We fill shortage. Treatment of anemia at children of
the Diagnosis “anemia“ quite often takes parents of small children unawares. What caused these states and than to help the kid? Whether there is enough change of a diet or it will be required to take medicine? Only the doctor can answer these questions.
A little physiology
Anemia represents a complex of symptoms which is externally shown by pallor of integuments and mucous membranes along with change of internals, and at a blood test - reduction of amount of hemoglobin, erythrocytes and average concentration of hemoglobin in one erythrocyte.
Hemoglobin is a complex substance which part the iron capable to form connection with oxygen is. The erythrocytes containing the hemoglobin connected to oxygen carry it on all organism to each section. Having given oxygen, erythrocytes take away the carbon dioxide which is formed as a result of their activity from cages. In lungs carbon dioxide is released from erythrocytes and then exhausts, and erythrocytes take oxygen again. So happens constantly over all human life.is born
of People with the large number of erythrocytes and high content of hemoglobin necessary for it in the course of pre-natal development as the need for oxygen is big during this period, and in its maternal blood it is less, than in air. Therefore for ensuring the necessary amount of oxygen more erythrocytes and according to hemoglobin are also formed.
After the birth the child begins to breathe air therefore the maintenance of erythrocytes and hemoglobin in blood at it decreases. At children 1 years normal are more senior contents in 1 mm 3 blood of 4,5 - 4,8 million erythrocytes is and not less than 110 g/l of hemoglobin is at children till 6 years. Life expectancy of each erythrocyte is equal to 3 - 4 months. The place of their development is red marrow which by the time of the birth is available almost in all bones, and approximately by 6 years remains only in flat bones - a breast, edges, basin bones, bodies of vertebras and the ends of tubular bones. In process of maturing erythrocytes come to blood.
of the Reason of anemia
at younger children`s age deficiency of iron in this connection they are called also iron deficiency is the Main reason for development of anemias.
Iron along with participation in transfer by hemoglobin of oxygen takes part in formation of many fermental systems of an organism which participate in tissue respiration, okislitelno - the recovery reactions proceeding in an organism in synthesis of protein and blood cells. Insufficient intake of iron leads to impoverishment of its natural “depots“ in an organism - marrow, a liver, muscles. Despite increase of vsasyvatelny function of intestines at iron deficiency anemia and the strengthened absorption of iron in a small intestine, the requirement of an organism remains unsatisfied as the soaked-up iron comes from blood serum first of all not to erythrocytes, and to “depot“.
Such anemia can be caused by many reasons. Among the prenatal reasons note polycarpous pregnancy, considerable and long deficiency of iron in an organism of the pregnant woman, violation matochno - placentary blood circulation, prematurity. Bleeding at the time of delivery, premature or late bandaging of an umbilical cord can promote development of anemia also. Postnatal factors - insufficient intake of iron with food, early artificial feeding, late introduction of a feeding up, long not various, generally milk diet, the vegetable food deprived of animal protein, frequent diseases of the child, rickets have bigger value. There can be violations of absorption of iron in intestines as a result of the different reasons including dysbacteriosis, a malabsorption syndrome (a syndrome of the broken intestinal absorption), at children with food allergy, at diseases of bodies zheludochno - an intestinal path - gastritises and gastroduodenita, diseases of a liver and pancreas, small and large intestine, loss of iron at the increased need of an organism of the child for it at the accelerated growth rates, at violation of an exchange of iron as a result of hormonal changes, at bleedings (nasal, wound).
Krom of iron an important role in processes of normal blood formation is played by such minerals as copper and cobalt, to a lesser extent - manganese, nickel, zinc, molybdenum, chrome, etc. Copper promotes utilization of iron for formation of hemoglobin, cobalt participates in development of an eritropoetin - the factor stimulating formation of erythrocytes.
of the Stage of anemia
Each anemia passes certain stages in the development:to
- Prelatent deficiency of iron - exhaustion of fabric reserves of iron, at the same time hemoglobin level in peripheral blood remains within age norm; in spite of the fact that the content of iron in fabrics decreases, its assimilation from foodstuff does not increase, and, on the contrary, decreases that is explained by decrease of the activity of intestinal enzymes.
- the Latent (hidden) deficiency of iron - decrease not only the fabric reserves of iron but also deposited and also its transport quantity - the content of iron in blood serum decreases.
- the Final stage of deficiency of iron in an organism which is characterized by decrease in level of hemoglobin, often combined with reduction of quantity of erythrocytes in unit of volume actually is also iron deficiency anemia.
