Anemia is lack of blood in the body. In our body, hemoglobin is an element that indicates the amount of blood in the body. Its quantity should be between 12 to 16 percent in men and between 11 and 14 in women.

Anemia is the reduction in RBC mass, and HB concentration of the blood below the values considered normal for age which is leading to reduced oxygen-carrying capacity.

This is a severe health problem, but now we see the relation between Covid and Anemia.

Anemia and covid

Anemia is an objective risk factor associated with the severe illness of COVID‐19.

Covid‐19 patients with anemia show severe inflammation response, which is positively connected with the severity of anemia.

Covid‐19 patients with anemia are older and exhibit severe organ injuries, including poor lung function, more myocardial critical injury, and renal dysfunction.

Anemia and oxygen levels

The patient who has anemia in these oxygen delivery decreases and oxygen extraction is increased. This leads to decreased venous hemoglobin and lower tissue oxygen saturation. The proportion of tissue deoxygenation during ischemia is dependent on oxygen consumption and the amount of oxygen available in the tissue.

Anemia

Anemia is a common blood disorder in infants and children, especially of the weak socioeconomic group.

Blood contains hemoglobin responsible for the constant supply of oxygen to the cells in the body.

Hemoglobin is the iron-containing pigment called “heme,” which imparts red color to the blood and a protein called “globin,” which made up of polypeptide chains.

Normal Values Of HB In Children

According to WHO

6 month-6 year : 11gm/dl
6 year-14 year : 12gm/dl
Above 14 year: Male – 13gm/dl
Female-12gm/dl

WHO Grading of Anemia

HB level between 10gm/dl and cut off point – Mild Anemia
HB level between 7gm/dl to 10gm/dl – Moderate Anemia
HB level below 7gm/dl – Severe Anemia

Clinical Grading of Anemia

Pallor observed in conjunctiva and mucus membrane only – Mild Anemia
Pallor found in skin – Moderate Anemia
Pallor found in palmar creases along with leather and mucus membrane – Severe Anemia

Main causes of anemia

Impaired RBC production due to deficiency of hemopoietic factors
Increased destruction of RBC

Due to intrinsic factors

Abnormal Hb synthesis
Enzymatic defects
Abnormality in RBC structure

Due to extrinsic factors

Infections – malaria
Drugs – primaquine
Poisoning – lead
Burns

Increased blood loss

Trauma
Hemorrhagic disease
Piles
Dysentery

Decreased RBC production

Hypoplasia
Leukemia
Nephritis
liver disease

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Classification of anemia

According to the morphological classification, Anemia divided into three groups

Microcytic – MCV <80fL

Iron Deficiency Anemia
Thalassemia

Normocytic – MCV 80-100 fL

Hemolytic – Hereditary Spherocytosis
G6PD Deficiency
Sickle Cell Anemia
Non – Hemolytic – Aplastic Anemia

Macrocytic – MCV >100 fL

Megaloblastic Anemia

Iron deficiency anemia

Iron deficiency anemia shared among the children. 60-80%of children are suffering from this condition.

The anemia that occurs due to deficiency of iron in the body referred to as Iron Deficiency Anemia.

Causes of iron deficiency anemia

Inadequate iron during
Intra-natal period
Poverty
Ignorance about child care
Prematurity
Insufficient iron in diet due to prolonged breastfeeding
Delayed weaning

Clinical Manifestation of iron deficiency anemia

The pallor of skin, conjunctiva, and mucus membrane

Irritability
Fatigue
Weakness
Anorexia
Failure to thrive
Vomiting
Diarrhea
Nails become thin, brittle and flat
Pica and atrophy of tongue papillae
In older children, the spleen may enlarge

Diagnostic evaluation of iron deficiency anemia

Dietary history
CBC examination shows,
RBC count
HB level
PCV, MCH, MCV – low
Serum iron – low
Serum ferritin – low

Management of iron deficiency anemia

Improvement in dietary intake, especially iron.
Iron therapy by oral or parenteral route. Oral iron intake is given with elemental iron dose 3-6mg/kg/day in divided doses between meals

Iron therapy include,

Ferrous sulfate
Ferrous gluconate
Ferrous fumarate
In cases of severe anemia, blood transfusion has given
Provide other symptomatic treatment.
Give awareness about iron deficiency anemia.

