Anemia at children - the hematologic syndrome which is characterized by decrease in concentration of hemoglobin and quantity of erythrocytes in blood unit of volume. At various forms of anemia at children the general weakness, bystry fatigue, pallor of skin and mucous, dizziness, heartbeat are noted. Anemia is diagnosed for children according to clinical and laboratory data (the general blood test, definition of bilirubin, serumal iron, the general iron-binding ability of serum, a research of a punktat of marrow etc.). The general principles of treatment of anemia at children include the organization of a balanced diet, timely introduction of feedings up, vitamin therapy, administration of drugs of iron, FTL (gymnastics, massage, Ural federal district), according to indications - carrying out hemotransfusions.
Anemia at children
Anemia at children (anemia) – the pathological state which is followed by decrease in level of hemoglobin and erythrocytes in the child's blood. Anemia at children – extremely widespread disease in pediatrics. About 40% of cases of anemia are diagnosed for children aged up to 3 years; 30% - in the pubertatny period; the others – during various age periods of development of the child.
Frequent developing of anemia at children is caused by their intensive growth, activity of process of an eritropoez, progressive increase in number of uniform elements and OTsK. At the same time, the blood formation device at children functionally did not ripen and is very vulnerable in the face of various influences. Normal course of blood formation demands a large amount of iron, protein, vitamins and minerals therefore any errors of feeding, infections, toxic impacts on marrow are capable to cause development of anemia in the child from children. Especially sensitive in this plan are children of the second half of the year of life at whom neonatal reserves of iron are exhausted. It is long the existing anemia at children is followed by development of a hypoxia, profound fabric and organ changes. Children with anemia lag behind in physical and intellectual development healthy peers, have interkurrentny diseases more often, are inclined to development of chronic pathological processes and different complications.
The anemia reasons at children
The factors promoting development of anemia in children share on antenatalny, intranatalny and post-natal.
Antenatalny factors work during pre-natal development. For normal course of processes of blood formation at the child during pregnancy his organism has to receive from mother and save up enough iron (about 300 mg). The most intensive transfer of iron from the pregnant woman and its deposition at a fruit happens on 28 — 32 weeks of a gestation. Violation of a normal course of pregnancy during this period (, fetoplatsentarny insufficiency, threat of spontaneous termination of pregnancy, a premature otsloyka of a placenta, bleeding, infectious diseases of mother, an aggravation of chronic processes) leads to violation of exchange of iron and its insufficient accumulation in the child's organism.
Anemia at children arises in case the woman also had anemia at pregnancy. Premature birth leads to the fact that anemia comes to light at all premature children since the birth or approximately from 3rd month of life. Development of anemia in newborn children is promoted by polycarpous pregnancy.
Intranatalny factors of anemia at children are connected, mainly, with blood loss at the time of delivery. Blood loss is possible in case of a premature otsloyka of a placenta during childbirth, early or late bandaging of an umbilical cord, the expiration of blood from the funic rest at its inadequate processing, applications of the injuring obstetric grants.
Post-natal factors of anemia at children join after the birth and can be endogenous or exogenous. As the reasons of endogenous anemia at children damage of erythrocytes owing to a hemolytic disease of newborns, anomalies of synthesis of hemoglobin, primary constitutional insufficiency of marrow can serve.
Exogenous anemias at children are most often caused by the alimentary reasons. In this case anemia develops mainly at the children of the first year of life who are on monotonous dairy feeding. Anemia at children of early age can arise at the insufficient content of iron in breast milk; early and unreasonable transfer of the child to the artificial or mixed feeding; use of not adapted mixes, cow's or goat milk for feeding; late introduction to a diet of the child of feedings up. The premature children and children born with the increased body weight need higher intake of iron in an organism. Therefore discrepancy between receipt and a consumption of iron can also serve as the anemia reason at children of the first year of life.
Anemias at children can arise owing to regular blood losses: at private nasal bleedings, blood diseases (hemophilia, Villebrand's disease), menorragiya, gastrointestinal bleedings, after surgeries. At children with food allergies, ekssudativny diathesis, neurodermatitis the increased loss of iron through an epithelium of integuments therefore such children make risk group on development of iron deficiency anemia is noted.
Except iron loss, can lead violation of its absorption and exchange to development of anemia in children. Such frustration usually meet at a malabsorption syndrome (a hypotrophy, rickets, laktazny insufficiency, a tseliakiya, an intestinal form of a mukovistsidoz, etc.). Anemia at children can be a consequence of any infectious or chronic somatic disease (tuberculosis, a bacterial endocarditis, a bronkhoektatichesky disease, pyelonephritis, etc.), leukoses, mycoses, a helminthic invasion, kollagenoz (hard currency, rheumatoid arthritis, etc.)
