IRON DEFICIENCY ANEMIA

ANEMIA
 is a condition in which the hemoglobin
concentration in the blood is below a defined
level, resulting in a reduced oxygen-carrying
capacity of red blood cells. It is the most
common hematologic disorder.
The main causes of anemia are:
(1) inadequate production of RBC’s or RBC
components
(2) Increased destruction of RBCs, and
(3) excessive loss of RBCs (Hockenberry and
Wilson, 2007).

 It occurs at all stages of the life cycle, but is
more prevalent in pregnant women and young
children (WHO Worldwide prevalence of
anaemia 1993-2005).
 Iron-deficiency anemia
(IDA)
 is caused by an inadequate supply or loss
of iron. It is the most prevalent nutritional
disorder and the most preventable mineral
disturbance. It is generally assumed that 50%
of the cases of anemia are due to iron
deficiency, but the proportion may vary among
population groups and in different areas
according to the local conditions. The main risk
factors for IDA include a low intake of iron, poor
absorption of iron from diets high in phytate or
phenolic compounds, and period of life when
iron requirements are especially high
 Causes of Iron-Deficiency
Anemia
I. Inadequate supply of iron
 Deficient dietary intake
Rapid growth rate
Excessive milk intake; delayed addition of
solid foods
Poor general eating habits
Exclusive breast-feeding of infant after 6
months of age
 Inadequate iron stores at birth
Low birth weight, prematurity, multiple
births
Severe iron deficiency in mother
Fetal blood loss at or before delivery

II.Impaired iron absorption
 Presence of iron inhibitors
Phytates, phosphates or oxalates
Gastric alkalinity
 Malabsorption disorders
Lactose intolerance
Inflammatory bowel disease
 Chronic diarrhea
iv.Blood loss
 Acute or chronic hemorrhage
 Parasitic infestation
 Excessive demands for iron required for growth
 Prematurity
 Adolescence
 Pregnancy

 Clinical Assessment
Visible severe wasting – severe wasting of the
shoulders, arms, buttocks, and legs, with ribs
easily seen, and indicates presence of
marasmus.
Edema of both feet
Weight for age - weight for age indicator is a
standard growth chart that helps identify
children with low or very low weight for age
and who are at increased risk of infection and
poor growth and development
Palmar pallor

Classification of Nutritional
Status and Anemia
Visible severe wasting or SEVERE MALNUTRITION Give first dose of vitamin A


Severe palmar pallor or OR SEVERE ANEMIA Needs urgent referral to a hospital



Edema of both feet

Some palmar pallor or ANEMIA OR ( VERY ) LOW Assess the child’s feeding and counsel the
( Very ) low weight for WEIGHT mother accordingly on feeding
age If there is a feeding problem, follow up in

5 days
If pallor is present , give iron (1 dose

daily)
Syrup to a child 12 months of age

Iron tablets if the child is 12 months or

older
If the child is receiving antimalarial

sulfadoxine-pyrimethamine, do not give

iron/folate tablets until a follow up visit
in 2 weeks, as this can interfere with the
action of the antimalarial
In areas where hookworm or whipworm is a

problem, give mebendazole if the child is 2

years or older and has not had a dose in
the previous 6 months
Follow up in 14 days

If very low weight for age, give vitamin A

Follow up in 30 days

Advise mother when to return immediately

NOT (very) low weight for NO ANEMIA AND NOT

 If the child is less than 2 years old,
age and no other signs of ( VERY ) LOW WEIGHT assess the child’s feeding and counsel the
malnutrition mother accordingly on feeding
If feeding is a problem, follow up in 5

days
Advise the mother when to return

immediately
Administering Oral Drugs at
Home
 VITAMIN A
 Treatment:
Give one dose in the health center
  

Supplementation:
Give one dose in health center if:
Child is six months of age or older,
Child has not received a dose of vitamin A
in the past 6 months

AGE Vitamin A capsules

100,000 IU 200,000 IU

6 months up to 1 ½ capsule
12 months

12 months up to - 1 capsule
5 years
 IRON
Give one dose daily for 14 days
AGE OR WEIGHT IRON / FOLATE IRON SYRUP IRON DROPS
TABLE Ferrous Ferrous sulfate Ferrous sulfate
Sulfate 150mg per 5ml (6mg 25mg (25mg
200mg+250mcg elemental iron per elemental iron per
Folate (60mg ml) ml)
elemental iron)

3 months up to 4 2.5 ml (1/2 tsp) 0.6 ml

months (4 - <6 kg)

4 months up to 12 4 ml (3/4 tsp) 1.0 ml

months (6 - <10 kg)

12 months up to 3 ½ tablet 5 ml (1 tsp) 1.5 ml

years (10 - < 14
kg)
3 years up to 5 1 tablet 10 ml (1 ½ tsp) 2.0 ml
years (14 – 19 kg)
 References
de Benoist, Bruno, Erin McLean, Ines Egli, and
Mary Cogswell, Worldwide prevalence of
anaemia11993- 2005 WHO Global Database
on Anaemia
 http://www.who.int/en/
Food and Nutrition Research Institute (FNRI)
http://www.fnri.dost.gov.ph
Hockenberry, Marilyn J. and David Wilson. 2007
Wong’s Nursing Care of Infants and Children,
8th ed. pp. 1516-1517. Elsevier Pte. Ltd.
Singapore.
Model Chapter for Textbooks IMCI (Integrated
Management of Childhood Illnesses), World
Health Organization, 2001