Anemia in children

Anemia in children is the most common disease. This is due to anatomophysiological immaturity of the hematopoiesis in children and their high sensitivity to the effects of adverse environmental factors. Children are given the same groups of anemia as adults (see the chapter "Diseases of the blood system").

Deficiency anemia is caused by insufficient intake of substances necessary for the formation of hemoglobin; They are observed more often in children of the first year of life. Among the scarce anemias, the most common are alimentary, which are caused by inadequate or monotonous nutrition. In most cases there is an insufficient intake of iron (iron deficiency anemia), protein, which disrupts the formation of the protein part of hemoglobin (protein-deficient anemia). The insufficiency of vitamins such as B6, B12 and folic acid (vitamin-deficient anemia), which are involved in the synthesis of hemoglobin, also plays a certain role in the development of scarce anemia. Often scarce anemia is noted in diseases accompanied by a violation of absorption in the intestine. The development of scarce anemia is promoted by frequent diseases, as well as prematurity.

In clinical practice, iron deficiency anemia is most common. Their manifestations depend on the severity of the disease. For mild cases, sluggishness, a decrease in appetite, pallor of the skin, a slight decrease in hemoglobin content to 80 g / l, and a number of red blood cells to 3.5 10 10 (in the twelfth degree) / l (3,500,000 in 1 μl) are noted. When the disease is of average severity, the motor activity of the child noticeably decreases, there is sluggishness, tearfulness, lack of appetite, pale and dry skin, tachycardia, systolic murmur, enlarged liver and green eyes; The hair becomes thin and brittle, the hemoglobin content in the blood drops to 66 g / l, the number of red blood cells - up to 2.8 ¬ 10 (twelfth degree) / l (2 800 000 in 1 μl), hypochromia is observed. When the disease is severe, the child's lag in physical development, anodynia, anorexia, constipation, pronounced dryness and pallor of the skin, changes in nails and hair (thin, brittle), pastovess of the face and lower limbs, changes in the cardiovascular system (tachycardia, systolic murmur ), The smoothness of the papillae in the tongue ("lacquered" language). The amount of hemoglobin is reduced to 35 g / l, the number of red blood cells is up to 1.4 ¬ 10 (twelfth degree) / l (1.4 million in 1 μl), hypochromia is observed. Iron deficiency anemia often develops in preterm infants during the 5th-6th month of life, when the body's iron stores are depleted in the body - late anemia of prematurity.

Vitamin deficiency anemia due to deficiency of vitamin B12 or folic acid in children can be both acquired and hereditary. The clinical picture is characterized by the same symptoms as in adults. Acquired vitamin-deficiency anemia is more common in premature infants, with impaired intestinal absorption, improper feeding. Hereditary folate-deficiency anemia is usually detected in the first year of life. B12-deficient - at the age of about 2 years. They are often accompanied by a delay in the physical and psychomotor development of the child.

The diagnosis of scarcity anemia is based on anamnesis, clinical picture and laboratory data: hemoglobin content below 100 g / l, serum iron below 14.3 μmol / l (80 μg%). With protein deficiency anemia, a decrease in serum protein content below 60 g / l (6 g%), hypopochromia, microcytomas and macro-cells appear, reticulocytes up to 1.7-2% or more, and siderocytes disappear. Vitamin deficiency anemia is characterized by hypochromia, macrocytosis and anisocytosis of erythrocytes.

Treatment of scarce anemias is to eliminate the causes of the disease, normalize the diet and regimen, prescribe the appropriate drugs: for example, iron deficiency anemia-iron. Before clarifying the diagnosis and the causes of anemia, do not prescribe vitamins B12 or folic acid. Acquired forms of hypoplastic (aplastic) anemia in children proceed in the same way as in adults. Among the congenital forms are Fanconi anemia, or Fanconi syndrome, the family hypoplastic anemia of Estren-Dameshek and the congenital partial hypoplastic anemia of Josephs-Diamond-Blackfen.

Fanconi anemia is usually found in children in the first years of life. Boys are 2 times more likely than girls. Children lag behind in physical and mental development. There are malformations of the eyes (microphthalmia), kidneys, palate, hands, microcephaly; Characterized by hyperpigmentation of the skin. Usually at the age of 5-7 years and older there is pancytopenia. With family hypoplastic anemia, Estrena-Dameshek, there are similar changes in blood, but there are no developmental defects.

Congenital partial hypoplastic anemia of Josephs-Diamond-Blackfen is usually found in the first year of life. The disease is often benign. The clinical picture develops gradually: lethargy, pallor of the skin and mucous membranes, appetite decreases. The blood reduces the content of hemoglobin, the number of erythrocytes and reticulocytes with a normal number of leukocytes and platelets. The diagnosis of hypoplastic anemia is established on the basis of the clinical picture and laboratory test data. For treatment apply the same means as in adults.

The causes of acquired hemolytic anemia in children may be incompatibility of blood of the mother and fetus, which is observed in hemolytic disease of newborns, autoallergies, uremia, vitamin E deficiency. Hereditary hemolytic anemias are caused by hereditary erythrocyte defects, the presence of abnormal hemoglobins in erythrocytes or suppression of normal hemoglobin synthesis, and Anomaly of enzymes. To hereditary hemolytic anemia are hemoglobinopathies.