Introduction
Anaemia is a serious public health problem in India. A national survey has reported a high anaemia prevalence rate of 72% children below 12 years and 52% in young women.1 An estimated 50-95 % of anaemia in India is iron (Fe) deficiency anaemia.2 Besides iron other nutrients such as vitamin A, E and C also play a key role in the formation and protection of red blood cells (RBC) by stimulating stem cells as well as by activating many antioxidant enzymes.3 Therefore inadequacy of any of these micronutrients may lead to anaemia in the vulnerable sections of the population.
In the children, age group under 12 years body grows rapidly and require high iron-rich and nutritious food that may not be fulfilled by their normal diet. Low economic status, less education, and poor health due to meagre dietary intake are the main causes of anaemia. Anaemia is the most predominant factor for morbidity and child mortality and hence, it is a critical health issue for children in India. Iron deficiency affects cognitive and motor development and increases the susceptibility to infections. 4 Hence an attempt was made to evaluate the causes, types, clinical manifestations, and grades of anaemia in children below 12 years.
Materials and Methods
92 (Ninety-two) children below 12 years regularly visiting paediatric OPD of Khaja Banda Nawaz university faculty of Medical Sciences hospital Kalaburgi-585101, Karnataka were studied.
Inclusive criteria
Children of age group 6 months to 12 years with pallor, clinically diagnosed as anaemia were selected for the study.
Exclusion criteria
Children more than 12 years, less than 6 months children with congenital heart disease, immune-compromised, tuberculosis, and hepatitis were excluded from the study.
Ethical approval
This research paper was approved by the Ethical committee of KBN Khaja Banda Nawaz University faculty of medical sciences Kalaburagi-585101, Karnataka.
Method
Routine blood examination for anaemia was morphologically based on peripheral findings packed cell volume (PCV), Mean corpuscular volume (MCV), Mean corpuscular haemoglobin (MCH), Mean corpuscular haemoglobin concentration (MCHC), and red cell distribution width (RDW) were determined by automated all counter. Haemoglobin was estimated by Sahli's method and expressed in gm% peripheral smear was stained by Leishman’s Stain. Reticulocyte count was done by brilliant crystal stain method, serum iron determination was done by Romany’s dipyri capacity was determined by Ramsay’s method serum vitamin B12 and folic acid was determined by architect method.
The duration of the study was June-2019 to July-2021.
Observation and Results
Table 1 In the age-wise distribution of patients 15(16.3%) were 6 months to 1 year of age, 37(40.2%) were 1 to 5 years, 29(31.5%) were 5 to 10 years of age, 11(11.9%) were between 10 to 12 years of age.
Table 1
Age-wise distribution of the patients with anaemia
|
Age in years |
No of patients |
Percentage % |
|
6 months to 1 year |
15 |
16.3 |
|
1 to 5 year |
37 |
40.2 |
|
5 to 10 year |
29 |
31.5 |
|
10 to 12 year |
11 |
11.9 |
|
Total |
92 |
|
Table 2
Prevalence of different types of anaemia
Table 3
Clinical Manifestations in anaemia patients
Table 4
Grades of anaemia based on haemoglobin level
|
Grades of anaemia |
Male |
Female |
Total |
Percentage % |
|
Mild |
15 |
6 |
21 |
22.8 |
|
Moderate |
30 |
12 |
42 |
45.6 |
|
Severe |
19 |
10 |
29 |
31.5 |
|
Total |
64 |
28 |
92 |
100 |
Table 2 Prevalence of different types of anaemia 53(57.6%) had Iron deficiency anaemia, 13(14.1%) had Thalassemia, 10(10.8%) had megaloblastic anaemia, 8(8.6%) had anaemia of acute haemorrhage, 5(5.4%) had sickle cell anaemia, 2(2.1%) had Aplastic anaemia, 1(1.08%) had leukaemia.
Table 3 Clinical manifestations in anaemia patients– 92(100%) had pallor, 78(84.7) had weakness and Fatigability, 36(39.1%) had fever, 26(28.2%) Icterus, 19(20.6%) shortness cough, 13(14.1%) history of pica, 12(13%) had Splenomegaly, 10(10.8%) had petechiae, 9(9.7%) had vomiting, 9(9.7%) Koilonychias, 5(5.4%) hyper pigmentation, 6(6.5%) had tremors.
Table 4 grades ofanaemia based on globulin level 15 male, 6 female and total 21(22.8%) had mild Hb%, 30 male and 12 female 42(45.6%) had moderate Hb%, 19 male, 10 female and total 29(31.5%) had severe anaemia.
