Iron Deficiency Anemia
Introduction
Iron deficiency anemia is the most common cause of microcytic anemia in children, particularly young children and adolescents, due to low iron intake in combination with insufficient iron stores. Other causes include chronic blood loss (eg. Gastrointestinal in worm infections or gastritis / ulcer, for example Helicobacter pylori infection, menstruation, rare: pulmonary hemosiderosis) or malabsorption (gastritis, worm infections, cow's milk protein allergy, Meckels diverticulum, celiac disease, Crohn's disease or ulcerative colitis) . For children aged 1-2 years, 9% and 3% iron deficiency anemia result. In adolescents is 10% and 2% actually anemia.
Premature born children have faster iron deficiency due to lack of landscaped iron stores. For children born at term is adequate iron stores for 6-9 months.
Iron is an essential element in the synthesis of heme and thus important for the production of hemoglobin in the red blood cells. Iron is absorbed in the small intestine by the enterocyte (via the iron transporter Dimetaaltransporter 1 (DMT1)). Then by the iron exporter ferroportine released into the blood, where it is bound to the protein transferrin, unbound iron molecules are harmful to the tissues. Transporting the transferrin bound iron to various tissues, including the liver, the heart and to the erythroid progenitor cells in the bone marrow. The liver contains the largest iron stores, the hepatocyte plays an important role in the regulation of iron metabolism, including via the protein hepcidin. In the erythroid progenitor cell, the transferrin-bound iron with the two molecules are included. Subsequently, the iron is disconnected from the transferrin and is released through DMT1 into the cytosol of the erythroid progenitor transported to be made available for the haemsynthese in this process, several proteins are involved, of which a large number of the last 10 years have been detected. (1)
The normal daily iron requirement is 0.8 mg per day. A daily intake of 8-10 mg of iron needed to achieve adequate iron stockpile, aangeziend e absoprtie of iron from the gastrointestinal tract, only 10% of the intake. Too little iron intake, clinical symptoms appear (see below). In the blood the following is seen: the first drop the iron stores (low ferritin), then creates a low serum iron and iron binding capacity increases in the serum (serum transferrin increases) and transferrin saturation off. Then hit the haemsynthese disturbed by iron deficiency and elevated free protoporfyrines arise (eg zinc protoporphyrin). Finally, the red blood cells smaller (lower MCV) and creates morphological abnormalities of the red blood cells, the hemoglobin falls.
The symptoms of iron deficiency anemia are highly dependent on the age, the severity of the anemia and the rate of anemia occurred. General symptoms include fatigue and pallor of skin and mucous membranes. In young children, growth retardation, anorexia, irritability, headaches and lethargy may occur. There are also indications that iron deficiency can lead to mental retardation. In extreme cases may occur pica, a behavior disorder that not only occurs when iron deficiency. During puberty iron deficiency anemia can lead to apathy and impaired concentration. If the anemia is established very slowly, sometimes only complaints arise when the Hb falls below 4 mmol / l. This is caused by the shift to the right of the O2-Hb dissociation curve. But if the anemia is severe or in a short time came, as with major blood loss, which may very soon lead to cardiovascular complications decisive for the existence of iron deficiency anemia is the rapid increase in Hb iron supplementation. In mild anemia is recommended to iron therapy for one month to give before being passed on to further diagnosis. If during this period the Hb with more than 1 mmol / L increases, the diagnosis of iron deficiency anemia fixed.
A hypochromic microcytic anemia with a commensurate low reticulocyte count (link to formula reticulocytenindex, piece diagnostics ijzergebreksanamie, see below) with morphological abnormalities in the red blood count (such as anisocytosis or poikilocytosis) and increased "red distribution index (RDW) are characteristic of iron deficiency anemia. Sometimes there is also a neutropenia and thrombocytosis. To iron deficiency anemia can objectify the iron stores measured by ferritin, serum iron, transferrin saturation (all three reduced) or transferrin or total iron binding capacity (TYBC) (increased) by link to tables below
Treatment
The treatment of iron deficiency anemia includes iron supplementation. Rarely is a RBC transfusion need, since the body very quickly create erythrocytes. Two to three days after starting iron supplementation, there is a greatly increased erytrocytenaanmaak (peak 5-7 days), and after 1-4 weeks, a significant increase in hemoglobin levels. Information relating to adequate iron intake is important. Vitamin C and orange juice can improve the absorption of iron. This is in contrast to milk .. Medication: Ferrofumaraat (Kinderformularium: www.kinderformularium.nl/search/stof.php?id=466)
With a persistent microcytic anemia and / or iron deficiency anemia, in which there is no evidence of non-compliance or malabsorption: think of other diagnoses, such as malabsorption, (carrier) of alpha or beta thalassemia or anemia based on iron metabolic disorders (very rare; see anemia iron metabolism (short)). Talk approachable with pediatric hematologist, because excess iron supplementation can be toxic.
Anemia of chronic disease also gives a picture of a mild microcytic or normocytic anemia with low iron levels, but usually a normal ferritin (website link piece). Iron supplementation is not necessary.
Because ferritin is an acute phase protein, a reduction by iron deficiency may be masked by an increase in cases of inflammation or infection. It is useful to CRP to determine, to get an idea whether there is an inflammation or infection.
Iron in plasma mornings average 30% higher than in the afternoon. Although not all patients exhibit this daily routine, it is a good interpretation of the iron in the blood plasma useful for morning and sober to carry.
