Iron deficiency and anemia

IDA: Basics & Etiology - Running on Empty

• Physiological Stores Depletion:
  • Term infants: by 4-6 months
  • Preterm/SGA infants: by 2-3 months
• Nutritional Deficiency (Most Common):
  • Exclusive breastfeeding beyond 6 months without iron supplementation.
  • Cow’s/goat's milk dominance before age 1 (low bioavailability, occult GI bleed).
  • Delayed introduction of iron-rich complementary foods.
• Pathological Causes:
  • Increased Demand: Growth spurts (infancy, adolescence).
  • Blood Loss: Hookworm (Ancylostoma duodenale), Meckel’s diverticulum.
  • Malabsorption: Celiac disease, chronic diarrhea.

⭐ The primary cause of IDA in Indian children (6 mo - 2 yr) is faulty feeding, notably excessive cow's milk intake, which is poor in iron and can cause colitis.

Clinical Features & Diagnosis - Pale, Pica, Probed

• General Symptoms: Pallor (best seen in palms & conjunctiva), lethargy, irritability, poor feeding, and breath-holding spells.
• Epithelial Changes (Classic Signs):
  • Koilonychia: Spoon-shaped nails.
  • Pica: Craving for non-nutritive substances (pagophagia: ice; geophagia: mud).
  • Glossitis: Smooth, sore tongue (atrophic glossitis).
  • Angular Cheilitis: Fissures at mouth corners.
• Diagnosis - Lab Investigations:
  • Complete Blood Count (CBC):
    • Microcytic hypochromic anemia (↓ MCV, ↓ MCH, ↓ MCHC).
    • ↓ Hemoglobin (< 11 g/dL).
  • Iron Profile:
    • ↓ Serum Ferritin (< 15 ng/mL) is the most specific marker.
    • ↓ Serum Iron, ↑ TIBC, ↓ Transferrin saturation (< 16%).

⭐ Increased RDW (Red Cell Distribution Width) is the earliest hematological indicator of iron deficiency.

Management & Prevention - Fixing the Ferrous Funk

• Oral Iron Therapy (First-Line):

  • Dose: 3-6 mg/kg/day of elemental iron, given in 2-3 divided doses.
  • Administer with Vitamin C (e.g., orange juice) between meals for optimal absorption.
  • Continue for 2-3 months after hemoglobin normalizes to replenish iron stores (ferritin).
  • ⚠️ Side effects: GI upset, black stools. Can be given with food to minimize, but this reduces absorption.

• Parenteral Iron (IV):

  • Reserved for severe anemia (Hb < 4-5 g/dL), malabsorption, non-compliance, or significant intolerance to oral therapy.

• Prevention & Dietary Counseling:

  • Promote iron-rich foods (green leafy vegetables, lentils, jaggery, meat).
  • Start iron-fortified cereals at 6 months.
  • Prophylactic iron for high-risk infants (preterm, LBW): 2 mg/kg/day from 2 weeks to 1 year.
  • Limit cow's milk to < 500 mL/day in toddlers.

⭐ Monitoring Response: The earliest indicator of response to therapy is an increase in reticulocyte count, which peaks around 7-10 days. Hemoglobin should rise by at least 1 g/dL after 4 weeks.

High‑Yield Points - ⚡ Biggest Takeaways

• Iron Deficiency Anemia is the most common nutritional deficiency in children.
• Exclusive breastfeeding beyond 6 months without iron supplementation is a key risk factor.
• Look for pallor, koilonychia (spoon nails), and pica.
• Labs show microcytic hypochromic cells, ↓ serum ferritin (most specific marker), and ↑ TIBC.
• Mentzer Index (MCV/RBC count) > 13 helps differentiate it from β-thalassemia trait.
• A therapeutic trial of iron leads to reticulocytosis within 5-10 days.