the Content of iron in foodstuff (in mg on 100 g of edible part)
|of Cocoa - powder||14,8||egg||2,5||Peas||6,8||Potatoes||0,9|
|buckwheat||6,65||of the Kura||1,6||Oat-flakes Grain||3,63||Pepper sweet||0,6|
|rye bread||3,9||Pork fat||1,94||Macaroni, century of page.||1,58||Apples||2,2|
|Meat of a rabbit||3,3||Cheeses firm||1,2||barley grits||1,81||walnuts||2,3|
|Beef||2,9||Fish||2,45||of the Croup millet||2,7||Strawberry||1,2|
|of the Kidney beef||5,95||Cod liver||1,9||of the Croup rice||1,02||Water-melon||1,0|
|Sausage boiled||2,1||Cottage cheese||0,46||bun||1,97||Carrots||0,7|
|beef liver||6,9||cow`s milk||0,2||semolina||0,96||Tomatoes||0,9|
of Display of a disease
For iron deficiency anemia at it is long the existing deficiency of iron and the level of hemoglobin lower than 90 g/l a number of syndromes (set of signs) is characteristic:
- the Epitelialny syndrome - pallor of skin and mucous membranes, auricles, dryness, a peeling and pigmentation of skin, dystrophy of hair and nails. Malosimptomny caries of teeth, loss of appetite, changes of sense of smell and taste, stomatitis, “zayeda“ in mouth corners, gastritis are typical for this syndrome, duodenit, various violations of processes of digestion and absorption - heartburn, an eructation, nausea, vomiting, unstable depletions of intestines from - for violations of processes of digestion and absorption, is more rare - the latent intestinal bleedings.
- the Astenonevrotichesky syndrome is characterized by hypererethism, irritability, emotional instability; gradual lag in psychomotor, speech and physical development; fatigue, slackness, apathy, block.
- It is warm - the vascular syndrome is followed by short wind and heartbeat, tendency to hypotonia, muting of tones, the functional systolic noise revealed at an electrocardiogram - research hypoxemic and trophic changes in a cardiac muscle.
- the Increase in a liver and spleen which is observed at the accompanying deficiency of proteins, vitamins, active rickets represents a gepatoliyenalny syndrome. the delay of physical development, weakness of a sphincter of a bladder is characteristic
- Of a muscular syndrome that can be shown by enuresis (an urine incontience).
- the Syndrome of decrease in local immune protection causes defeat of barrier fabrics and finds the manifestation in frequent SARS, early emergence of the chronic centers of an infection.
degree of anemia easy (with the level of hemoglobin of 110 - 91 g/l), medium-weight (90 - 71 g/l), heavy (less than 70 g/l) or superheavy (50 g/l and less).
of Manifestation of the hidden deficiency of iron are reminded by those at anemia, however they are shown much more rare.
At easy degree of anemia all specified clinical syndromes can be absent, at the same time lack of timely diagnostics and treatment leads to increase in deficiency of iron to both heavier functional and exchange frustration. There are also paradoxical situations when at anemia of easy degree the symptomatology which was more expressed, than at heavier options of a current. In this regard the great value in diagnosis of anemia is got by data of laboratory researches.
Rare forms of anemia
- Iron deficiency anemias occur at children in 90% of cases from all anemias, however in other 10% occupy seldom found anemias. At belkovodefitsitny anemia decrease in protein content in blood serum is characteristic
- . Hemoglobin level low, there are mikrotsita and makrotsita (erythrocytes of the reduced and increased sizes).
- Vitaminodefitsitny anemias are caused by insufficiency of iron, 12 vitamin B or folic acid. Hereditary foliyevo - scarce anemia comes to light usually on the first year of life, and In 12 - scarce - at the age of about 2 years.
- Yaksh`s Anemia - Hayema develops at prevalence in food of children of the goat milk containing not enough iron and derivatives of folic acid. It is shown by lag in development, bleeding, increase in a spleen and, to a lesser extent, a liver. Sideroblastny anemias are caused by violation of synthesis of hemoglobin and defects of inclusion of iron in it. Hemoglobin level low, however iron level in blood serum high, and iron-binding ability of serum low, is noted decrease in leukocytes and platelets. Besides, with such anemia find structural and functional changes of a pancreas in children. Such anemias can be at poisoning with lead, treatment with an isoniazid (at a tubinfitsirovaniye) and sulfanylamide preparations, at some chronic diseases, chromosomal violations. Talassemiya`s
- it is caused by violation of formation of proteinaceous chains in structure of hemoglobin, defect of utilization of iron. Difference of such anemia otzhelezodefitsitny is its hereditary character - emergence of the first symptoms of an illness in children of 2 - 8 years, is more rare - by the end of the first year of life, and also the frequency of congenital genetic anomalies (a daunizm, anomalies of development of a skull, teeth, etc.) .
the Leading role are occupied by indicators of content of hemoglobin and erythrocytes. At inspection it is important to specify what blood was investigated as the level of venous hemoglobin is 5 - 10 g/l less, than arterial. The accepted norms of hemoglobin offered WHO provide research of a blue blood.have not enough
For statement of the diagnosis of anemia of natural decrease in level of hemoglobin, such indicators as quantity of erythrocytes, a color indicator, average volume of an erythrocyte, average content and average concentration of hemoglobin in an erythrocyte, the content of iron in blood serum, the effect of application of preparations of iron revealed on 7 - 12 - y day of treatment, and some other factors are considered.
Very simple test which can guard parents in respect of a zhelezodefitsit is the bituriya symptom - pink coloring of urine after the use with food of red beet. It is explained by the fact that at healthy children at enough iron the liver by means of ferriferous enzymes is capable to decolour beet dye completely. This sign is characteristic not only for deficiency of iron - it meets also at tranzitorny (passing, temporary) immunodeficiency. Anyway it is an occasion to see a doctor.