Discussion
In the present study of the prevalence of anaemia and haematological parameters in children below 12 years in northern Karnataka, 15(16.3%) were 6 months to 1 year of age, 37(40.2%) were 1 to 5 years, 29(31.5%) were 5 to 10 year of age, 11(11.9%) were between 10 to 12 years of age. (Table 1). The types of anaemia were 53(57.6%) was iron deficiency 13(14.1%) Thalassamia, 10(10.8%) megaloblastic anaemia, 8(8.6%) anaemia of acute haemorrhage, 5(5.4%) sickle cell anaemia, 2(2.1%) aplastic anaemia, 1(1.08%) leukaemia (Table 2). The clinical manifestation were 92(100%) pallor, 78 (84.7%) weakness and fatigability, 36(39%) fever, 26 (28.2%) Icterus, 19(20.6%) shortness of breathing, 16(17.3%) hepatomegaly, 14(15.2%) cough, 13(14.1%) history of pica, 12(13%) splenomegaly, 10(10.8%) petechiae, 9(9.7%) vomiting, 9(9.7%) Koilonychias, 5(5.4%) had hyperpigmentation, 6(6.5%) tremors (Table 3). 21(22.8%) mild, 42(45.6%) moderate, 29(31.5%) severe anaemia based on Hb% (Table 4) These findings are more or less in agreement with previous studies. 5, 6, 7
Approach to anaemia in paediatric patients included is pertinent issues, related to the history, physical examination, and initial laboratory investigations. Hematocrit (HCT) is the fractional volume of the whole blood sample occupied by RBC, expressed as a percentage. As an example, the normal HCT in children aged 6 to 12 years is approximately 40% HGB in children 6 to 12 years is approximately 13.5 g/dL (135 g/L).
Characterizing the symptoms helps to elucidate the severity and chronicity of anaemia and may identify patients with blood loss or hemolytic aetiologies. Common symptoms of anaemia include lethargy, tachycardia, and pallor. 8 Infants may present with irritability and poor, oral intake. However, because of the body's compensatory abilities, patients with chronic anaemia may have few or no symptoms compared with those with acute anaemia at comparable haemoglobin (HGB) levels. Changes in urine colour, sclera icterus, or jaundice may indicate the presence of haemolytic disorders such as G6PD (glucose 6-phosphate dehydrogenase deficiency).
Bleeding from GIT (gastrointestinal tract) includes changes in stool colour; identification of blood in stool, history of blood symptoms should be reviewed. Severe or chronic epistaxis also may result in anaemia from blood loss and iron deficiency.
Past medical history also plays a vital role in anaemia in children, gestational age, duration of birth, hospitalization, and history of jaundice and/or anaemia in the newborn period. Travel to/from areas of endemic infection (E.g. Malaria, hepatitis, tuberculosis) should also be taken into consideration to evaluate the cause of anaemia. Moreover herbal or oxidant drugs may cause haemolysis particularly in patients with underlying G6PD deficiency, possible environmental toxins exposure should be explored including lead exposure and nitrates in well water, Family history of inherited haemolytic anaemia’s.
Anaemia with high ARC reflects an increased (ARC=Absolute Reticulocyte count) reflects increased erythropoietic response haemolysis or blood. Anaemia with a low or normal ARC reflects deficient production of RBC (i.e. reduced marrow response to the anaemia). However, haemolysis or blood loss can be associated with a low concurrent disorder that impairs RBC production (infection). In some cases, reticulocyte counts depend on the phase of the illness.
A review of peripheral smear is an essential part of anaemia evaluation. Even if the patient's RBC indices are a normal review of the blood smear may reveal abnormal cells that can help to identify the cause of anaemia. 9
The diagnostic approach of anaemia includes pancytopenia in leukaemia, thrombocytopenia indicates haemolytic uremic syndrome, and thrombocytosis in iron deficiency, leukocytosis in elevated WBC count includes leukaemia and infection.
Conclusion
The present study of anaemia in children below 12 years of age is related to malnutrition. The prevalence of high lymphocyte count indicates viral infection. The prevalence of anaemia was higher in the lower age group which was furthermore due to frequent infections. Girls of preschool age had a probable iron, vitamin B12, or folate deficiency as indicated by high RDW values. Girls of adolescent age (11-12 years) were more anaemic indicating more nutritional requirements with the onset of puberty. Overall children below 12 years boys were found to be suffering from a higher level of hypo chromic and microcytic anaemia. This study recommends awareness about pure water, sanitation, and nutritional counselling to parents having low social-economic status.
