What is iron deficiency anemia? Iron deficiency anemia is caused by a decrease in hemoglobin synthesis due to iron deficiency in the body. Iron deficiency anemia is the most common type of anemia in children, with the highest incidence in infants and children, and is a serious health risk for children. Some studies have reported that the rate of iron deficiency in children under 2 years old is as high as 30% or more. It is one of the common pediatric diseases that China focuses on preventing and treating. The World Health Organization reports that half of the women in the third world suffer from anemia due to malnutrition, and the incidence of women, especially pregnant women, may be 10 times higher than that of men. Among the 464 million women of childbearing age (15-19 years old) in developing countries except China, about 230 million women have the disease, which shows that it is very alarming to see such a wide geographical area of incidence and such a large number of women suffering from the disease, and it deserves attention. The prevention and treatment of iron deficiency anemia is a worldwide concern. What is the cause of iron deficiency anemia? 1.Increased iron demand and insufficient intake Children’s iron demand increases during the birth period and infant lactation, especially for premature babies, twins or mothers with original anemia, the original iron stores of infants are already insufficient, if they are only fed with human milk containing less iron, and if they are not supplemented with more iron-containing by-products such as eggs, vegetables, meat and animal liver in time after teething, iron deficiency anemia can result; the iron demand increases during pregnancy and lactation. Iron deficiency anemia can be easily caused by the increase in iron demand during pregnancy and lactation, and the lack of gastrointestinal function and stomach acid during pregnancy, especially after multiple pregnancies; iron deficiency anemia can also occur in young people due to rapid growth and increased iron demand, especially in young women due to menstrual blood loss, if the food they eat for a long time does not contain enough iron. 2. Excessive consumption of stored iron Since 2/3 of the total iron in the body exists in the red blood cells, repeated and excessive blood loss can significantly deplete the body’s iron stores, and the long-term loss of chronic small intestinal bleeding caused by intestinal parasitic infections (such as hookworm disease), repeated bleeding from upper gastrointestinal ulcers, years of anal bleeding or excessive menstrual flow in women can eventually lead to insufficient iron stores in the body, resulting in iron deficiency anemia. In addition, paroxysmal sleep hemoglobinuria, mechanical hemolysis caused by artificial mechanical heart valves, and idiopathic pulmonary iron-containing hemoglobinosis can cause anemia due to long-term iron loss in urine. Free iron can be lost with the aging and continuous shedding of epithelial cells in the gastrointestinal tract. In atrophic gastritis, major gastric resection and steatorrhea, the renewal rate of epithelial cells is accelerated, so the loss of free iron also increases. It can cause abnormalities in lipid, protein and sugar metabolism, resulting in abnormal red blood cells, which are easily destroyed in the spleen and shorten their life span. What are the manifestations of iron deficiency anemia? It can develop at any age, but it is most common between 6 months and 2 years old, and its clinical manifestations vary with the severity of the disease. 1. General manifestations The skin and mucous membranes gradually pale, with the lips, oral mucosa and nail bed more obvious. Easy fatigue and inactivity. Older children may complain of dizziness, blackness in front of the eyes, tinnitus, etc. 2. Extramedullary hematopoietic manifestations Due to extramedullary hematopoiesis, the liver and spleen may be mildly enlarged; the younger the age, the longer the disease duration, and the more severe the anemia, the more obvious the enlargement of the liver and spleen. 3. Non-hematopoietic system symptoms (1) Digestive system symptoms: loss of appetite, a few have xenophagia (such as addiction to mud, wall skin, cinders, etc.); vomiting and diarrhea may occur; stomatitis, tongue inflammation or atrophy of tongue papillae may appear; atrophic gastritis or malabsorption syndrome may appear in severe cases. (2) Neurological symptoms: manifested as restlessness or depression, mental inattention, memory loss, and intelligence mostly lower than that of children of the same age. (3) Cardiovascular system symptoms: heart rate increases when anemia is obvious, and in severe cases, heart enlargement or even heart failure occurs. (4) Other: Infections are often combined with reduced cellular immune function. Anti-nails may appear due to abnormal epithelial tissue. What laboratory tests are available for iron deficiency anemia? Laboratory tests such as blood, bone marrow and iron metabolism can be performed for iron deficiency anemia. (1) Blood picture When the anemia is mild, the erythrocytes are still orthocytic orthopigmented. When the anemia is severe, the erythrocytes show typical characteristic small cell hypochromia, and the mean erythrocyte volume (MCV), mean erythrocyte hemoglobin (MCH), and mean erythrocyte hemoglobin concentration (MCHC) are reduced. In the blood film, the size of the erythrocytes can be seen to be very heterogeneous, with a predominance of small size and an enlarged central lightly stained area. (2) Bone marrow The erythrocyte lineage is actively proliferating, the bone marrow is negative for iron-containing hemoglobin, and very few iron granulocytes are found. (3) Iron metabolism examination ①Serum iron, total iron binding capacity and ferritin In iron deficiency anemia, serum iron concentration is often significantly reduced, total iron binding capacity is increased, iron saturation is reduced, serum ferritin can detect the earliest iron deficiency, and decreased stored iron is the only reason for decreased serum ferritin. ②Free protoporphyrin (FEP) in erythrocytes The concentration of free protoporphyrin in erythrocytes is increased in iron deficiency anemia. How should iron deficiency anemia be treated? The main principles are to remove the cause and to supplement iron. 1. Remove the cause of the disease The unreasonable diet and food composition should be corrected for those who have improper diet, and those who have partial eating habits should be corrected. If there are chronic blood loss diseases, such as hookworm disease, intestinal malformation, etc., they should be treated in time. 2.Iron therapy Commonly used oral iron supplements include ferrous sulfate, ferrous fumarate, ferrous gluconate, ferrous succinate, ferric gluconate, ferric succinate, etc. It is suitable to be taken orally between meals to reduce gastrointestinal side effects and increase absorption. Take vitamin C at the same time, it can increase the absorption of iron. Milk, tea, coffee and antacids can affect the absorption of iron when taken together with iron. How to prevent iron deficiency anemia? The main preventive measures include: ① advocate breastfeeding, because the absorption rate of iron in breast milk is higher; ② do a good job feeding guidance: generally full-term children’s body iron stores can meet the needs of the four months after birth, add supplementary food on time, whether breastfeeding or artificial feeding of infants, should add iron-rich and iron absorption rate of supplementary food, especially breastfeeding children, such as fine meat, blood, offal, fish, etc., and pay attention to dietary If infants are fed with fresh cow’s milk, they must be heated to reduce intestinal blood loss due to milk allergy; ③ Infant foods (cereal products, milk products, etc.) should be fortified with appropriate amounts of iron; ④ Premature infants, especially very low weight preterm infants, should be given iron prophylaxis from about 2 months of age.