Iron- Deficiency Anemia

Iron-deficiency anemia is very common among infants due to insufficient dietary iron. Infants have high iron requirements because they grow rapidly and have small stores.

Causes

1. Inadequate intake - Most common causes of anemia in infants.

                             Infants most at risk:

• Premature infants (lower iron stores and more to grow). Oral iron supplements are recommended for these infants until the age of 2 years.
• Inadequate solid food after 6 months of age (solid foods rich in iron provide more iron than milk),  i.e., given too much milk. Seen especially in the developing world in predominantly breast-fed infants after 9-12 months of age.
• Formula-fed infants (iron poorly absorbed)
• Those fed cow's milk under 1 year (iron from cow's milk is very poorly absorbed)

2. Malabsorption - Coeliac disease (a condition where your immune system attacks your own tissues when you eat gluten).

3.Excess loss (bleeding) - Gastrointestinal loss, e.g. Meckel's diverticulum, menstrual loss.

Clinical findings

• Usually asymptomatic- discovered on the incidental blood test
• General features of anemia
• Nails - bottle, ridged, spoon-shaped (koilonychia)
• Mouth -angular stomatitis, painful smooth glossitis
• Gastrointestinal tract - pica (toddlers with iron deficiency), atrophic gastritis, if severe - oesophageal web (Plummer-Vinson syndrome)
• Subtle neurological impairment in toddlers (low motor and cognitive scores and increased behavioral problems)

Specific investigation findings

1. RBC indices and film - Hypochromic, microcytic, anisocytosis, target cells, pencil cells, moderately raised platelets.
2. Serum iron - Decreases
3. Serum ferritin- Decreases
4. Total iron-binding capacity (TIBC) - Increases
5. Bone marrow - No iron stores in macrophages, no siderotic granules in erythroblasts.

 Management

• Investigate and treat underlying cause:
• Take full dietary and absorption history, do baseline investigations
• Coeliac screen if necessary
• Search for blood loss if necessary (endoscopy, colonoscopy, Meckel's scan, haematuria, and menorrhagia)
• Give oral iron supplements (elixir or tablets). Dietary management if necessary.
• Parenteral iron is rarely needed. It can be given IM or IV. Anaphylactic reactions can occur.