IRON DEFICIENCY ANAEIA. IT IS A MOST COMMON IN CHILDREN, WE CAN PREVENT THIS IF MOTHER TAKE PROPER DIET AND MEDICIN AT THE TIME OF ANTENATAL PERIOD

1. SEMINAR
ON
TOPIC – IRON DEFICIENCY
ANEMIA IN CHILDREN
SUBJECT - CHILD HEALTH NURSING
BY,
MR. ABHIJIT P. BHOYAR
M. SC. NURSING
CHILD HEALTH NURSING

2. GENERAL OBJECTIVES
At the end of the class, the students will be able to gain in
depth knowledge regarding blood disorders and appreciate
and develop positive attitude and practice this knowledge in
clinical settings.

3. SPECIFIC OBJECTIVES
At the end of the class, the students
will be able to:
• Review the anatomy and
physiology of blood cells.
• Define anaemia.
• Enlist etiological and risk factors of
anaemia.
• Classify anaemia.
• Discuss management of anaemia.

4. HEMATOLOGY
• Study of blood and blood forming
tissues
• Key components of hematologic
system are:
– Blood
– Blood forming tissues
• Bone marrow
• Spleen
• Lymph system 4

5. WHAT DOES BLOOD DO?
• TRANSPORTATION
– Oxygen
– Nutrients
– Hormones
– Waste Products
• REGULATION
– Fluid, electrolyte
– Acid-Base balance
• PROTECTION
– Coagulation
– Fight Infections
5

6. COMPONENTS OF BLOOD
• Plasma
– 55%
• Blood Cells
– 45%
– Three types
• Erythrocytes/RBCs
• Leukocytes/WBCs
• Thrombocytes/Platelets 6

7. ERYTHROCYTES / RED BLOOD CELLS
• Composed of hemoglobin
• Erythropoiesis = RBC production
– Stimulated by hypoxia
– Controlled by erythropoietin (Hormone synthesized in
kidney)
• Hemolysis = destruction of RBCs
– Releases bilirubin into blood stream
– Normal lifespan of RBC = 120 days

8. LEUKOCYTES/WHITE BLOOD CELLS
• 5 TYPES
–Basophils
–Eosinophils
–Neutrophils
–Monocytes
–Lymphocytes
8

9. THROMBOCYTES / PLATELETS
• Must be present for clotting to occur
• Involved in hemostasis

10. STRUCTURES OF THE HEMATOLOGIC
SYSTEM
BONE MARROW
LIVER
LYMPH SYSTEM

11. BONE MARROW
– Soft substance in core of bones
– Blood cell production (Hematopoiesis): The production of all
types of blood cells generated by a remarkable self-regulated
system that is responsive to the demands put upon it.
• RBCs
• WBCs
• Platelets
11

12. LIVER
 Receives 24% of the cardiac output
(1500 ml of blood each minute)
 Liver has many functions
 Hematologic functions:
– Liver synthesis plasma proteins including clotting factors and
albumin
– Liver clears damaged and non-functioning RBCs/erythrocytes
from circulation

13. SPLEEN
• Located in upper L quadrant of abdomen
• Functions
– Hematopoietic function
• Produces fetal RBCs
– Filter function
• Filter and reuse certain cells
– Immune function
• Lymphocytes, monocytes
– Storage function
• 30% platelets stored in spleen

14. DETERMINATION OF RBC INDICES
• RBC count (RBC) - RBC’s / 100 mL of Blood = 4.5-5.0 Million / 100 mL
• Hematocrit (Hct) - % of (RB) Cells By Volume = 36-45%)
• Hemoglobin (Hgb) - mg / 100 ml of Blood = 13-15 mg/dL)
• Mean Corpuscular Volume (MCV)
– Hct/RBC - Normal = 90 (+- 10) cubic microliter
• Mean Corpuscular Hemoglobin (MCH)
– Hgb/RBC - Normal = 30 (+- 3) picograms
• Mean Corpuscular Hgb Concentration (MCHC)
– Hgb/Hct - Normal = 33 (+- 2) %

15. ANEMIA
INCIDENCE
• The prevalence of anemia in
young children continues to
remain over 70 % in most parts
of India .
• Acc. to WHO, India is one of the
countries in the world that has
highest incidence on anemia.