Treatment of any anemia is based on the mechanism of its development. At deficiency of iron treatment provides use of ferriferous preparations in an organism.
needs to be noticed that compensation of considerable deficiency of iron at anemias of average and heavy degrees by means of special diets cannot be reached, and those parents who prefer to treatment “food“ correction have to remember it.
Iron most often is appointed inside in the form of zakisny salts, mainly iron sulfate which is soaked up and acquired most fully. Medicines make of iron salts in combination with amino acids, apple, ascorbic, lemon acids which in acidic environment of a stomach promote formation of easily soluble compounds of iron and its fuller assimilation. It is recommended to accept iron between feedings or for an hour to food as some components of food can form with it insoluble connections. It is necessary to wash down preparations with fruit and vegetable juice; juice of a citrus is especially useful, but it is necessary to remember that they often cause allergic reactions.
Purpose of adequate treatment - business of your attending physician. However to all parents will not prevent to know the general principles of treatment zhelezodefitsit - ache anemias. They are the following:
- cannot compensate deficiency of iron without medicinal ferriferous preparations at anemias of moderate severity and heavy;
- treatment should not stop after normalization of level of hemoglobin as initial increase of hemoglobin is temporary, compensatory, along with simultaneous decrease in its stocks in “depot“.
the Prevailing quantity of anemias is polyscarce (there is a deficiency not of one, but several factors) that is not least connected with deterioration in an ecological situation in the world.
Complex treatment includes also application of other means:
- of the balanced balanced diet taking into account physiological needs of an organism for proteins, fats, carbohydrates vitamins and minerals, including in the menu products with the greatest contents of iron;
- of phytopreparations - at functional violations of a digestive tract and violations of processes of absorption the herbs having anti-inflammatory effect, promoting restoration of mucous membranes and their normal functioning apply, and also they normalize intestinal microflora. At diseases of a liver collecting from an immortelle, corn a rylets, mints, camomiles, a yarrow, a dogrose is recommended. Will help at problems of a stomach and intestines a St. John`s Wort, alty, a camomile, flax, a glycyrrhiza, a plantain, a sage, a dandelion, sporysh. Oak bark, the mountaineer snake, alder cones, a train grass, flowers of cornflowers normalize work of intestines, and normalization of microflora in it leaves of an eucalyptus and a sage, fruits of raspberry, a mountain ash ordinary, a yarrow, fennel will promote.
- of preparations of antioxidant action for normalization of processes of free radical oxidation and, protection of cellular membranes against damage (vitamins A, With, E, selenium).
For aboutfilaktik of anemias dispensary supervision at the pediatrician and regular laboratory inspection for the purpose of identification of easy degrees of anemias and purpose of timely treatment is necessary.
the Doctor pays special attention to children from risk group: been born from mothers with anemia or with latent deficiency of iron who had late toxicosis of pregnancy: under the influence of various factors characteristic of toxicosis at the woman (increase of arterial pressure, hypostases, proteinurias etc.) process of blood formation at a fruit is oppressed. Also children with small body weight at the birth treat risk group, from polycarpous pregnancy, quickly growing, being on irrational artificial feeding which is not balanced on a ratio in food of proteins, of fats, carbohydrates (it is more often happens when using of not adapted mixes). Premature children as prevention of anemia are recommended to give iron medicines in a half medical dose since the end of the second month of life to 2 - summer age.
For the prevention of anemia and for the correct development children have to receive various food with the sufficient content of the full-fledged proteins, vitamins and mineral substances necessary for normal a shelter - creations. Full-fledged squirrels contain mainly in meat, cottage cheese, a liver, eggs, fish, cheese, bean. Contains in products of an animal origin (a liver, meat, fish, caviar) 12 vitamin B , taking active part in blood formation process. Content of iron in foodstuff is presented in the table.Minerals copper, cobalt, manganese, nickel, vitamins, especially groups B, ascorbic and folic acids beef, brains, an egg yolk, oat and buckwheat grain, green peas, beet, tomatoes, blackcurrant, a gooseberry, grade apples “antonovka“ contain
. Therefore an important factor in prevention of anemia is sufficient use in food of children of fresh fruit and vegetables, berries, vegetable and fruit juice, soups, the vegetables and fruit purees containing a lot of iron and vitamins - apples, carrots, etc.
Is important not only to remember these products, but also to follow rules of their culinary processing for full preservation of substances, important for an organism.the correct alternation of a dream and wakefulness, sufficient stay in the fresh air, a hardening, massage and gymnastics is Not less important
. The forecast at scarce anemias in most cases favorable. Modern diagnostics and methods of treatment of anemia and the diseases contributing to its development lead to an absolute recovery.
Independent treatment of anemia at the child can do it harm as means, effective at one form of a disease, can make an adverse effect at another.
Cannot be forgotten that data of blood test reflect all processes happening in the child`s organism, and decrease in level of hemoglobin can be one of displays of any disease.
At the seeming first symptoms of anemia should address the local pediatrician.