anemia, you need to see a doctor oh, the diagnosis especially needs to be differentiated from another similar anemia – thalassemia especially thalassemia minor, well, this problem, you need to see a doctor.