Prevention of iron deficiency anemia

Adequate antenatal care for prevention of maternal anemia
Iron – folic acid supplementation
Introduction of semisolid and solid foods from 6 months of age
Immunization
Improvement in living conditions
Balanced diet
Hygiene

Complication of iron deficiency anemia

CCF
Recurrent infections
Malabsorption syndrome
Growth retardation
Mental sub normality

Thalassemia

It is a group of hereditary hemolytic anemia characterized by a reduction in the synthesis of Hb

Classification of thalassemia

Thalassemia Major

It is a severe form of illness and associated with the homozygous state.
In this condition, the beta genes inherited from both parents and the beta chain’s synthesis markedly reduce.

Thalassemia Intermedia

It is a state of chronic hemolytic anemia caused by alpha or beta chain deficiency

Thalassemia Minor

It is a mild form of illness produced by heterozygosity of either alpha or beta chain.

Clinical manifestations of thalassemia

Pallor
Jaundice
Respiratory infections
Enlarged lymph nodes
Growth failure
Poor feeding

Diagnosis of thalassemia

Blood examination
Bone marrow examination

Complication of thalassemia

CCF
Gall stones
Delayed puberty
Growth retardation
MODS

Hemolytic crisis

The sudden and severe hemolytic condition occurs when more amount of RBCs are destroyed.

Clinical manifestation of hemolytic crisis

- Progressive anemia
- Mild jaundice
- Fever
- Headache
- Growth retardation
- Enlarged heart

Diagnosis of hemolytic crisis

- Peripheral blood smear
- Electrophoresis
- Chorionic villus sampling

Management of hemolytic crisis

- Blood transfusion
- Parenteral fluid therapy
- Treat the infections
- Analgesics
- Blood transfusion
- Parenteral fluid therapy
- Treat the infections
- Analgesics

G6PD deficiency anemia

It is an inherited disorder that transmitted as an autosomal recessive trait.

The enzyme G6PD is responsible for maintaining the integrity of RBCs.

The absence of this enzyme is deficient in the body; it causes this type of anemia.

Clinical manifestations of g6pd deficiency anemia

Some children do not have any signs and symptoms until they are exposed to certain drugs like,

Antimalarial
Antipyretics
Sulphonamides
If the child is exposed to jaundice, hemolytic anemia, hepatomegaly, and interferes with growth.

Management

Avoidance of mentioned drugs,
Antimalarial
Antipyretics
Sulphonamides

Aplastic anemia

It is a deficiency of all types of blood cells due to abnormal bone marrow development.

It can be congenital, such as Fanconi anemia, Diamond – Blackfann syndrome, and TAR syndrome.

Causes of aplastic anemia

Virus – HIV
Bacteria
Exposure to radiations
Chemicals – DDT
Drugs – antimetabolites

Clinical manifestation of aplastic anemia

Weakness
Fatigue
Ecchymosis
Bleeding
Hematuria
Recurrent infections

Diagnosis of aplastic anemia

Blood examination
Bone marrow study

Management of aplastic anemia

Bone marrow transplantation
Immunotherapy
Children with mild to moderate anemia treated with androgens for 3-5 months.

Megaloblastic Anemia

The common cause of this anemia is a deficiency of folic acid or vitamin B12 or both.

Folic acid deficiency

It always found along with vitamin C deficiency and iron deficiency.

Causes of folic acid deficiency

Use of goat milk for infant feeding
Diarrheal disease
Malabsorption syndrome
Prematurity
Drug therapy with anticonvulsant and anti-folic acid agent

Vitamin b12 deficiency

It may develop due to dietary inadequacy, lack of intrinsic factor in the stomach,
Malabsorption and infants of B12 deficient mothers

Clinical manifestations of vitamin b12 deficiency

Paresthesia of hands and feet
Loss of vibratory sensation
Absent tendon reflexes

Diagnosis of vitamin b12 deficiency

Serum vitamin B 12
Bone marrow study

Management of vitamin b12 deficiency

Provide folic acid and vitamin B12 in the oral or parenteral route.
Provide treatment of Various causative factors.
Dietary improvement is essential. The blockage of the capillaries causes infarction of various tissues and organs.

Treatment of anemia

Repeated blood transfusions: It is given at regular intervals to maintain hb levels.

Iron chelation therapy: iron chelating agent deferral recommended preventing complications.

Splenectomy: It indicated when the child needs a frequent blood transfusion and develop hypersplenism.

Folic acid supplement: It recommended preventing more iron deposition.

Immunization: Supportive management to treat the complication

Bone marrow transplantation: It is useful to treat thalassemia. Defective stem cells replace by the with healthy stem cells

Gene therapy

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