16. DEFINITION
“Anemia is a deficiency in the
number of erythrocytes (Red
Blood Cells), the quantity of
hemoglobin and/or the volume
of packed RBCs (Hematocrit).”

17. WHO proposed the cut- off points of Hb level for
different age groups for the diagnosis of anemia
Children 6
months to 6 yrs
Children 6 yrs to
14 yrs
Above 14 yrs ie
• 11 g/dl
• 12 g/dl
• Male :-13 g/dl
• female :-12 g/dl

18. CLASSIFICATION OF ANEMIA
THERE ARE DIFFERENT TYPES OF ANEMIA DEPENDING ON THE
BASIS OF ETIOLOGY AND RBC MORPHOLOGY. BUT THE MOST
COMMON ONE IS IRON DEFICIENCY ANEMIA.

19. CLASSIFICATION OF ANEMIAS

20. O
N
T
H
E
B
A
S
I
S
O
F
E
T
I
O
L
O
G
Y

21. ON THE BASIS OF RBC MORPHOLOGY
 Hb levels decreased
 MCV normal
 Acute blood loss
 Anemia of chronic
disease
 Aplastic anemia
 Hemolytic anemia
size of erythrocytes
is larger than
normal
 Megaloblastic
anemia – Vitamin
B12, Folate
deficiency.
 size of erythrocytes is
smaller than normal
 Heme synthesis
defect
 Iron deficiency anemia
 Anemia of chronic
disease
 Thalassemia
 Sideroblastic anemia

22. WHO GRADING OF ANEMIA
MILD
ANEMIA
• Haemoglobin
level between
10g/dl
MODERATE
ANEMIA
• Haemoglobin
level between
7 g/dl to 10
g/dl
SEVERE
ANEMIA
• Haemoglobin
level below
7g/dl

23. IRON DEFICIENCY ANEMIA
INTRODUCTION :
Iron deficiency anemia, one of the
most common chronic hematologic
disorders, is found in young
children up to 43% of the world’s
population.

24. “Iron deficiency anemia is
the insufficient supply of
iron in the body.”
DEFINITION:

25. Iron deficiency anemia may develop from
• Inadequate iron intake
• Malabsorption
• Blood loss
• Inadequate iron stores at birth
• Excessive demands for iron
• Errors of iron metabolism.
CAUSES AND RISK FACTORS

26. CLINICAL MANIFESTATIONS

28. HEADACHE
BRITTLE
NAILS
KOILONYCHIA

29. DYSPNEA
ANGULAR STOMATITIS
(Cracking at the corners of the mouth)
PALPITATIONS
CHEILITIS
( INFLAMMATION OF THE
LIPS)

30. Anorexia
Failure To Thrive
Cardiac enlargement
Short attention span
poor school performance
Cont…..

31. DIAGNOSTIC EVALUATION
 History and physical examination.
 Blood studies
• Hematocrit (< 33%) and hemoglobin.
• WBC,RBCs count including morphology
• Reticulocyte count
• MCH, MCHC, MCV values

32. • Serum ferritin concentration (below 10ng/ml)
• Serum transferrin ( < 15%)
• Serum iron : below 30 microgm / dl
• Total Iron Binding Capacity (TIBC >350microgm/dl)
Stool examination for occult blood.
 Bone marrow studies

33. ORAL IRON
THERAPY
- 3-6 mg/kg /day
- Hb level rise upto
0.41g/dl/day.
- most available form
is ferrous sulphate
(200mg)
MANAGEMENT

34. SIDE EFFECTS OF ORAL IRON
THERAPY
• Nausea and Vomiting
• Constipation
• Teeth &Tongue staining
• Blackened stool
• Diarrhea

35. PARENTRAL IRON THERAPY
-Intramuscular
injection
-Intravenous
injection

36. INTRAMUSCULAR INJECTION
The compounds used are:-
 Iron dextran
 Iron sorbitol
50mg of elemental iron/ml
 Give IM injection in ‘Z –
track technique’.
 Retract the skin over the
muscle of upper outer quadrant
of buttock

37. INTRAVENOUS INJECTION
• The compounds used
are:-
• Iron dextran
• Iron sucrose.
• contains 50mg
iron/ml.

38. •Blood transfusion is valuable in treating anemia resulting
from acute blood loss.
•It also may benefit clients with severe chronic anemia
(Hb<6gm) who have responded poorly to other forms of
therapy.

