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Children more prone to anaemia — Expert

Dr. Hannah Olawunmi

Consultant haematologist and member, African Society for Blood Transfusion, Dr. Hannah Olawunmi, talks about anaemia with MOTUNRAYO JOEL

What is anaemia?

Anaemia can be defined as a decrease in the amount of red blood cells or the amount of haemoglobin in the blood. It can also be defined as a lowered ability of the blood to carry oxygen to the tissues. The common test that is used to determine whether an individual has anaemia is the packed cell volume. The normal PCV for a man is 40-54 per cent and for a woman, it is 37-47.

What causes anaemia?

Broadly, causes of anaemia may be classified as impaired red blood cell production, increased RBC destruction (haemolytic anaemias), blood loss and fluid overload. The most common cause of anaemia all over the world is lack of iron. This is called iron-deficiency anaemia. If you eat a normal balanced diet, it usually contains enough iron but certain conditions may lead to lack of iron resulting in iron-deficiency anaemia. Pregnancy or childhood growth spurts, heavy menstrual periods, hookworm infestation, poor absorption of iron due to some gut diseases – for example, coeliac disease and Crohn’s disease, bleeding from the gut (intestines) as a result of peptic ulcer or haemorroids etc may lead to this. Other causes of anaemia include lack of certain vitamins such as folic acid and vitamin B12, red blood cell problems such sickle cell anaemia, thalassemia and other causes of haemolytic anaemia in which the red cells are fragile and break easily in the bloodstream. Other causes are chronic kidney disease, rheumatoid arthritis. Chronic infections like tuberculosis and bone marrow problems like leukaemia also cause anaemia.

What are its symptoms?

Common symptoms are due to the reduced amount of oxygen in the body. These include tiredness, fatigue, weakness, feeling faint, breathlessness, concentration difficulty, loss of appetite, headaches, a racing heart (palpitations), altered taste, ringing in the ears (tinnitus), and pale skin. Other symptoms may develop, depending on the underlying cause of the anaemia.

How is it treated?

Treatments for anaemia depend on cause and severity. Vitamin supplements given orally (folic acid or vitamin B12) or intramuscularly (vitamin B12) will replace specific deficiencies.

Oral iron: Nutritional iron deficiency is common in developing nations like Nigeria. An estimated two-thirds of children and of women of childbearing age in most developing nations are estimated to suffer from iron deficiency; one-third of them have the more severe form of the disorder. Mild to moderate iron-deficiency anaemia is treated by oral iron supplementation with ferrous sulphate, ferrous fumarate, or ferrous gluconate. When taking iron supplements, stomach upset and/or darkening of the faeces are commonly experienced. The stomach upset can be alleviated by taking the iron with food; however, this decreases the amount of iron absorbed. Vitamin C aids in the body’s ability to absorb iron, so taking oral iron supplements with orange juice is of benefit.

Injectable iron: In cases where oral iron has either proven ineffective, would be too slow (for example, pre-operatively) or where absorption is impeded (for example in cases of inflammation), parenteral iron can be used. The body can absorb up to 6 mg iron daily from the gastrointestinal tract. In many cases the patient has a deficit of over 1,000 mg of iron which would require several months to replace. This can be given concurrently with erythropoietin to ensure sufficient iron for increased rates of red cell production.

Antibiotics may be required if is caused infection is the cause. It is also treated via surgery if it requires to treat abnormal bleeding or haemolytic anaemia. Blood transfusion is undertaken in cases of cardiovascular instability, in patients going for surgery or those due to take anticancer drugs. Erythropoiesis-stimulating agent: The motive for the administration of an erythropoiesis-stimulating agent is to maintain haemoglobin at the lowest level that both minimizes transfusions and meets the individual person’s needs. They are not used for mild or moderate anaemia. They are used along with parenteral iron.

Does it affect a particular set of people?

Anaemia is not restricted to a particular set of people but certain people are at increased risk of anaemia, these include menstruating women, pregnant and breastfeeding women, babies, especially if premature, malnourished children, children going through puberty, vegetarians, people with cancer, stomach ulcers and some chronic diseases.

If left untreated, can anaemia lead to a worse condition?

If anaemia is left untreated it can lead to heart failure or even death.

Which specialist should one see if one has anaemia?

Any qualified doctor can be seen if one has anaemia. Usually the doctor will carry out some tests to determine the likely cause of the anaemia and then refer to the appropriate specialist. For example if the full blood count shows increase in abnormal white blood cells the patient will be referred to the haematologist who will likely investigate to rule out leukaemia.

What are the different ways to supplement iron?

Iron can be supplemented by taking iron tablets as prescribed by your physicians

Is anaemia hereditary?

Anaemia is not a disease in itself, but a result of malfunction somewhere in the body. There are so many disease conditions that cause anaemia. The majority are acquired but some like sickle cell anaemia and thalassemia are inherited.

What are the factors that increase the risk of anaemia?

The factors that increase the risk of anaemia include malnutrition, bleeding or blood loss, prematurity, poor treatment of malaria and infections especially in children etc.

What are the complications of anaemia?

Its complications include: hseart failure, impaired mental development and function in children

What is the difference between sickle cell anaemia and sickle cell disease?

Sickle cell disease is an inherited condition in which an individual’s two abnormal haemoglobin genes with at least one of them being an s gene eg Hb SC, Hb SS.

Sickle cell anaemia is a term that is restricted to SS only.

There are claims that people with sickle cell anaemia do not suffer from malaria?

People with sickle cell anaemia do suffer malaria and in fact malaria usually precipitates crisis in them. But studies have shown that haemoglobin AS Children under the age of five years are more resistant to malaria than AA children. So in countries like Nigeria where malaria is endemic childhood survival is better for AS than AA children.

Are there risks involved in taking iron tablets during pregnancy?

There are no risks involved in taking iron tablets during pregnancy. In fact a pregnant woman needs a lot of iron for the growth of the baby in the womb. There is therefore the need for a pregnant woman to take iron supplements in order not to develop iron deficiency anaemia.

Are children with anaemia cared for differently?

Children do not have body iron reserve and that is why they are easily tipped into anaemia following infections like malaria. It is therefore very necessary that children should be fed with food that is very rich in iron like liver, meat, milk, egg etc and any infection in them be treated promptly. If they develop anaemia they should be given iron and foliate supplements if blood transfusion is not indicated.

What types of food should one eat constantly to prevent anaemia?

Iron, folate and Vitamin B12 are very essential nutrients needed for the production of blood cells. Food that are rich in these essential nutrients include animal sources like meat, liver, kidney, dairy products like egg and milk, vegetables and cereals.