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Iron-deficiency Anemia: Signs and Diagnosis (Pediatric Nursing)

by Paula Ruedebusch

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    00:01 These are the most common signs and symptoms of iron deficiency anemia.

    00:05 The patient's going to look pale.

    00:07 They may be irritable or fussy, and they're gonna lack energy and tire easily.

    00:12 Maybe this patient was previously active and now they're laying around, they just don't want to go run and play.

    00:18 Tachycardia or a fast heartbeat.

    00:21 The heart rate is gonna increase to try to distribute the oxygen around.

    00:24 There are less red blood cells and each has less oxygen carrying capacity so the body's gonna compensate by increasing the heart rate to deliver the blood and oxygen to the tissues.

    00:35 A sore or swollen tongue, this is called glossitis.

    00:38 Low levels of iron are gonna lead to low levels of myoglobin which is a substance in the blood that plays a role in muscular health including the tongue.

    00:47 An enlarged spleen, and something called PICA, Now this is when a patient wants to eat items without nutritional value such as dirt or ice and the reason for this is unclear.

    00:58 when a patient presents with these symptoms, they should be evaluated for iron deficiency anemia as a possible cause.

    01:05 So in most cases anemia is diagnosed with pretty simple blood test.

    01:09 Routine anemia screening by checking the hemoglobin level is done because this condition is so common in children and they're often asymptomatic.

    01:18 The American Academy of Pediatrics recommends anemia screening with a hemoglobin blood test for all infants at 12 months of age in addition to performing a risk assessment.

    01:28 The risk assessment questions try to identify patients with risk factors for iron deficiency anemia including children with feeding problems, poor growth and children with special healthcare needs.

    01:40 If the hemoglobin level is low in the initial screening, then more follow-up tests are done.

    01:46 This includes a CBC - a complete blood count, and this is gonna check the red and white blood cells, The blood clotting cells which are the platelets, young red blood cells called reticulocytes, the hemoglobin, hematocrit and there will be a differential if indicated.

    02:01 A peripheral smear - this is a small sample of blood that's gonna be loked at under a microscope.

    02:05 Blood cells arechecked to see if they have a normal size, shape and color.

    02:10 Iron studies - blood tests can be done to measure the amount of iron in your child's body.

    02:15 Here are the components to the CBC or the complete blood count: You'll see a total red blood cell count, a white blood cell count including the differential, the platelet count, the reticulocyte distribution width and that's gonna measure the variation in the red blood cell size.

    02:32 This is called the RDW and it's usually elevated in patients with iron deficiency anemia because their body is constantly trying to churn out more cells.

    02:41 You'll see the hematocrit and this is the ratio of the volume of blood cells to the total volume of blood.

    02:46 And finally the hemoglobin - this is the protein responsible for transporting oxygen and iron.

    02:52 Next you'll see the the calculation of the red blood cell indices.

    02:56 First it starts with the mean cell volume and that's the cell size.

    03:00 You also have the ratio of the mean cell hemoglobin concentration and then the mean cell hemoglobin.

    03:07 When we're looking at iron deficiency anemia, we're really looking at the MCV - the size and the MCH which is the color.

    03:15 Part of this includes the peripheral smear and all these red blood cell indices.

    03:20 Cells can be a normal size which is normocytic, too large which is macrocytic or too small which is microcytic and the cells can also have different levels of hemoglobin so a normal cells gonna be normochromic or they can have two little hemoglobin which is hypochromic.

    03:35 There is no such thing as a red blood cell with too much hemoglobin.

    03:40 So here on the left on the normal peripheral smear, you're gonna see normal size - these are normocytic.

    03:47 You're also gonna see a normal color so these cells are normochromic.

    03:52 On the right, you see a patient smear with severe iron deficiency anemia.

    03:57 Now there's different characteristics when you look at these cells.

    03:59 Remember they're going to be smaller than normal so they're microcytic and they're gonna be a pale cells because they don't have enough hemoglobin, so they're hypochromic, and there's also going to be a change in the variation of the size so anisocytosis means there's a huge variation the size bigger than normal and poikilocytosis means they're variable in shape.

    04:23 Next you're gonna do an iron panel.

    04:25 And the iron level, the total iron levels gonna tell you the amount of iron carried by transferrin.

    04:31 Next you'll see the ferritin level and and this is the amount of stored iron.

    04:35 The patient can have an artificially high ferritin in the setting of an infection, late- stage cancer, severe inflammation and alcoholism.

    04:44 You'll also see the transferrin level and remember transferrin is the transfer protein and this is gonna be produced by the liver.

    04:52 When patients have liver dysfunction, they're going to make less transferrin.

    04:56 And last we have the total iron binding capacity and this is the measure of proteins available for binding iron.

    05:03 If a patient has low iron levels, they're gonna have no more proteins and docking sites available for binding.

    05:11 Now let's compare the blood.

    05:13 Here on the left, there's a normal patient they're gonna have a normal total iron binding capacity or TIBC and they're also gonna have normal levels of their serum iron, serum ferritin and transferrin.

    05:25 On the right, we see a patient with iron deficiency anemia.

    05:29 They're gonna have a high TIBC or total iron binding capacity because these sites are open and they're just ready to capture the iron.

    05:37 They're gonna have a low serum iron, they're gonna have low serum ferritin because they don't have any iron stored up and a low transferrin.

    05:45 So these are the diagnostics, remember we're gonna do a CBC and the characteristics of iron deficiency anemia are a low MCV.

    05:53 So these are microcytic cells, they're small, they have a small volume a low hemoglobin and a high RDW.

    06:01 Next you'll do the blood smear and you're gonna see this microcytic hypochromic anemia and in severe cases, you'll see the poikilocytosis.

    06:09 And you're gonna look at biochemical indices which is your iron panel and these patients will have decreased serum iron, decreased transferrin decreased iron stored which is thir ferritin and an increased total iron binding capacity waiting to capture more iron.


    About the Lecture

    The lecture Iron-deficiency Anemia: Signs and Diagnosis (Pediatric Nursing) by Paula Ruedebusch is from the course Blood Disorders – Pediatric Nursing. It contains the following chapters:

    • Signs and Symptoms
    • Labs to Evaluate

    Included Quiz Questions

    1. Pale skin
    2. Increased appetite
    3. Irritability or fussiness
    4. Fast heartbeat
    5. Enlarged spleen
    1. 12 months
    2. 24 months
    3. 6–9 months
    4. 5 years
    1. Anisocytosis (variation in size)
    2. Poikilocytosis (variation in shape)
    3. Microcytic and hypochromic red blood cells smaller than the nucleus of a lymphocyte
    4. Microcytic (small)
    5. Hypochromic (pale)
    1. Human parvovirus B19
    2. Infections by Streptococcus viruses
    3. Epstein-Barr virus
    4. Salmonella
    5. Escherichia coli
    1. Iron level
    2. Ferritin
    3. Transferrin level
    4. Hematocrit

    Author of lecture Iron-deficiency Anemia: Signs and Diagnosis (Pediatric Nursing)

     Paula Ruedebusch

    Paula Ruedebusch


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