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Year : 2017 | Volume : 5 | Issue : 4 | Page : 141 - 144  


Original Articles
A study of effect of iron on hematological status in iron deficiency anemic children

L Reshma Shireesha1, Satyanarayana B2*

1Assistant Professor Department of Physiology, Siddhartha Medical College, Vijayawada, Andhra Pradesh, India

2Professor & HOD of Physiology, Malla Reddy Medical College for Women

*Corresponding Author

Email: satyam.burra@gmail.com

Abstract:

Background: Iron Deficiency is the most widely prevalent nutritional disorder affecting the world population today. Anaemia has been described as a major health problem in the developing countries. Iron Deficiency Anaemia is readily preventable even in a profound stage by the provision of iron supplements.

Objective: The study was conducted to estimate the incidence of iron Deficiency Anaemia in school going children & to create awareness among parents and children regarding the consequences of Iron Deficiency Anaemia & to treat iron Deficiency Anaemia & to improve the IQ for better academic performance of children with iron Deficiency Anaemia.

Methods: The study was conducted over a period of 6 months. About 400 children from Indira Gandhi Municipal High School, Kurnool were examined and Only 200 out of these found suitable for the study and were given letters of information and consent. From those who responded favorably, a comprehensive data could be obtained form 100 children from proformas. A formal consent letter from the parents of each child included in the study was obtained after explaining to them the whole procedure.

Results: The strength of association between iron therapy and increase of Hb values is highly significant. The strength of association between iron therapy and increase of RBC values is highly significant. The strength of association between iron and increase of PCV is highly significant. The strength of association between iron and increase of MCV is highly significant.

Conclusion: It is concluded that iron supplementation along with iron-fortified foods in children with Iron Deficiency Anaemia improves hematological parameters significant extent. The academic performance, and physical well-being and behavioral patterns of the children were also improved.

Key words: anemia, hematological status, children

Introduction:

Anaemia means deficiency of hemoglobin in the blood, which can be caused by either too few red cells or too little hemoglobin in the cells. 1

Anaemia is a condition in which there is diminished oxygen carrying capacity of the blood as a result of reduction in total circulated hemoglobin or reduction in red cell mass.

Iron Deficiency is the most widely prevalent nutritional disorder affecting the world population today, 2 particularly pregnant and lactating mothers, infants, young children and adolescent girls. 3. Prevalence is disproportionately high in developing countries due to poverty, inadequate diet and poor access to health services. According to the nutrition Foundation of India, 90% of adolescent girls, women and children suffer from iron Deficiency. 3 1/5th Adolescent of the worlds population and in India they account for 22.8% of the total population. 4

Adolescence is the most vulnerable phase of life. The nutritional requirements of adolescent are influenced primarily by the normal event of puberty and simultaneous spurt of growth. Puberty is an intense anabolic period with increase in height and weight, 4 associated with high iron requirement for growth and development accompanied by expansion of blood volume, muscle mass, natural loss of blood in girls and increased demands with the onset of pregnancy. 5

Anaemia has been described as a major health problem in the developing countries, 6 in Indian children, a high prevalence of anaemia varying from 27%-90% have been reported in different studies 7, 8 with iron Deficiency Anaemia being the most commonest cause 9 Anaemia prevalence was more among girls of low weight and height and 8 times more when compared to those who were heavier, taller and having higher Body Mass Index. The peak incidence of iron Deficiency occurs in adolescents of 11-17 years age group. 5

Anemia prevalence being than 30 percent in adolescents (10-19 years) who constitute more than 20 percent of our Indian population and more than 50 percent suffer from Iron Deficiency Anaemia. Both urban and rural children suffer from Anaemia and chronic energy deficiency, being more in girls than boys. 5

Iron Deficiency can be corrected with dietary management. Iron is present in green leafy vegetables, cereals, pulses i.e. grams, grains and greens, molasses, eggs , meat , etc and cooking in iron pots is also beneficial.

Iron Deficiency Anaemia is readily preventable even in a profound stage by the provision of iron supplements. The study was conducted to estimate the incidence of iron Deficiency Anaemia in school going children & to create awareness among parents and children regarding the consequences of Iron Deficiency Anaemia & to treat iron Deficiency Anaemia & to improve the IQ for better academic performance of children with iron Deficiency Anaemia.

