September 23, 2005

Anemia and Iron Deficiency: Symptoms, Causes and Treatment

By Dr. Meena Sathappan
Special to the Times

A popular Venezuelan proverb says, “Blood is inherited, and virtue is acquired.”

The word ‘anemia’ has its origins from the Greek word anaimi which means ‘without blood,’ where, ‘an’ = without, ‘haima’ = blood.

Anemia is a condition of the blood where there is a lower than normal number of red blood cells, usually measured by a decrease in the amount of hemoglobin. Hemoglobin is the red pigment in RBCs that transport oxygen.

Anemia occurs when the body produces too few RBCs, loses too many of them, or if RBCs are destroyed faster than they can be replaced. As a result, the body’s organs and tissues receive less oxygen than needed to function properly.

There are close to 100 types of anemia and the causes are dependent on the type of anemia. Some of the frequent causes include blood loss, vitamin or iron deficiencies, side effects of medications, bone marrow-related problems and genetic or acquired diseases.

Major symptoms of anemia include extreme fatigue, dizziness or fainting, pale skin, nail beds and palms, weakness, shortness of breath, confusion or loss of concentration and rapid heart rate.

In children, symptoms include a mild paleness of the skin, usually most apparent as a decreased pinkness of the lips, the lining of the eyelids and the nail beds, which are the pink part of the nails. Anemic children may be irritable, mildly weak or tire easily.

Those with severe anemia may have shortness of breath, rapid heart rate and swelling of the hands and feet. If the anemia continues, it may interfere with normal growth. Anemic newborns may become jaundiced, where they turn yellow, although many newborns are mildly jaundiced and don’t become anemic.

Doctors diagnose anemia with the help of a medical history, physical exam and blood tests, including a complete blood count (CBC) to measure levels of RBCs and hemoglobin in the blood. A person is determined to be anemic if the levels are below the normal ranges. It is important to note that “normal” is something that varies from person to person.

Though some children are not anemic, they could still be deficient in iron. These kids may have decreased appetite, be irritable, fussy and inattentive. If untreated, it could contribute to delays in their development or poor performance in school.

These problems can usually be cured when the children take iron supplements. Doctors, via periodic blood checks, determine the length of time a child is required to take iron supplements.

Other signs of iron deficiency that may be unrelated to anemia include a tendency to eat weird things, such as ice, dirt, clay and cornstarch. This behavior is called pica. It is not harmful unless the material eaten is toxic (such as lead).

Usually the behavior improves after the anemia is treated and as the child becomes older, although it may persist longer in children who are developmentally delayed.

Tips about iron medication
It is best not to give iron with milk because it blocks the absorption of iron. Vitamin C increases iron absorption. So, follow the iron dose with a glass of orange juice.

Don’t be too concerned with the dental stains (grayish black color) that are left behind by liquid iron, because they are not permanent. Make sure your child swallows the liquid iron rapidly and rinses his mouth with water. You may also want to brush your child’s teeth after every dose of iron.

Iron medications cause the stools to turn dark black. Don’t be worried.

IMPORTANT: Iron medications are extremely poisonous if taken in excessive amounts. Iron is one of the most common causes of poisoning in children under age 5. Keep this and all medication out of reach of small children.

Well-balanced diet
A well-balanced diet is crucial to the prevention and cure of iron deficiency and other types of nutritional anemia.

Make sure your older child has a well-balanced diet and eats foods that contain iron to set the right example for the younger siblings. Check the labels to make sure that you select grains and cereals that are iron-fortified.

Egg yolks, green and yellow vegetables, yellow fruits, red meat, potatoes, tomatoes, molasses and raisins are good sources of iron. Also, using fruit pulp in juices and cooking potatoes with the skins on are good ways to increase the iron content for the entire family.

Infants
Do not give your infant cow’s milk until he or she is at least a year old. If your child is breast-fed, there is enough iron in breast milk. Once you start solid foods, it is important to feed iron-fortified foods such as cereal.

If you choose to solely breast-feed beyond four months, an iron supplement is recommended. However, the introduction of iron-poor solid foods will decrease the amount of iron your baby absorbs from the milk. If your baby is formula-fed, give him or her formula with added iron.

Identify cause first
There are so many different types of anemia, it is very important to identify the cause before any treatment is begun. Do not attempt to treat your child with vitamins, iron or other nutrients or over-the-counter medications unless it is at your physician’s direction. This is important because such treatment may mask the real reason for the problem and thus delay the diagnosis.

In adults, the treatment of anemia varies greatly depending on the type. Doctors could recommend diet modification, nutritional supplements or medication, if needed. Prescription treatments may be used to stimulate red blood cell production and help correct anemia.

Because the symptoms of anemia are easily confused with the symptoms of other conditions, it is important to see a doctor for an evaluation if you or your child is experiencing significant fatigue or other signs and symptoms listed above.

The “What’s your AQ?” (Anemia Quotient) quiz posted on the Web at www.anemia.com is a useful tool to help assess the symptoms and discuss them with your doctor.

Source: www.anemia.com and American Academy of Pediatrics

Dr. Meena Sathappan is a board-certified pediatrician who lives and practices in Evergreen. She is available for questions and consultation at Aasha Pediatrics, 2060 Aborn Road, # 230, San Jose, Calif. 95121 (corner of Aborn Road and Capitol Expressway). You can call her at (408) 274-9099, or e-mail her at msathappan@gmail.com. For more information, go to her Web site: www.aashapediatrics.com.