Iron-deficiency Anemia: Etiology and Pathology (Pediatric Nursing)

00:01 Now let's talk about iron-deficiency anemia.

00:04 Iron is very important in maintaining many body functions including the production of hemoglobin which is the molecule in your blood that carries oxygen.

00:11 It's also necessary to maintain healthy cells, skin, hair and nails.

00:17 Here is some dietary sources of iron including beans, liver and spinach.

00:22 Only a small portion of what you eat though is absorbed out of your food.

00:27 Transferrin, a blood protein made by the liver is going to take this iron and deliver it to the liver, that's where it will be stored as ferritin.

00:35 The iron is released to make new red blood cells in the bone marrow.

00:40 Once these red blood cells have gone through their cycle of life, they're going to be recycled.

00:45 20% of the iron is stored as ferritin in your bone marrow, the liver the spleen and the muscles.

00:51 80% of your total body iron is stored in the hemoglobin on the red blood cells.

00:57 The body keeps iron levels under really tight control.

01:00 Normally if we have enough iron in our body, then no further iron will be absorbed from your diet and the levels remain pretty constant.

01:08 But the body also has no way of excreting excess iron, it only eliminates what it knows we will take in via our diet.

01:16 Here's an example - the patient eats some iron, it's gonna travel to the stomach and then down onto the duodenum.

01:22 About 85 to 90% of this ingested iron is going to be excreted in the feces, the urine and the sweat, and remember this is a constant process.

01:30 About 10 to 15% will be absorbed by the mucosal cells and go to the blood.

01:35 Here, they'll the go to the bone marrow to be incorporated into new red blood cells and then at the end of the red blood cells' life, they will be recycled.

01:43 They'll also travel to other body cells.

01:45 This iron is also gonna be transported in the blood attached to a transport protein called transferrin and it can be stored in the liver in the spleen as ferritin or hemosiderin.

01:56 So what causes iron deficiency anemia in a child? Well the first is a diet low in iron.

02:02 Remember only a small amount of the dietary iron is actually absorbed.

02:07 Infants of mothers with anemia or other health problems may not have enough iron stored and infants born early may not get enough iron.

02:15 At 4-6 months of age, the iron stored during pregnancy is at a low level.

02:21 This can also happen due to growth spurts.

02:23 When the body goes through a growth spurt, it needs more iron for making more red blood cells.

02:30 This can also be from GI tract problems because there is poor absorption of iron and that's common after a lot of GI surgeries.

02:37 When you eat foods containing iron, most of that iron absorbed is absorbed in the upper small intestine.

02:42 Any abnormalities in the GI tract can alter the iron absorption and cause iron deficiency anemia.

02:50 Blood loss is another cause and this can decrease your iron.

02:53 This can be through GI bleeding, menstrual bleeding or injuries.

02:57 Iron deficiency anemia is observed in 2% of adolescent girls and is mostly related with their growth spurts and menstrual blood loss.

03:05 A detailed menstrual history should be obtained by the nurse and adolescent girls and underlying bleeding disorders such as von Willebrand's disease should be considered in girls who have excessive bleeding.

03:17 Here we can see the comparison of the amounts of iron in infant drinks and infant foods.

03:22 While breast milk is the preferred drink for babies, it is seriously lacking when it comes to iron.

03:28 Breastmilk only has a small amount of available iron for the baby and the amount of the iron in the breast milk is at a highest level in the first month.

03:36 The amount of iron available in breastmilk is going to dwindle over the next 5 months.

03:41 Foods are introduced to a baby around 5 to 6 months of age because this is when the baby is ready developmentally to handle and safely swallow them.

03:48 However this is also introduced because this is when iron needs to be supplemented in the diet.

03:54 So you might be wondering, what happens if a breastfeeding mother increases the iron in her diet? Well it turns out that the maternal diet does not affect the amount of iron and her breast milk, so that won't work.

04:05 Other foods given to the baby in the first 6 months can actually disrupt the absorption of iron in the breast milk so these should be given at separate meals.

04:13 Most importantly, the amount of iron present in the breast milk by around 6 months of age is not adequate.

04:20 Infants will tap into their iron stores that they stored up from their mother while in-utero to carry them through those first 6 months until they start receiving foods that are higher in iron.

04:30 According to the World Health Organization data, 98% of the iron requirement in infants ages 6 to 23 months should be met by solid foods.

04:40 Sometimes cow's milk is given to an infant at an age earlier than one year.

04:45 It's more affordable than formula and families usually already have it at home so it seems like a really easy thing to give to their baby.

04:52 But cow's milk protein can irritate the lining of the stomach in the intestine and can cause bleeding resulting in chronic blood loss.

05:00 If iron-rich foods are not introduced to an infant after 6 months when they've exhausted most of their stores, they can easily develop iron deficiency anemia.

05:09 Here you can see that rice cereal and baby foods are introduce first and the rice cereal can be mixed with breastmilk or formula.

05:17 Some groups of people may have an increased risk of iron deficiency anemia.

05:22 Adolescent females and women, and this is because they lose blood during menstruation and they're at a greater risk for iron deficiency anemia.

05:30 Infants and children.

05:31 Infants, especially those who were born at a low birthweight or born prematurely or those who are exclusively breastfed may be at risk.

05:39 Children need extra iron during their growth spurts and they can be at risk if they're picky eaters because they are not getting a variety of foods.

05:47 Vegetarians.

05:48 People who don't eat meat have a greater risk for iron deficiency anemia if they don't eat other iron-rich foods.

05:54 And finally, frequent blood donors.

05:57 People who donate blood frequently have an increased risk of iron deficiency anemia because this will deplete the iron stores.

06:03 Low hemoglobin related to their blood donation might be a temporary problem and this can be remedied by eating iron-rich foods waiting a week and trying again.

06:14 The pathology.

06:15 Regarding low iron levels, remember the patient cannot control the rate of excretion but they can only attempt to maximize their dietary intake and the absorption of what they're ingesting.

06:26 Here on the left you see a healthy red blood cell in a blood vessel.

06:30 On the right, you see a patient with iron deficiency anemia.

06:33 Now look at the cells here, they have less hemoglobin meaning they are pale or hypochromic.

06:39 There is also fewer and smaller cells and these cells are microcytic.

06:43 Remember the blood is going to deliver less oxygen to the tissues in this state.