In development of anemia in children a certain value has deficiency of vitamins of group B, minerals (magnesium, copper, cobalt), adverse hygienic conditions, the exhaustion of reserves of endogenous iron coming at the baby by 5-6 months.
Classification of anemia at children
According to etiopatogenezy allocate the following groups of anemias:
I. The post-hemorrhagic anemias at children caused with sharp or chronic blood loss.
II. The anemias at children caused by violation of a hematopoiesis:
- iron deficiency (gipokhromny)
- hereditary and acquired zhelezonasyshchenny (sideroakhrestichesky - are connected with defects of synthesis of porphyrines)
- megaloblastny (B12-scarce and foliyevodefitsitny)
- the hereditary and acquired dizeritropoetichesky
- hereditary and acquired hypoplastic and aplastic (are connected with blood formation oppression)
III. The hereditary and acquired hemolytic anemias at children caused by the increased destruction of erythrocytes and prevalence of process of a krovorazrusheniye over process of a krovoobrazovaniye (a membranopatiya, a fermentopatiya, a gemoglobinopatiya, autoimmune anemias, a hemolytic disease of newborns, etc.).
Anemia symptoms at children
The norm of hemoglobin of blood at children up to 6 years makes 125–135 g/l; at the child speak about anemia in case this indicator falls lower than 110 g/l (at children up to 5 years) and lower than 120 g/l (at children 5 years are more senior).
Visible changes at anemia at children are observed from skin and its appendages: integuments become pale, dry, shelled; nails are deformed and become fragile; hair lose healthy gloss. A characteristic symptom of anemia at children is Filatov's symptom – pallor of lobes of ears at survey in the passing light. At severe forms of anemia children have cracks on palms and soles, in mouth corners; aftozny stomatitis develops, glossit. Children with anemia are weakened, astenichna, often have a SARS, bronchitis and pneumonia, sharp intestinal infections.
From the nervous system testing a hypoxia slackness, tearfulness, a bystry exhaustion, dizzinesses, a superficial dream, enuresis is noted. Decrease in a muscular tone comes to light, the child badly transfers physical activities, quickly gets tired. At children of the first year of life the hypotrophy is noted, there is a regress of psychomotor development.
From a gastrointestinal tract at children with anemia frequent vomiting and vomiting after feeding, a meteorizm, diarrhea or locks, the lowered appetite are observed, increase in a spleen and liver is possible.
Diagnosis of anemia at children
The basis of diagnosis of anemia at children is made by laboratory researches. In the general blood test at anemia at children decrease in hemoglobin (Hb less than 120-110 g/l), decrease in Er (12/l), decrease in the CPU of a puncture and a research of marrow comes to light.
In the course of diagnostics the form and severity of anemia at children is defined. The last is estimated on the maintenance of erythrocytes and hemoglobin:
- anemia of easy degree – Hb of 110-90 g/l, Er - to 3,5Õ1012/l;
- anemia of average degree - Hb of 90-70 g/l, Er - to 2,5Õ1012/l;
- anemia of heavy degree - Hb less 70g/l, Er - less than 2,5Õ1012/l.
According to indications children with anemia can need consultations of narrow experts (the children's gastroenterologist, the children's rheumatologist, the children's nephrologist, the children's gynecologist, etc.), inspection of a GIT (EGDS, ultrasonography of an abdominal cavity) and kidneys (ultrasonography of kidneys).
Treatment of anemia at children
At anemia the organization of the correct day regimen and balanced food of the child, performing medicinal therapy and the all-strengthening actions is required from children. Sufficient stay in the fresh air, an additional dream is recommended to children; the gymnastics and massage, Ural federal district is appointed.
The children with anemia who are on breastfeeding should enter in due time feedings up (juice, an egg yolk, vegetables, meat mash). It is at the same time necessary to correct a diet of the feeding woman, to add reception of polyvitamins and medicines of iron. To the children receiving artificial feeding the adapted dairy mixes enriched with iron are appointed. The diet of children of advanced age has to contain a liver, beef, bean, greens, seafood, fruit and vegetable juice.
Medicamentous therapy of anemia at children includes purpose of medicines of iron and polyvitaminic medicines before full normalization of clinical laboratory indicators (on average 6-10 weeks). In hard cases carrying out a hemotransfusion can be required.
The forecast and prevention of anemia at children
The forecast of iron deficiency anemias at children usually favorable. At timely diagnosis, the correct catering services, treatment of anemia and associated diseases there comes the absolute recovery. Heavy anemia at children can be the basis for vaccination postponement.
The Antenatalny stage of prevention of anemia at children includes good nutrition of the pregnant woman, sufficient stay in the fresh air, reception of the mineral and vitamin complexes containing iron. The post-natal prevention of anemia at children comes down to natural feeding, introduction of feedings up to the recommended terms, prevention of diseases of early age, the organization of good leaving and the optimum mode for the child, to carrying out preventive treatment-and-prophylactic courses in risk groups.