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Lahari N and Bharathi M: Morphological pattern based analysis of anemia in paediatric age group


Introduction

Anemia is a major problem affecting all age groups across the world. Anemia is a clinical condition in which there is decreased red blood cell count and hemoglobin levels.1 Anemia is prevalent in about one fourth population of the world.2 Anemia plays an important role in morbidity and mortality among children.3 Anemia is a manifestation and not a disease per se. Malnutrition is the most common cause of anemia among children. Nutritional anemia due to iron deficiency, vitamin B12 or folic acid deficiency and hookworm infestation can be easily prevented and treated.4 Routine investigations like complete blood count and Peripheral smear are useful to investigate case of anemia.

Materials and Methods

The study was conducted on 200 cases among children aged between 6 months and 5 years who were referred to Hematology laboratory, department of Pathology at Mysore medical college and research institute for a duration of 3 months.

The anticoagulated blood samples were analyzed by an automated counter Sysmex XN 1000. RBC parameters like RBC count, Hemoglobin, Hematocrit, Mean cell volume, Mean cell hemoglobin, Mean cell hemoglobin concentration and Red cell distribution width were studied.

Results

The cases were in the age group between 6 months and 5 years. A total of 200 cases with hemoglobin less than 11g/dl were included in the Prospective study group.

Table 1
Morphology No.of Cases Percentage
Normocytic normochromic anemia 41 20.5%
Normocytic hypochromic anemia 38 19%
Microcytic hypochromic anemia 102 51%
Macrocytic anemia 4 2%
Dimorphic anemia 15 7.5%

The following patterns were observed:

Table 2
Gender No of cases
Male 116
Female 84

Sex wise distribution of anemia

Table 3
Morphology Our study RathnaS5 et al study
Normocytic normochromic anemia 20.5% 55%
Normocytic hypochromic anemia 19% 11%
Microcytic hypochromic anemia 51% 27%
Macrocytic anemia 2% 4%
Dimorphic anemia 7.5% 3%

Comparison of morphological types of anemia

116 cases (58%) were males and 84 cases(42%) were females. So majority of the males were affected by anemia (Table 2 ) and is similar to the study conducted by Gombur.5

Our study results are compared with study done by Rathna S6 et al. The commonest morphological type observed was Microcytic hypochromic anemia (51%) followed by Normocytic normochromic anemia (20.5%) as shown in (Table 3)

The anemia was subtyped again based on the morphology as shown in (Table 1). The morphological categories given were

  1. Normocytic normochromic anemia (NCHC)

  2. Normocytic Hypochromic anemia (NHA)

  3. Microcytic hypochromic anemia (MCHC)

  4. Macrocytic anemia (MA)

  5. Dimorphic anemia (DA)

Discussion

Anemia has high prevalence in preschool children. The most common cause of anemia in Paediatric age group is Iron deficiency anemia which is associated with Microcytic hypochromic pattern. So supplementing with iron tablets and syrups, iron rich diet will prevent and treat the cause.7

In these days due to modern lifestyle people are prone to nutritional anemia. The most common types of anemia are Microcytic hypochromic anemia (63%) followed by Normocytic normochromic anemia (24%), Normocytic hypochromic anemia (9%), and Dimorphic anemia8

Approximately 50% of the population suffers from nutritional anemia as known in countries where meat consumption is low9

In our study male were more affected than female children. This is similar to studies conducted by Roosy Aulakh, et al10 included 151 children with 106(70.2%) boys and 45(29.8%) girls.

Conclusion

Anemia is a major health issue among children as it is associated with delayed milestones, recurrent illness, increased mortality and morbidity.

Routine screening programs using cost effective basic blood parameters are useful to detect and treat anemia among vulnerable children.

Study of morphology is useful to know the causative factors and hence provides information to prevent and treat anemia.

Special investigations like serum iron profile, vitamin B12 & folic acid assays are useful for further workup to diagnose nutritional anemia. Suitable investigations like Hemoglobin electrophoresis and bone marrow study are useful to confirm the diagnosis and to guide treatment.

Source of Funding

None.

Conflict of Interest

None

References

1 

N J Kassebaum R Jasrasaria M Naghavi A systematic analysis of global anemia burden from 1990 to 2010Blood20141235615624

2 

M S Leite A M Casdoso Jr C Ea Coimbra Prevalence of anemia and associated factors among indigenous children in Brazil; Results from the First National Survey of Indigenous People's Health and NutritionNutr J20131269

3 

R K Singh S Patra Extent of Anemia among Preschool children in EAG states, India: A challenge to Policy makersAnemia2014201441

4 

Chen Awu L Respirance H Birnstein Screening for Iron deficiencyPed Rev2002235171177

5 

Sunil Gombur Bhawana Nishi Madan Avtarlal Prevalence and etiology of nutritional anemia among school children of urban slumsIndian J Med Res2003118167171

6 

S Rathna J Venkatraman Govindarajl . Study of Morphological Pattern of Anemia in childrenJEMDS201432775407543

7 

K H Kamil N S Mohammad A laboratory study of Anemia in children Aged 6 months to 6 years in Erbil CityMed J Babylon2014112274284

8 

G Suba Shradha Ambekar H T Jayaprakash Anemia in children - A hospital based studyIntJ Curr Res Aca Rev201537307311

9 

L Allen B O De Benoist R Dary - Hurrell Guidelines on food fortication with micronutrients2006Geneva,Switzerland

10 

R Aulakh Adolescent Anemia: Risk FactorsInt J Pediatr Res201637478479



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