39. Deworming and other symptomatic and supportive care to
be provided .
 Deficiencies of haemopoitic factors such as follic acid,
VitB-12 should give attention.
 Oxygen therapy administration.

40. PREVENTION
 Adequate antenatal care -- iron and follic acid
supplementation.
 Preterm and LBW infants are supplemented with 10-15
mg of elemental iron daily.

41. PREVENTION
 Hookworm infestations should be managed with antihelminthics.
 Exclusive breast feeding up to first 6 months.
 Universal immunization
 Supplementary foods rich in iron should be administered from 4
months onwards.
 Availability of iron fortified salts (ferrous sulphate)

42. REQUIREMENT OF IRON FOR DIFFERENT AGE
GROUPS (DAILY)
AGE GROUPS IRON (MG)
Infant (0-12 month) 11mg/day
Children(1-3 yrs) 7 mg/day
Children(4-8 years) 10mg /day
Children(9-13 years)
8 mg/day
Adolescent(14-18 years) 11 mg (male)
15 mg (female)

43. Normal food, supplying over 10 mg iron along with
a daily oral iron supplement of 10-20 mg is adequate
in moderate iron deficiency anemia especially in
adolescents.

44. VEGETARIAN
Cereals (Ragi, Soyabean, Bajra), pulses, spinach,
beans, tomato, citrus fruit (orange), apricots,
almonds, walnuts are helpful.

45. JAGGERY IRON VESSEL’S
PREPAIRED
FOOD
SPINACH/G
REEN LEAFY
VEGETABLES
COMMON IRON RICH
SOURCES

46. NON- VEGETARIAN
Mutton, beef, liver, kidney and egg are helpful.

47. FOOD SOURCE QUANTITY IRON (MG)
Bajra
Ragi
Soyabean
Iron Fortified formula
Pulses
Spinach
Mint leaves
Fenugreek leaves
Drumstick leaves
100 g
“
“
1 tbsp
100g
“
“
“
“
8.8
5.6
11.5
3.0
9.8
5
15.6
17
7

48. Food source Quantity Iron (mg)
Dates
Jaggery
cashewnuts
Pork Liver
Egg yolk
Fish ( prawn)
100g
“
“
“
1 medium
100g
10.6
12
5.2
17.3
3.0
10

49.  Complete history and physical examination.
 Anthropometrical measurements.
 Vital signs, elimination pattern.
 Signs of complications
 Provide adequate rest.
 O2 administration.
 Parent education
NURSING MANAGEMENT

50.  Fatigue related to decreased Hb level and diminished
oxygen carrying capacity.
 Imbalanced nutrition less than body requirement related
to inadequate dietary intake and chronic blood loss.
 Altered growth and development related to decreased
energy level and poor general condition.
NURSING DIAGNOSIS

51.  Altered tissue perfusion related to inadequate
hemoglobin and hematocrit.
 Risk for infection related to general weakness.
 Deficient knowledge related to disease condition
cont…..

52. COMPLICATIONS
Malabsorption
syndrome
Reccurent infections
PARASTHESIA
CONFUSION
ANGINA
DYSPNEA
Mental subnormality
Growth retardation

53. PRECAUTIONS WHILE TAKING
IRON SUPPLEMENTS
• - Take iron on an empty stomach (one hour before meal, two hrs after meal)
iron absorption is reduce with food especially dairy product.
-Startwithonlyonetablet/dayforafewdaysthen increase2tablets/day,
-permitthebodytoadjusttotheiron.
- - Increase the intake of vitamin-C as it enhances iron absorption.
- - Eat food high in fiber to diminish problem with constipation.
- - Remember stool will become black from iron.
- - If a liquid form of iron is taken, Use a straw or can be given through syringe
or medicine dropper to prevent teeth discoloration.