Acute Anemia in Children

Acute Anemia in Children

Etiology

Three factors have been implicated as causal for acute anemia in children. These are loss of red blood cells (RBCs), decreased or lowered production of RBCs, and widespread destruction of red blood cells.

Epidemiology

The global prevalence of pediatric anemia is approximately 41%. In the U.S., the prevalence of anemia for all preschool children is 8.1% (Li et al., 2020). The incidence of anemia among children was higher in females than in males.

Pathophysiology

The pathophysiology of anemia varies and depends on the disease’s causal factor. Increased destruction of RBCs results from blood loss, as seen in acute hemorrhage. Lowered production of RBCs also results in anemia since the RBCs produced are not proportional to systemic requirements. Such is the case with Vitamin B12 deficiency (Chaparro & Suchdev, 2019).

Clinical Manifestations

A child with acute anemia will present pallor, fatigue, anorexia, dizziness, and lethargy. Coldness of extremities may also be present. Tachycardia and breathlessness are an indication of severe disease.

Work-up

Complete blood count (CBC), reticulocyte count, and a peripheral smear are required to evaluate anemia (Wang, 2016).

Nonpharmacological 

Dietary modification to include iron-rich foods and supplements can alleviate the symptoms of the disease. Such foods include seafood, red meat, beans, and iron-fortified cereals. Blood transfusion, stem cell transplants, and surgery to remove the spleen are other nonpharmacological measures to manage anemia.

Pharmacological management

Methylprednisolone is given to children with hemolytic disease. Oral iron preparations can be used to treat the disease. Iron preparations include ferrous sulfate, ferrous gluconate, ferrous succinate, and ferrous fumarate.

Education

Children’s parents and guardians should be educated on foods rich in iron and vitamin C. Those on oral supplements should be told that they may pass black tarry stool.

Follow-up 

All patients with unclear etiologies should be followed up to rule out malignancies. Screening for sickle cell disease may also be warranted, especially where the genetic propensity is unknown.

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Link to Guidelines:

American Academy of Family Physicians (AAFP): Iron Deficiency and Other Types of Anemia in Infants and Children

 

 References

Chaparro, C., & Suchdev, P. (2019). Anemia epidemiology, pathophysiology, and etiology in low‐ and middle‐income countries. Annals Of The New York Academy Of Sciences. https://doi.org/10.1111/nyas.14092

Li, H., Xiao, J., Liao, M., Huang, G., Zheng, J., & Wang, H. et al. (2020). Anemia prevalence, severity and associated factors among children aged 6–71 months in rural Hunan Province, China: a community-based cross-sectional study. BMC Public Health, 20(1). https://doi.org/10.1186/s12889-020-09129-y

WANG, M., 2016. Iron Deficiency and Other Types of Anemia in Infants and Children. [online] Aafp.org. Available at: <https://www.aafp.org/pubs/afp/issues/2016/0215/p270.html> [Accessed September 8, 2022].

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Discuss Etiology, Epidemiology, Pathophysiology, Clinical Manifestations, Work-up, Nonpharmacological and Pharmacological Management, Education, and Follow-up for a pediatric diagnosis or care consideration. Five hundred words or less for the initial post. Add second and third-line treatments and additional considerations for peer and subsequent posts under the initial discussion board thread (250 words maximum for responses). For example, requirement: only evidence-based sources, such as AAFP, CDC, IDSA, ADA, JNC 8, etc. (textbook resources and internet sites affiliated with medical associations are considered credible sources to obtain the most up-to-date guidelines). ADD THE LINK to the guidelines WITHIN the discussion board for further reading by your peers.

Length: A minimum of 250 words, not including references
Citations: At least one high-level scholarly reference in APA from within the last five years
MY TOPIC IS ACUTE ANEMIA IN CHILDREN
Please, no acute gastroenteritis. My classmate did it already. Thank you.
EXAMPLE
ACUTE OTITIS MEDIA (AOM)

Etiology: Acute Otitis media is a multifactorial disease. Infectious, allergic, and environmental factors contribute to otitis media.

A.Bacterial in origin: Streptococcus pneumonia, Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pyogenes (Danishyar & Ashurst, 2022).

B: Viral in origin: Respiratory syncytial virus (RSV), coronaviruses, influenza viruses, adenoviruses, human metapneumovirus, and picornaviruses (Danishyar & Ashurst, 2022).

C: Other risk factors:

Age, which is more common for younger than two.
Pediatric patients who are bottle-propping and using pacifiers in infants six months and above are more likely to have AOM than pediatric patients who are breastfed.
Pediatric patients who attend daycare have low socioeconomic status and crowded living conditions, and pediatric patients who are living with a smoker in the household (Meadows-Oliver & Banasiak, 2021).
Genetic predisposition can also be a contributing factor, including patients with anatomic abnormalities of the palate and other immune deficiencies.
Epidemiology: Acute Otitis Media is one of the most common pediatric diagnoses for children under 5 in the United States. It is a slightly higher incidence in boys than girls (Meadows-Oliver & Banasiak, 2021).

