How to detect an anaemic child

May 29, 2011

LORA'S daughter, Melisa, developed health complications at two years. Her eyes and lips became pale, and she was irritable. Melisa was diagnosed with anaemia. <br>

By Agnes Kyotalengerire
LORA'S daughter, Melisa, developed health complications at two years. Her eyes and lips became pale, and she was irritable. Melisa was diagnosed with anaemia.

Dr. Jane Achan, a paediatrician at Mulago Hospital, describes anaemia as a blood disorder characterised by an abnormally low number of red blood cells or less than the normal quantity of haemoglobin in the blood. “Low levels of haemoglobin can lead to health complications because haemoglobin carries oxygen to the body tissues,” she says.

Anaemia in children is mainly caused by blood loss, excessive destruction of the red blood cells and inadequate production of red blood cells. Besides, it can also result from inherited disorders, deficiency in iron or vitamin, cancer and infections. With malaria being the commonest cause, the parasites multiply within the red blood cells of a patient, massively destroying them.

Worm manifestation is next to malaria. “Worms suck up blood from the lining of the intestines, causing a child to become anaemic,” Carol Namukwaya, a nursing officer at Mulago Hospital, says.

Destruction of the red blood cells
With haemolytic anaemia, the red blood cells are destroyed prematurely. The normal lifespan of the red blood cell is 120 days, but in a child with haemolytic anaemia, it is much shorter.

“The bone marrow that makes new blood cells simply cannot keep up with the body’s demand for new cells,” Achan says.

In autoimmune hemolytic anaemia, the immune system mistakes red blood cells for foreign invaders and begins destroying them; the most common form being sickle cell anaemia and thalassemia (a hereditary blood disorder).

Sickle cell anaemia is a condition in which the haemoglobin forms long rods when it gives up its oxygen, stretching the red blood cells into abnormal sickle shapes.

This leads to premature destruction of red blood cells, chronical low levels of haemoglobin, recurring pain episodes and problems that affect other body organs.

Blood loss
Excessive bleeding due to injury, surgery, or a problem with the blood’s clotting ability and slower long-term blood loss such as intestinal bleeding from inflammatory bowel disease may cause anaemia.

Inadequate red blood cells
Failure of the bone marrow to make enough red blood cells causes anaemia. This can result from a viral infection, exposure to certain toxic chemicals, radiation or medications.

Some childhood cancers and certain chronic diseases affect the ability of the bone marrow to make blood cells, leading to anaemia.

Iron deficiency
“Poor dietary intake of iron, or increased loss of iron can lead to iron deficiency anaemia,” Namukwaya explains, adding that the most affected group are children younger than two years because they mainly take milk, which does not have iron.

Symptoms
Achan says paleness of the conjunctiva (transparent membrane in the eye), tongue, palms and fingernails are mild symptoms of anaemia. These happen gradually and are sometimes difficult to notice.

Irritability, body weakness, dizziness and a rapid heartbeat are moderate signs, though some children present with heart failure in case of severe anaemia.

But when anaemia is caused by excessive destruction of the red blood cells, jaundice a yellowing of the whites of the eyes, urine and enlarged spleen presents.

In infants and pre-school children, iron deficiency anaemia manifests into developmental delays, behavioural disturbances, problems with social interaction and learning difficulties, though this occurs in a chronic anaemic state.

Treatment
This depends on the cause. For patients with severe anaemia, blood transfusion is necessary.

Depending on the presentation and magnitude of anaemia, other aspects of management include provision of deworming medication, folic acid and iron supplementations.
Children with sickle cell disease are given folic acid supplements for life in addition to malaria treatment.

Prevention
Emphasis should be put on prevention of malaria. Parents are also encouraged to deworm and give foods rich in iron, for example green leafy vegetables, beef, liver and iron fortified feeds.
Achan warns parents not to give children foods that impair iron absorption, for example black tea because it contains tannins.

Diagnosis
A patient is assessed clinically and evaluated on the degree of paleness and signs that suggest possible causes of anaemia.

Baseline laboratory tests may include assessed haemoglobin levels, complete blood count and stool analysis.

Other diagnostic tests include haemoglobin electrophoresis (a blood test that can detect different types of haemoglobin), bone marrow aspiration (removal) and biopsy (removal of cells or tissues) and a blood test that measures how rapidly immature red blood cells

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