Methodology:

The study was conducted over a period of 6 months. About 400 children from Indira Gandhi Municipal High School, Kurnool were examined and Only 200 out of these found suitable for the study and were given letters of information and consent. From those who responded favorably, a comprehensive data could be obtained form 100 children from proformas. A formal consent letter from the parents of each child included in the study was obtained after explaining to them the whole procedure.

Malnutrition was ruled out by excluding those children whose height was less for age. Out of 100, only 60 students co-operated for hematological investigations.

Hematological and anthropometric parameters were recorded before starting the therapy. The children with (Hb) < 10 g/dl were assigned to the anemic group and those with (Hb)>g/dl was assigned to the control group. Both the groups of the children were given Albendazole 400 mg single dose therapy starting the study and both groups also received Ascorbic acid 100 mg OD therapy for the 120 days of the study period. Iron Deficiency Anaemia is confirmed by peripheral smear.

There were 20 boys and 40 girls in the study. The analysis of the boys and girls was done separately. In boys there were 08 anemic and 12 control children and in the girls there were 22 children in the anemic and 18 in the control group. Totally 8 boys and 22 girls (30) received iron therapy. Thereafter all children are monitored for clinical response and adverse effects. A detailed history was taken from all the children and a complete physical examination with measurement of hematological & anthropometric parameters was done at the time of recruitment.

After one month, there was noticeable improvement in academic performance, behavioral and hematological and anthropometric parameters in a good number of children.

Statistical analysis was done by: Odds test, Student t test and by mean values.

Results:

Table 1: Distribution of Hb values after iron Therapy

Hb improved

Hb not improved

Total

Anemic group

22

8

30

Control group

9

21

30

Total

31

29

60

The value of Odds ratio is 6.42 and hence the strength of association between iron therapy and increase of Hb values is highly significant as Hb content is raised after iron therapy. Hence the iron therapy is suggested for those children with IDA

Table 2: Distribution of RBC values after iron Therapy

RBC improved

RBC not improved

Total

Anemic group

19

11

30

Control group

9

21

30

Total

28

32

60

The value of Odds ratio 4.03 and hence the strength of association between iron therapy and increase of RBC values is highly significant as RBC count is raised after iron therapy in IDA group. Hence the iron therapy is suggested for children with iron Deficiency

Table 3: Distribution of PCV values after iron Therapy

PCV improved

PCV not improved

Total

Anemic group

22

8

30

Control group

12

18

30

Total

34

26

60

The Value of Odds ratio 4.13 and hence the strength of association between iron and increase of PCV is highly significant as PCV is raised after iron therapy in anemic group children. Hence the iron therapy is suggested for children with iron Deficiency.

Table 4: Distribution of MCV values after iron Therapy

MCV improved

MCV not improved

Total

Anemic group

25

5

30

Control group

20

10

30

Total

45

15

60

The Value of Odds ratio 2.50 and hence the strength of association between iron and increase of MCV is highly significant as MCV is raised after iron therapy. Hence the iron therapy is suggested for children with iron deficiency.

Table 5: Distribution of MCV values after iron Therapy

MCH improved

MCH not improved

Total

Anemic group

24

6

30

Control group

17

13

30

Total

41

19

60

The value of Odds ratio is 3.06 and hence the strength of association between iron and increase of MCH is highly significant and MCH is raised after iron therapy. Hence the iron therapy is suggested for children with iron deficiency

Table 6: Comparison of outcome in both the groups

Anemic group

Control group

Parameter

improved

Not improved

improved

Not improved

OR

  1. Hb

22

8

9

21

6.42

2.RBC

19

11

9

21

4.03

3.PCU

22

8

12

18

4.13

4.MCV

25

5

20

10

2.5

5.MCH

24

6

17

13

3.06

Discussion:

In the present study, the study sample consists of 60 children of age group between 12 and 15 years. Out of which 30 children belong to anemic group and 30 children belong to anemic group and 30 children belong to control group.

The results of the present study show that the hematological and anthropometric parameters are low in the anemic children as compared to their controls. More significance is found in demagogical parameters in anemic children followed by iron therapy and Vitamin-C supplementation for a period of 4 months consequent to deworming. Comparative to boys, girls had less significance due to their physiological menstrual loss. For both, few anthropometric parameters had less significance due to the non compliance between their developmental demands and supply of iron. The control children also benefited from deworming and Vitamin – C therapy.