Pathophysiology: AOM is an acute inflammation or infection of the middle ear. The children have a higher risk because the eustachian tube is narrower, straighter, shorter, and more proximal to the adenoids than adults and older children. Eustachian tube dysfunction (ETD) leads to obstruction and inflammation, decreasing protective ciliary action (Burns et al., 2017).

Clinical Manifestation:

Pediatric patients with a history of rapid onset ear pain for older children, ear pulling noted in infants or toddlers, and fever may or may not be present.
Pediatric patients usually have irritability, disturbance of sleeping patterns, excessive crying, and feeding difficulties.
Pediatric patients might also have signs and symptoms of Upper respiratory infections (Cash et al., 2021).
Diagnostic Tests:

Pneumatic Otoscopic examination is usually the first and most convenient diagnosing method. On physical findings, the tympanic membrane can show signs of inflammation, including bulging TM, possible purulent middle ear effusion, and poor mobility of TM (Meadows-Oliver & Banasiak, 2021).
Culture and sensitivity may help diagnose a causative agent and determine the correct line of therapy. Consider a complete blood count if the patient appears toxic with a high fever ( Cash et al., 2021).
Nonpharmacological Treatment:

For older children, a cold or warm compress can be beneficial in relieving pain.
Hand hygiene is important to the caregiver in caring for the children, and ensuring children do not put their hands inside their ears can cause further bacterial infections.
Encouraging breastfeeding would be beneficial to increasing the immune system, while avoiding bottle-propping would be vital.
Preventive measures like vaccinations against pneumonia and influenza are recommended for all children.
Providing tobacco-free living spaces and altering childcare management for those caregivers with current respiratory infections could lessen patient exposure.
Pharmacological Treatment: Once acute otitis media diagnoses are established, treatment goals are to control pain and treat the infectious process with antibiotics.

American Academy of Pediatrics (AAP) has set forth guidelines for the use of antibiotics. Treat patients with oral antibiotics and analgesics for patients who have bilateral AOM in children 6-23 months of age without severe signs or symptoms; bilateral or unilateral AOM with severe signs or symptoms in children six months and older; otalgia for at least two days; and fever of 102.2-degree Fahrenheit or higher (Lieberthal et al., 2013).

Drug of choice: Amoxicillin 90 mg/kg/day divided into two doses.

Beta-lactam coverage (amoxicillin/clavulanate, third-generation cephalosporin): If a child received amoxicillin within the previous 30 days or has recurrent OM and did not respond with amoxicillin, has coexisting purulent conjunctivitis, or allergic to penicillin. If allergic to penicillin, erythromycin-sulfisoxazole can also be given (Meadows-Oliver & Banasiak, 2021).

Ceftriaxone 50 mg/kg intramuscularly may be effective for vomiting in children unable to tolerate oral medications or with failed treatment from amoxicillin/clavulanate (Cash et al., 2021).

Analgesics and antipyretics: acetaminophen, ibuprofen, or topical anesthetic eardrops if necessary.

Education: Holding off antibiotics when signs and symptoms are not severe, including unilateral AOM in children 6-23 months and bilateral or unilateral AOM in children two years older (Lieberthal et al., 2013). The patients can be observed, close follow-up, and start a patient on analgesics. Moreover, educate parents that antibiotics can be initiated if symptoms worsen or fail to improve in 2-3 days.

Follow-Up: It is empirical in children younger than three months; patients should be followed up in 1 to 2 days. Scheduling a follow-up appointment for 1 to 2 months to evaluate for otitis media with effusion (OME). Thus, this case usually resolves within three months. In this case, it does not need any antibiotics (Burrows et al., 2013).

Pediatric consideration: Ensuring the continuation of an entire course of antibiotics, even if symptoms subside, to decrease antibiotic resistance. For a child younger than two years of age, treatment with amoxicillin/amoxicillin/clavulanate for ten days and therapy for five or seven days for children older than two (Burns et al., 2017).

American Academy of Pediatrics (AAP): The Diagnosis and Management of Acute Otitis Media | Pediatrics | American Academy of Pediatrics (aap.org)

References

Burns, C. E., Blosser, C. G., Brady, M. A., Dunn, A. M., Garzon, D. L., & Starr, N. B. (2017). Pediatric primary care. Elsevier.

Cash, J. C., Glass, C. A., & Mullen, J. (2021). Family practice guidelines (Fifth). Springer Publishing Company.

Danishyar, A., & Ashurst, J. V. (2022, January 1). Acute otitis media. National Center for Biotechnology Information. Retrieved September 4, 2022, from https://pubmed.ncbi.nlm.nih.gov/29262176/

Lieberthal, A. S., Carroll, A. E., Chonmaitree, T., Ganiats, T. G., Hoberman, A., Jackson, M. A., Joffe, M. D., Miller, D. T., Rosenfeld, R. M., Sevilla, X. D., Schwartz, R. H., Thomas, P. A., & Tunkel, D. E. (2013, March 1). The diagnosis and management of Acute Otitis Media. American Academy of Pediatrics. Retrieved September 4, 2022, from https://publications.aap.org/pediatrics/article/131/3/e964/30912/The-Diagnosis-and-Management-of-Acute-Otitis-Media?autologincheck=redirected%3FnfToken

Meadows-Oliver, M., & Banasiak, N. (2021). Pediatric practice guidelines. Springer Publishing.