Clinicolaboratory findings and treatment of iron-deficiency anemia in childhood

One of the major causes of anemia in childhood worldwide is iron deficiency. Its prevalence depends mainly on age, being higher in infancy and adolescence. Its etiology varies, but poor iron diet is considered the commonest causative factor. Better tactics may be needed, like the targeted screening of children who belong to high-risk groups, to eradicate childhood iron deficiency. The amount of the body iron regulates its absorption from the gut through mechanisms that are still poorly understood. Early identification of iron deficiency is essential for the prevention not only of anemia but also the numerous and long-term consequences caused by the lack of iron. Many tests are available for the diagnosis of the disease. Some of them seem very promising for the early detection of iron deficiency, but further research is needed before they become widely acceptable in clinical practice. Treatment is based on oral iron salts, which do not have any serious side effects.     

Spontaneous motor activity in human infants with iron-deficiency anemia

This study compared spontaneous motor activity in 6-month-old Chilean infants with or without iron-deficiency anemia (IDA) who were otherwise healthy. Activity was assessed in conjunction with polysomnographic recording during an afternoon nap in 11 infants with IDA and 15 with normal hemoglobin levels. All infants were given oral iron, and activity was reassessed at 12 and 18 months. Using actigraphs placed on the ankle, the frequency of movement units per minute was determined for each waking/sleep state. The total amount of time infants were in an alert-active state before and after the nap was used to calculate the proportion of movements/minute of waking. There were no differences between anemic and nonanemic infants in total recording time, duration of sleep, or motor activity during sleep. However, infants with IDA showed reduced motor activity during waking at all ages. The magnitude of the differences increased at 12 and 18 months. Thus, IDA was associated with reduced motor activity in infants even after iron treatment. It will be important to confirm these results in a larger sample and to determine the 24-h pattern of motor activity, since reduced motor activity may limit infants' opportunities to explore and learn from the social and physical environment.     

Helicobacter pylori-associated iron-deficiency anemia in adolescent female athletes.

OBJECTIVE: The objective was to investigate the role of Helicobacter pylori infection in iron-deficiency anemia (IDA) of pubescent athletes. STUDY DESIGN: Blood sampling and a questionnaire survey were performed on 440 regular high school students and 220 athletes of a physical education high school. Hemoglobin, serum iron, total iron-binding capacity, ferritin, and immunoglobulin G antibody to H. pylori were measured to compare the prevalence of IDA and H. pylori infection in the groups. Nutritional analysis and a questionnaire survey for socioeconomic status were undertaken to compare and control for other risk factors that might influence IDA and H. pylori infection in the groups. In those with IDA coexistent with H. pylori infection, we also determined whether IDA can be managed by H pylori eradication. RESULTS: The prevalence rates of IDA, H pylori infection, and H. pylori -associated IDA in female athletes were higher than in the control group. The relative risk of IDA was 2.9 (95% CI, 1.5 to 5.6) for those with H. pylori infection. Athletes who exhibited H. pylori -associated IDA showed significant increases in hemoglobin, iron, and ferritin levels after H. pylori eradication. The subjects in the control group who were treated orally with iron alone showed no significant changes. CONCLUSION: Adolescent female athletes may have development of H. pylori -associated IDA, which can be managed by H. pylori eradication.     

Supplemental food may not prevent iron-deficiency anemia in infants

Objective  The present study evaluates the role of supplementary food and medicinal iron intake in preventing irondeficiency anemia in children aged between 4 to 6 months. Methods  During a case-control study in “Tabriz Children Hospital”, nutritional and medicinal-iron intake of 60 consecutivelyselected patients with iron-deficiency anemia were compared with 60 non-anemic children of similar age and sex distributions. Results  The mean hemoglobin concentration, corpuscular volume and serum iron were 9.11 g/dl, 65.41 fL and 19.33 μg/dl, in case group; and 12.6 g/dl, 75.18 fL and 78.28 μg/dl, in control group, respectively. There was no statistically significant difference between age of case and control groups when complementary-semisolid foods were started (P=0.058), but the mean of received medicinal iron in case group was significantly lower than control group (P<0.001). Conclusion  Supplementary food intake alone is not efficient to prevent iron deficiency anemia since the age of 4–6 months. So, regular administration of medicinal iron is crucial to prevent iron-deficiency anemia in children aged 4–6 months.     

