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Dr. Andrew Rynne

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What is the cause and treatment for anemia in children?

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Dr. Jyothi B L

Pathologist and Microbiologist

Practicing since :2003

Answered : 849 Questions

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Posted on Mon, 4 Aug 2014 in Blood Disorders
Question: Respected doctor
i am father of 10 years old boy , on chronic microcytic hypochromic anemia from the age 5 till now, enlarged kissing tonsillits, planned to remove tonsils ,on pre operative work up found prolonged prothrombime time (17 sec) and finally done complete coagulation factor diagonsed mild factor vii deficient , which corrected with normal plasma,
no history of bleeding or brisuing , mild hyperactive , normal in acadamics .,
he is on iron tablets of three different salts totally 150mg a day for past 5 days.,
morning - ferrous calcium citrate elemental iron50mg
noon------iron chelate complex elemental iron 30mg
night ----ferrous succinate elemental iron 70mg

his stools is green to black in colour, negative for occult blood test
i have attached his latest anemia profile blood investigation along with this query .,
i am totally confused that some doctors in our town hbg of 10.8 as normal and some of doctors replied as chronic anemia and some as to do full gastroscope , full colonoscope., and rbc labeled nuclear scan.,
this hbg was not corrected for the past 5 years inspite of iron and vitamin c supplements.,
deworming done for once in 3 months (400mg on 1st day and 400mg on 15th day)
so i need your opinion whether this is normal or not , and advice for further
please please advice further
doctor
Answered by Dr. Jyothi B L 26 hours later
Brief Answer:
Hemoglobin is near normal

Detailed Answer:
Hi
I am Dr Jyothi BL, I would like to take up your query.
I went through your reports and my opinion is as follows.
1. Lab reports are within normal limits except for hemoglobin and retic count which is slightly lower than normal( 11.5 to 15.5) for your son's age.
2. Next is peripheral smear which is suggestive of microcytic hypochromic anemia.
3. Commonest cause of anemia in children is nutritional, and in his case appears to be iron deficiency as it is known to cause microcytic hypochromic anemia.
4. But iron studies are normal in his case, which means his iron stores are good enough. You will have to rule out other causes of microcytic anemia like chronic diseases/ thalassemia/ Sideroblastic anemia.
5. Retic count should increase with treatment, do repeat retic count after two weeks.
6. Discuss with your consulting doctor regarding hemoglobin electrophoresis to rule out thalassemia trait.
7. Gastroscopy and colonoscopy is not necessary as stool examination is negative for occult blood.
However get the stool examined for parasites and malabsorption syndromes.
8. Finally on concluding note, be regular with his nutritional supplements, Good nutrition and a check on any symptoms of anemia.
Do attach reports of bone marrow study if done anytime before.
Hope I have answered your query, any clarifications happy to help you again.
Regards
Dr Jyothi BL

Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Jyothi B L 50 minutes later
Thanks doctor
hbg variant analysis done
he is negative for beta thal
and also for alpha thal
please give me what test has to be done for malabsorpt ion


Stool examination done
No parasite found
Bone marrow biopsy not yet done
Now he is in three iron salts namely
Iron as chelate complex
Ferrous succinate
Ferrous calcium citrate and totally he is taking element Al iron 150 mg per day
It's normal or else it has to be changed
doctor
Answered by Dr. Jyothi B L 7 hours later
Brief Answer:
More investigations and details necessary

Detailed Answer:
Hi XXXX
As the stool examination is normal, malabsorption is ruled out.
Five years anemia of microcytic type is uncommon without thalassemia.
I was thinking of other things like:
1. Lead poisoning - Any exposure to lead or toys, paints etc. Blood lead levels evaluation required.
2. Anemia is nearly normal. But MCV low. When was iron treatment started?
3. The iron levels are normal in blood. At present, no iron deficiency.
4. Pyridoxine deficiency, commonly in infants. Its also one cause of microcytes. You can start on multi B complex vitamins specifically B-6 vitamin.
5. Repeat reticulocyte count. Now and after 15 days. It should be at least one for this anemia. Rechecking necessary. After 15 days necessary for evaluation of vit B-6 therapy.
6. Lead levels if more can have some neurological symptoms.

I want you to test blood levels of lead, start on vit B-6 therapy and repeat reticulocyte count.
I require some iron and hemoglobin levels history since five years if you can tell in a nut shell.

Hope it helps.
Dr. Jyothi BL
Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
doctor
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Follow up: Dr. Jyothi B L 32 minutes later
Doctor
Please give us the name of blood test to be done like
Blood lead and blood pyridoxine levels

In which lab it has been done
I am blank please advise for further

For the past years his hbg never crossed 11 gm/dl
And mcv below 73
doctor
Answered by Dr. Jyothi B L 6 hours later
Brief Answer:
list of tests provided.

Detailed Answer:
Hi XXXX
The tests required to be done are -
1. Blood/ serum lead levels - to rule out lead poisoning. It is necessary.
2. Serum pyridoxal phosphate (PLP) and serum albumin levels - rare chance - to rule out pyridoxine deficiency. Treatment with vitamin B-6 can be started and checked for improvement instead of test.
3. Serum copper and cerruloplasmin levels - Another anemia cause due to copper deficiency.
4. Reticulocyte count - Now and after fifteen days of adding cocoa powder, vitamin B-6 (multivitamin becosules can be used) to assess bone marrow response.

I wanted one confirmation. Was iron deficiency proved any time, at any age? He has low MCV, but iron is one of the cause. At present, his iron levels are within normal range. Anytime it was previously done and it was low? And then iron therapy started. You can reply to this with above reports, whenever possible.

The above tests except 4 are usually done in major labs and you can ask your nearest lab to collect and send the samples. Most of them do it.

Dr. Jyothi BL

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Jyothi B L 3 days later
DOCTOR
AS PER REQUEST I HAVE DONE BLOOD INVESTIGATION
I HAVE ATTACHED THE REPORTS
PLEASE ADVICE FOR FURTHER
doctor
Answered by Dr. Jyothi B L 1 hour later
Brief Answer:
Reticulocyte count improving - continue treatment

Detailed Answer:
Hi XXXX
Looking at the values given in the recent report, I would say values are improving.

Importantly, comfort is of reticulocyte count which is increasing. Previously it appeared to be less, now it is in normal limits and should be improving.

The serum copper and cerruloplasmin levels are normal and so rules out the cause of copper deficiency.

Hemoglobin is also improving. Continue with iron therapy and after two weeks, get a "reticulocyte count" and "hemoglobin estimation" done. If it is increasing, it shows "iron deficiency" as the cause.

If there is no further improvement, you can add b-complex medication to the continuing iron treatment.
Blood lead levels are not evaluated and after 15 days, you can get it done, if there is no response.

Hemoglobin is near normal limits. Only concern is of MCV and it should also increase in due course. Peripheral smear shows normocytes compared to previous ones and suggests improvement.

Next time on followup, do mention ( I had asked previously too) - Was iron deficiency proved any time, at any age? He has low MCV, but iron is one of the cause. At present, his iron levels are within normal range. Anytime it was previously done and it was low? And when was iron therapy started? You can reply to this with above reports, whenever possible.

Any further queries, happy to help again.

Dr. Jyothi BL
Above answer was peer-reviewed by : Dr. Ashwin Bhandari
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