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Symptoms of Iron Deficiency Anemia and Treatment

Iron deficiency anemia (ADB) is iron deficiency anemia for hemoglobin synthesis, and is the most nutritional deficiency in children and causes the greatest health problems worldwide, especially in developing countries including Indonesia. From the result of SKRT 1992, the prevalence of ADB in under fives in Indonesia is 55,5%. ADB complications due to low total body iron count and hemoglobin formation (Hb) are associated with cognitive function, behavioral changes, delayed growth and impaired immune function in children.
The highest prevalence is found at the end of infancy, early childhood, schoolboy, and adolescence due to accelerated growth during this period with low iron intake, the use of cow's milk with less iron content that can lead to exudative enteropathy and blood loss from menstruation.

Clinical Manifestations

Pale that lasts long without bleeding manifestations
Easy fatigue, weakness, irritability, no appetite, body resistance to infections decreased, as well as behavioral disorders and learning achievement
    
Fond of eating unusual food (pica) such as ice cubes, paper, soil, hair
   
Eat less iron-containing foods, food ingredients that inhibit iron absorption such as calcium and phytate (rice, wheat), and milk consumption as the main source of energy from infancy to 2 years (milkaholics)
  
Malaria infections, parasitic infestations such as ankylostoma and schistosoma
ADB's clinical symptoms often occur slowly and are not so noticed by the family.
When the Hb level
Pale is found when Hb levels are 14.5% in iron deficiency, when normal RDW (<13%) in thalassemia trait.
 Ratio MCV / RBC (Mentzer index) »13 and if RDW index (MCV / RBC xRDW)
    220, is a sign of iron deficiency anemia, whereas if less than 220 is a sign of thalassemia trait.
Peripheral blood smear: microcytic, hypochromic, anisocytic, and poicylocytosis.
Low serum iron levels, TIBC, serum ferritin
Reticulocyte values: normal or decreased, indicate inadequate production of red blood cells
Serine transferrin receptor (STFR): sensitive to iron deficiency, has a high value for distinguishing iron deficiency anemia and anemia due to chronic disease
 Zinc levels of protoporphyrin (ZPP) will increase
Therapeutic trial: a response of iron preparation at a dose of 3 mg / kgBW / day, characterized by an increase in reticulocyte counts between 5-10 days followed by elevated 1 g / dL hemoglobin or 3% hematocrit after 1 month supporting the diagnosis of iron deficiency anemia . Approximately 6 months after therapy, hemoglobin and hematocrit are revalued to assess treatment success.

Investigations are conducted in accordance with existing facilities.

ADB diagnostic criteria according to WHO:
Hb levels are less than normal for age
The mean erythrocyticHb concentration was 31% (N: 32-35%)
Serum Fe content
Saturation transferin<15% (N: 20-50%)

These criteria must be met, at least criterion number 1, 3, and 4. The most efficient test for measuring body iron reserves is serum ferritin.

When the means are limited, the diagnosis can be established on the basis of:
Anemia without bleeding
No organomegaly
Blood edge image: microcytic, hypochromic, anisocytosis, target cells
Response to iron therapy
Handling

Knowing the causal factors: history of nutrition and birth, the existence of abnormal bleeding, post-surgery.
Iron preparations. Preparations are available ferous sulfate, ferousgluconate, ferrous fumarate, and ferrous succinate. Iron dose elemental 4-6 mg / kgBB / day. The response of therapy by assessing the increase of Hb / Ht level after one month, ie the increase of Hb level of 2 g / dL or more. When the response is found, therapy is continued for 2-3 months.
Elemental iron composition:
    Ferousfumarate: 33% is elemental iron
    Ferousgluconas: 11.6% is elemental iron
    Ferous sulfate: 20% is elemental iron
Blood transfusion. Rarely needed, given only under very severe anemia with Hb<4g / dL. Blood component given PRC.
Prevention

Primary prevention
Maintain exclusive breastfeeding for up to 6 months
Delay the use of cow's milk until the age of 1 year
Use fortified cereals / fortified foods on time, from 6 months to 1 year of age
Provision of vitamin C such as oranges, apples at meal times and drinking iron preparations to increase iron absorption, and avoid ingredients that inhibit iron absorption such as tea, phosphate, and phytate on food.


Avoid excessive drinking of milk and increase foods that contain iron content derived from animal
Environmental hygiene education
Secondary prevention
ADB Screening
ADB screening is done by Hb or Ht examination, the time is adjusted for birth weight and infant age. The exact time is still controversial. The American Academy of Pediatrics (AAP) recommends between the ages of 9-12 months, 6 months later, and 24 months of age. In areas with high risk are performed every year from the age of 1 year to 5 years.
Screening may proceed with an MCV, RDW, serum ferritin, and iron therapy trial. Screening is done until the age of adolescence.
A low MCV value with a wide RDW is one of the ADB screening tools Screening the most sensitive, easy and recommended is zinc erythrocyte Protoporphyrin (ZEP).
If infants and children are given cow's milk as a major and excessive menu should be considered for screening for ADB detection and immediate therapy.
Iron supplementation. It is the most appropriate way to prevent ADB in areas with high prevalence. Recommended iron dose recommended:
A normal birth weight infant starting at the age of 6 months is recommended 1 mg / kg body weight / day
    - Infants 1.5-2.0 kg: 2 mg / kgBW / day, given since the age of 2 weeks
    - Infants 1.0-1.5 kg: 3 mg / kgBW / day, given since the age of 2 weeks
    - Babies - Really fortified foods like formula milk for babies and complementary foods like cereal.

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