A study on Swiss Webster mice to see the effects of marginal ID showed a reduction in grip strength, a significant lowering of body weight and a reduction in the iron levels in the liver and brain of these animals. It was suggested that chronic marginal ID during periods of growth could result in functional changes in the motor development even in the absence of Iron Deficiency Anaemia. Alteration in the mineral status and Oxidative stress are the mechanisms contributing to the observed changes. 10

The boys anemic children have shown improved hematological parameters than the girl children with supplementation of iron therapy the reason is that there is physiological growth and pubertal changes and menstrual blood loss resulting into less significant improvement than the boys.

Topaloglu et al 11, studied the correlation between plasma leptin levels and appetite in ID children. Following iron treatment, both the appetite scores and food increased significantly as did the serum ferritin levels but there was a lack of association between plasma leptin and the degree of appetite suggesting a leptin independent mechanism for the observed increase in the appetite. Increased hemoglobin resulting from enhanced food availability of iron in conjunction with increased appetite was observed in anemic rats provided with ad libitum diet supplemented with lyophilized chicken essence rich in iron. 12

Rozenweig et al have suggested that Iron Deficiency Anaemia and iron depletion both cause physiological changes in the body during exercise and the resting conditions. The nor epinephrine levels in the blood and urine of the iron deficient anemic subjects are elevated and the metabolic rate also increased leading to slower growth rates and lower body weights of Iron Deficiency Anaemia subjects. An adverse hormonal profile effects the growth in Iron Deficiency / Iron Deficiency Anaemia. 13

Campos MS et al 14 observed that Iron Deficiency produces stress as evidenced by enhanced cortisol levels in the serum of rats. High parathormone levels and demineralization was alone seen. Iron Deficiency Anaemia has been shown to alter thyroid metabolism with goitrous ID children showing improved responsiveness to iodine after iron supplementation. 15

The hyper adrenergic state consequent to Iron Deficiency Anaemia in hypothyroid individuals causes intolerance to them to thyroxin administration as evidenced by nervousness, palpitations and restlessness. This was corrected after iron supplementation. 16

The impairment in brain biochemistry and neurotransmitter production and function, cognitive function, motor activity, thermoregulation, endocrine system dysfunctions and immune system dysfunctions are major consequences of Iron Deficiency. 17

Conclusion:

It is concluded that iron supplementation along with iron-fortified foods in children with Iron Deficiency Anaemia improves hematological parameters significant extent. The academic performance, and physical well-being and behavioral patterns of the children were also improved.

References:

  1. Arthur C. Guyton, M.D: Text book of Medical Physiology – 11th Edition: Unit VI: Chapter 32: Pg-421, Fig -32.3.
  2. Indu Khurana – Textbook of Medical Physiology – Ch 3.2. pg. 164.
  3. The Hindu: Anaemia Free India Friday, July 01, 2005.
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  11. Topaloglu AK, Hallioglu O, Canim A, Duzovali O, Yilgor E. Lack of association between plasma leptin levels and appetite in children with iron deficiency. Nutrition 2001;17(7-8):657-659.
  12. Geissler C, Boroumand – Nani M, Harada M, Iono T, Hirai K, Suwa Y, Tanaka T, Iwata S. Chicken extract stimulates hemoglobin restoration in iron deficient rats . Int J Food Sci Nutr 1996;47(4):351-360.
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  14. Campos MS, Barrionuevo M, Alferez MJ, Gomez –Ayala AE, Rodriguez –Matas MC, Lopez Aliaga I, Lisbona F. Interactions among iron calcium, phosphorous and magnesium in the nutritionally iron deficient rat . Exp Physiol 1998;83(6):771-81.
  15. Zimmermann M, Adou P, Torresani T, Zeder C, Hurrell R. Iron supplementation in goitrous iron deficient children improves their response to oral iodized oil. Eur J Endocrinol 2000;142(3):217-223.
  16. Shakir KM, Turton D, Aprill BS, Drake AJ, Eisold JF. Anaemia: a cause of intolerance to thyroxin sodium. Mayo Clin proc 2000;75(2)189 192.
  17. Youdim MB, Yehuda S. The neurochemical basis of cognitive deficits induced by brain iron deficiency: involvement of dopamine opiate system. Cell Mol Biol 2000;46(3):91-500




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