Today is April 1st.  We begin on our April A to Z Challenge.  To refresh your memory, I have chosen as my theme:  Chronic Illnesses of Children.

A – Anemia (Chronic)

Moby’s Medical Dictionary defines anemia as a blood disorder that is most commonly caused by iron deficiency either from blood loss, or a lack of iron in a person’s diet. Without iron, the body does not produce enough hemoglobin, a substance in the red blood cells that helps transport oxygen throughout the body.

There are two types of chronic anemia.  The first is known as Primary autoimmune hemolytic anemia.  It is characterized by an abnormal immune system response. The body’s immune system produces antibodies against the body’s own red blood cells which leads to the destruction of red blood cells and hence anemia.  An example would be sickle cell anemia, infections like malaria and some autoimmune diseases.

The secondary form of the condition is the result of a non-hematologic problem (chronic blood loss, chronic renal failure, osteomyelitis, inflammatory bowel disease, tuberculosis).

Chronic anemia is classified into the following 3 primary categories:  Decreased red cell production, increased red cell destruction (hemolysis), and blood loss.

Symptoms include:  Pale complexion, dizziness, fatigue, and rapid heartbeat.  The patient may also show signs of infection and fever (even mild).  The child may have a medical history of chronic inflammatory or infectious disease or cancer.  In order to make a diagnosis blood tests will be done including:  Red blood cell count, hemoglobin level, serum iron level, serum ferritin level, and serum transferrin receptor level.

The doctor will ask carefully about any evidence of blood loss [ hemoptysis (vomiting blood), hematochezia (passing blood with or without feces), melena (the passage of dark tarry stools containing decomposing blood that is usually an indication of bleeding in the upper part of the alimentary canal and especially the esophagus, stomach, and duodenum), hematuria (blood in the urine).

Age is always an important consideration. Nutritional iron deficiency is seen in older infants and toddlers (aged 6 mo to 3 y), where iron deficiency due to blood loss occurs in menstruating girls. The deficiency can be surprisingly severe, but transfusion is indicated only in the rare circumstance of impending high-output cardiac failure.

Dietary history is important with regard to the amount and source of milk ingested by infants and toddlers and to their risk of chronic iron deficiency (24 oz of milk/d or more is a clear risk factor for nutritional iron deficiency in infants and young children).

Pallor may be difficult to appreciate unless carefully sought. Pallor of the conjunctivae, nail beds, palm creases, or gums may be recognized. Parents and friends usually do not notice any difference, because the problem is chronic.  Scleral icterus (jaundice) is common in chronic hemolytic anemia. The icterus waxes and wanes.

My son Alex had chronic anemia due to the ulcerations in his esophagus.