Iron Deficiency Anemia

What is it?

Iron deficiency anemia is a decrease in the number of red blood cells, caused by a lack of sufficient iron. Iron is an essential component of hemoglobin, the oxygen-carrying protein in blood Children require approximately 2.0 mg/day. The causes of iron deficiency are too little iron in the diet, poor absorption of iron by the body, and loss of blood (including menstrual bleeding). The most common reason for iron deficiency anemia in infants and children is the inadequate supply of iron in the diet. In the first 6 months of age, iron stores are dependent on what has occurred during pregnancy. Due to the possible low stores of iron during pregnancy, low birth weight or premature infants are particularly vulnerable. During the following six to twelve months iron deficiency can be brought on by poor feeding practices. At this age prolonged exclusive breast-feeding, the delayed introduction of foods, lack of meat in the diet or the over-dependence on cow’s milk may bring on anemia. Adolescents, especially menstruating girls, are particularly at risk because of the growth spurts during puberty and poor eating habits. Other cause of iron deficiency include loss of blood from the intestinal tract as a result of various gastrointestinal disorders e.g. inflammatory bowel disease, milk protein allergy, celiac disease. The prevalence of iron deficiency anemia has declined over the past decades but children that are at increased risk include those from low socioeconomic status, aboriginal children, infants with low birth weight, and infants fed whole cows milk during the first year of life.

The symptoms of iron defeciency anemia may be:

• Pale skin color (pallor)
• Fatigue
• Irritability
• Weakness
• Shortness of breath
• Sore tongue
• Spoon-shaped brittle nails
• Unusual food cravings (called pica)
• Decreased appetite
• Headache
• Blue-tinged or very pale sclerae (whites of eyes)
• Recurrent infections
• Decreased attention span, alertness and learning

Note: There may be no symptoms if anemia is mild.

Blood tests are done to make the diagnosis of iron deficiency anemia and distinguish it from other causes of anemia. The laboratory tests that are performed to look for iron defeciency anemia include:

• Low hematocrit and hemoglobin (red blood cell measures)
• Small red blood cells
• Low serum ferritin (serum iron) level
• High iron binding capacity (TIBC) in the blood
• Blood in stool (visible or microscopic)

Blood smear of iron deficiency anemia:

The child's diet is the most important way to prevent and to treat mild iron deficiency.
(See Table 1 below). Drinking too much milk can make anemia worse. Drinking more than 32oz. per day can cause iron loss through intestinal walls, and can cause a decrease in appetite for solid foods. For picky eaters, a vitamin supplement that includes iron may be needed.

Iron from animals, poultry and fish is absorbed better than iron from vegetables and cereals. Many foods are good sources of iron.:

• Best sources: breast milk, formula with iron, iron fortified cereals, liver, prune juice
• Good sources: eggs, meat, fish, chicken turkey, soybeans, peanut butter, dried beans, lentils, molasses, peas
• Other sources: tuna, oatmeal, apricots, raisins, kale, prunes, greens

If the diet is deficient in iron or a child’s anemia is more severe the treatment consists of oral iron supplements. Milk and antacids may interfere with absorption of iron and should not be taken at the same time as iron supplements. Vitamin C (ascorbic acid) can increase absorption and is essential in the production of hemoglobin. Serve a citrus fruit or juice with an iron-rich food (for example, orange juice with a hamburger).The hemoglobin should return to normal after 2 months of iron therapy, but iron supplements should be continued for another 6 to 12 months. This will replenish the body's iron stores, contained mostly in the bone marrow. It is important that your doctor rechecks your child's blood counts about one month after he has started treatment to make sure it is working and the anemia is resolving.

TABLE 1

A. Term, Breastfed Infants
• 1. Start a source of iron (supplemental iron at 1 mg/kg/day or iron-fortified infant cereal or meat) at age 4 months. If using supplemental iron, keep iron out of reach of infants and children.
• 2. After weaning from the breast, stop the iron supplement and use iron-fortified infant formula until age 12 months.
• 3. Avoid cow's milk until after age 12 months.

B. Term, Formula-Fed Infants
• 1. Use iron-fortified formula until age 12 months.
• 2. If feeding iron-fortified infant formula, iron-fortified cereal is not needed.
• 3. Avoid cow's milk until after age 12 months.

C. Preterm Infants (post discharge from hospital care)
• 1. Start supplemental iron (2 mg/kg/day) or iron-fortified formula no later than age 1 month and continue to age 12 months.
• 2. Preterm infants (weight, >1,000 g) fed iron-fortified formula do not need additional iron.
• 3. For preterm breastfed infants, follow the recommended guidelines under A.2 through A.3 above.

D. Starting Solid Foods
• 1. After about age 4 months, use iron-fortified infant cereal and meat.
• 2. Use ascorbic acid-rich foods with meals to improve iron absorption.