268例儿童缺铁性贫血影响因素分析

目的探讨儿童缺铁性贫血(IDA)影响因素及影响贫血程度的相关危险因素。方法回顾性分析自2003年3月至2014年10月收住广东医学院附属医院儿科的268例明确诊断IDA患儿病例资料,设同期非贫血组患儿进行对照。结果本研究中男、女性患儿检出率分别为16.1%和31.3%。儿童IDA相关危险因素多因素Logistic回归模型分析结果:年龄、断奶时间、4~6个月添加辅食、挑食、体重增长过快、母亲文化程度等组间差异有显著性(P<0.05)。影响儿童IDA贫血程度因素Logistic回归结果示:不同分娩医院组间差异有显著性(P=0.026,OR=1.438,95%CI1.048~2.099),不同出生体重患儿间差异有显著性(P=0.008,OR=0.414,95%CI 0.217~0.791)。结论儿童IDA应着重以综合预防为主,加大儿童营养保健知识普及范围,实施个体化辅食添加方案。     

儿童轻度缺铁性贫血间歇补铁疗法的有效性研究北大核心CSCD

目的研究间歇性补铁疗法治疗儿童轻度缺铁性贫血的临床疗效。方法前瞻性选取147例轻度缺铁性贫血患儿分为间歇补铁组(n=83)和常规补铁组(n=64),检测两组患儿治疗前、治疗1个月后和治疗3个月后血红蛋白水平,对两组的治疗有效率及不良反应发生率进行统计分析。结果经过补铁治疗后,常规补铁组和间歇补铁组血红蛋白水平均较治疗前升高(P<0.05)。治疗1个月后,常规补铁组治疗有效率(61%)高于间歇补铁组(42%)(P<0.05)。治疗3个月后,常规补铁组治疗有效率(86%)与间歇补铁组(78%)比较差异无统计学意义(P>0.05)。常规补铁组的不良反应发生率(25%)高于间歇补铁组(8%)(P<0.05)。结论虽然间歇补铁法对轻度缺铁性贫血患儿的短期疗效不及常规补铁法,但是长期疗效无差异;而且相对于常规补铁法,间歇补铁法可降低不良反应发生率,减轻家庭经济负担,提高患儿治疗依从性,值得临床推广应用。     

Severe iron-deficiency anemia among hospitalized young children in an urban hospital

The aim of this study was to investigate the prevalence and some characteristics of young children with severe iron-deficiency anemia hospitalized in an urban hospital. All of the young children (aged 7-24 months) hospitalized in a city hospital during the last 3 years were searched for iron-deficiency anemia and those with severe anemia were retrospectively evaluated. During this period, 3117 young children were hospitalized and 61.6% of them had a hemoglobin value of less than 11 g/dL and 52 children (2.7%) had severe iron-deficiency anemia (hemoglobin < 6 g/dL). It was concluded that iron-deficiency anemia is still an important health problem among young children in our society.     

缺铁性贫血铁剂治疗过程各项铁参数动态变化的相互关系

目的：探讨缺铁性贫血铁剂治疗过程各项铁参数动态变化的相互关系。方法：对２９例缺铁性贫血患儿以菲普利（Ｆｅｒｐｌｅｘ，元素铁４ｍｇ．ｋｇ＾－１．ｄ＾－１）治疗４０天，观察治疗前及治疗后１、３、５、６周各项参数，血清铁蛋白（ＳＦ）锌原卟啉（Ｚｐｐ）血红蛋白（Ｈｂ）网织红细胞（Ｒｅｔ）的动态变化，并以正常值为横坐标，各项参数进行值为纵坐标制成图，显示各项同铁参数变化的相互关系，结果：ＳＦ推导值线在治疗后     

Idiopathic pulmonary hemosiderosis: a rare cause of iron-deficiency anemia in childhood

Idiopathic pulmonary hemosiderosis is a chronic, rare disorder confined to the lung, which is commonly characterized by the triad of recurrent hemoptysis, diffuse parenchyma infiltrates on chest radiography, and iron-deficiency anemia. Diagnosis may be difficult and the clinical course may be widely variable. Here, we describe an 8-year-old boy whose isolated symptom on presentation was iron-deficiency anemia. Presence of hemoptysis and bilateral alveolar infiltrates on chest x-ray led to the diagnosis of pulmonary hemosiderosis, subsequently confirmed by the finding of hemosiderin-laden macrophages by bronchoalveolar lavage. The patient was started on prednisolone 2 mg/kg/d and no further bleeding episodes were noted after the onset of therapy.