Iron deficiency anemia is the most common cause of microcytic anemia in children, particularly young children and adolescents, due to low iron intake in combination with insufficient iron stores. Other causes include chronic blood loss (eg. Gastrointestinal in worm infections or gastritis / ulcer, for example Helicobacter pylori infection, menstruation, rare: pulmonary hemosiderosis) or malabsorption (gastritis, worm infections, cow's milk protein allergy, Meckels diverticulum, celiac disease, Crohn's disease or ulcerative colitis) . For children aged 1-2 years, 9% and 3% iron deficiency anemia result. In adolescents is 10% and 2% actually anemia.
Premature born children have faster iron deficiency due to lack of landscaped iron stores. For children born at term is adequate iron stores for 6-9 months.
Iron is an essential element in the synthesis of heme and thus important for the production of hemoglobin in the red blood cells. Iron is absorbed in the small intestine by the enterocyte (via the iron transporter Dimetaaltransporter 1 (DMT1)). Then by the iron exporter ferroportine released into the blood, where it is bound to the protein transferrin, unbound iron molecules are harmful to the tissues. Transporting the transferrin bound iron to various tissues, including the liver, the heart and to the erythroid progenitor cells in the bone marrow. The liver contains the largest iron stores, the hepatocyte plays an important role in the regulation of iron metabolism, including via the protein hepcidin. In the erythroid progenitor cell, the transferrin-bound iron with the two molecules are included. Subsequently, the iron is disconnected from the transferrin and is released through DMT1 into the cytosol of the erythroid progenitor transported to be made available for the haemsynthese in this process, several proteins are involved, of which a large number of the last 10 years have been detected. (1)
The normal daily iron requirement is 0.8 mg per day. A daily intake of 8-10 mg of iron needed to achieve adequate iron stockpile, aangeziend e absoprtie of iron from the gastrointestinal tract, only 10% of the intake. Too little iron intake, clinical symptoms appear (see below). In the blood the following is seen: the first drop the iron stores (low ferritin), then creates a low serum iron and iron binding capacity increases in the serum (serum transferrin increases) and transferrin saturation off. Then hit the haemsynthese disturbed by iron deficiency and elevated free protoporfyrines arise (eg zinc protoporphyrin). Finally, the red blood cells smaller (lower MCV) and creates morphological abnormalities of the red blood cells, the hemoglobin falls.
The symptoms of iron deficiency anemia are highly dependent on the age, the severity of the anemia and the rate of anemia occurred. General symptoms include fatigue and pallor of skin and mucous membranes. In young children, growth retardation, anorexia, irritability, headaches and lethargy may occur. There are also indications that iron deficiency can lead to mental retardation. In extreme cases may occur pica, a behavior disorder that not only occurs when iron deficiency. During puberty iron deficiency anemia can lead to apathy and impaired concentration. If the anemia is established very slowly, sometimes only complaints arise when the Hb falls below 4 mmol / l. This is caused by the shift to the right of the O2-Hb dissociation curve. But if the anemia is severe or in a short time came, as with major blood loss, which may very soon lead to cardiovascular complications decisive for the existence of iron deficiency anemia is the rapid increase in Hb iron supplementation. In mild anemia is recommended to iron therapy for one month to give before being passed on to further diagnosis. If during this period the Hb with more than 1 mmol / L increases, the diagnosis of iron deficiency anemia fixed.
A hypochromic microcytic anemia with a commensurate low reticulocyte count (link to formula reticulocytenindex, piece diagnostics ijzergebreksanamie, see below) with morphological abnormalities in the red blood count (such as anisocytosis or poikilocytosis) and increased "red distribution index (RDW) are characteristic of iron deficiency anemia. Sometimes there is also a neutropenia and thrombocytosis. To iron deficiency anemia can objectify the iron stores measured by ferritin, serum iron, transferrin saturation (all three reduced) or transferrin or total iron binding capacity (TYBC) (increased) by link to tables below
Treatment
The treatment of iron deficiency anemia includes iron supplementation. Rarely is a RBC transfusion need, since the body very quickly create erythrocytes. Two to three days after starting iron supplementation, there is a greatly increased erytrocytenaanmaak (peak 5-7 days), and after 1-4 weeks, a significant increase in hemoglobin levels. Information relating to adequate iron intake is important. Vitamin C and orange juice can improve the absorption of iron. This is in contrast to milk .. Medication: Ferrofumaraat (Kinderformularium: www.kinderformularium.nl/search/stof.php?id=466)
With a persistent microcytic anemia and / or iron deficiency anemia, in which there is no evidence of non-compliance or malabsorption: think of other diagnoses, such as malabsorption, (carrier) of alpha or beta thalassemia or anemia based on iron metabolic disorders (very rare; see anemia iron metabolism (short)). Talk approachable with pediatric hematologist, because excess iron supplementation can be toxic.
Anemia of chronic disease also gives a picture of a mild microcytic or normocytic anemia with low iron levels, but usually a normal ferritin (website link piece). Iron supplementation is not necessary.
Because ferritin is an acute phase protein, a reduction by iron deficiency may be masked by an increase in cases of inflammation or infection. It is useful to CRP to determine, to get an idea whether there is an inflammation or infection.
Iron in plasma mornings average 30% higher than in the afternoon. Although not all patients exhibit this daily routine, it is a good interpretation of the iron in the blood plasma useful for morning and sober to carry.