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Treatment of iron deficiency anemias - Practical hematology of children's age

Table of contents
Practical hematology of children's age
Embryonal hemopoiesis
Morfofunktsionalny characteristic of cells of marrow and peripheral blood
Marrow parenchyma cells
Peripheral blood of children of different age
The system of a hemostasis is normal
Etiology and pathogeny of leukoses
Acute leukoses
Acute leukoses - a preleukosis
Possibilities of a predictive assessment of a course of an acute lymphoblastoid leukosis at children
General principles of treatment of an acute leukosis
Chemotherapeutic drugs
Treatment of an acute lymphoblastoid leukosis
Treatment of myeloid forms of an acute leukosis
Infectious complications and symptomatic therapy of an acute leukosis
Consolidation and maintenance therapy of an acute leukosis
Immunotherapy
Remission and recurrence of an acute leukosis
Inborn leukosis
Neuroleukosis
Myelosis
Lymphogranulomatosis
Gematosarkoma
Macrofollicular lymphoma
Angioimmunoblastny lymphadenopathy
Leukemoid tests
Infectious lymphocytosis
Infectious mononucleosis
Leukemoid tests of different types
Dysfunctions of granulocytes
Leukopenias
Histiocytoses
Histiocytoses - an eosinophilic granuloma
Malignant histiocytosis
Family erythrophagocytal histiocytosis
Accumulation diseases
Nimann's illness — Peak
Angiopathies
Hemorrhagic vasculitis (Shenleyn's illness — Genokh)
Mayokki's purpura
Ataxy teleangiectasia
Entsefalotrigeminalny angiomatosis
Kortiko-meningealny diffusion angiomatosis
Cerebroretinal angiomatosis
Hypertrophic gemangiektaziya
Multiple and huge hemangiomas
Elastic fibrodisplaziya
Coagulopathies
Hereditary coagulopathies
Hemophilia And
Clinic of hemophilia
Treatment of hemophilia
Angiohemophilia
Cristmas disease (Kristmas's illness)
Hereditary deficit of factors of XI, XII, XIII and I
Dysfibrinogenemias
Hereditary deficit of factors of VII, X, V and II
Deficit K-vitaminozavisimykh of factors of coagulation
Syndrome of the disseminated intravascular coagulation
Clinic and diagnosis of the IDCS
Treatment of the IDCS
Thrombocytopenia
Idiopathic Werlhof's disease
Clinic and diagnosis of an idiopathic Werlhof's disease
Treatment of an idiopathic Werlhof's disease
Isoimmune Werlhof's disease
Transimmune Werlhof's disease of newborns
Trombogemolitichesky Werlhof's disease (syndrome Moshkovich)
Hereditary Werlhof's diseases
Trobotsitopatiya
Anemias
The anemias connected with blood loss
Chronic posthemorrhagic anemia
Iron deficiency anemias
Clinic and diagnosis of an iron deficiency anemia
Treatment of iron deficiency anemias
Sideroakhrestichesky, sideroblastny anemias
Megaloblastny anemias
Foliyevodefitsitny anemia
Hereditary forms of megaloblastny anemias
Hereditary dizeritropoetichesky anemias
The anemias connected with oppression of proliferation of cells of marrow
Hereditary hypoplastic anemias
Hemolitic anemias
Hemolitic anemias - an ovalocytosis, a hereditary stomatocytosis
Acanthocytosis, piknotsitoz
The hereditary hemolitic anemias connected with disturbance of activity of enzymes of erythrocytes
The hereditary hemolitic anemias connected with disturbance of structure or synthesis of hemoglobin
The acquired immune hemolitic anemias
Isoimmune hemolitic anemias
Treatment of a hemolitic illness of newborns
Autoimmune hemolitic anemias
List of references

Treatment of iron deficiency anemias when performing all complex of necessary actions in most cases can be carried out in out-patient conditions. Etiological treatment provides elimination of the reasons leading to development of a hyposiderosis. Important links of complex therapy are the correct organization of the mode and food. Especially it concerns children of early age. An effective treatment-and-prophylactic measure is long stay in the fresh air. It is important to carry out hydrotherapeutic procedures, massage, gymnastics. The good nutrition is of great importance. It is necessary to eliminate the available defects of feeding and to appoint a balanced diet, on the main food ingredients corresponding to age indicators. The children having anemia need to enter the first feeding up on 2 — 4 weeks earlier, than healthy. The dishes rich with iron salts shall be the first feeding up: potatoes, beet, carrots, cabbage, vegetable marrows, etc. The food allowance has to include fruit and berry juice, grated apples. Already with the first feeding up to the children sick with anemia, it is possible to give calf's or beef liver. Children reluctantly accept hepatic dishes therefore they need to be given in the wiped look, mixing with vegetable or fruit purees. Since 6 months, it is possible to enter meat dishes in the form of forcemeat into a food allowance. It is necessary to remember that the gemovy iron which is contained in meat dishes is best of all soaked up in a digestive tract. The salt iron which is a part of vegetables and fruit is much worse acquired. These moments need to be considered at creation of a diet at children of advanced age.
Pathogenetic therapy of an iron deficiency anemia includes iron preparations, one of them apply inside, others — enter parenterally. In most cases, except special indications, treatment of iron deficiency anemias is carried out by drugs for internal use. It is the most reasonable to use the drugs containing the bivalent iron which is a part of sulfate or a lactate. These connections are well soaked up and give high rate of a gain of hemoglobin. At the choice of drug for children of early age it is necessary to consider degree of toxicity and a form of release. The preference is given to drugs in a liquid form. Now consider inexpedient to wash down iron preparations with Acidum hydrochloricum. At the same time medicine should be taken on an empty stomach, it promotes the best absorption of iron. At reception after food iron absorption sharply decreases and, besides, it is partially spent for formation of insoluble compounds with food components. The iron preparations which found a wide clinical use is the following.
Ferrocalum — domestic drug, let out in tablets, contains 0,2 g of ferrous sulfate (44 mg of iron), 0,1 g of calcium of fructose diphosphate and 0,02 g of a tserebroletsitin. Drug has high therapeutic effect and is well transferred.
Ferroplexum — is let out in Hungary and Yugoslavia. Contains 0,05 g of ferrous sulfate (11 mg of iron) and ascorbic acid which improves iron absorption. Drug is well transferred. Small content of iron is convenient for a dosage to children of early age.
Con F er he — let out in Hungary. Contains 0,25 g of ferrous sulfate (51 mg of iron) and the sodium salt of succinic acid strengthening absorption. Drug is highly effective, is well transferred.
Rezoferon — let out in Switzerland. Contains 0,12 ferrous sulfates (37 mg of iron) and 0,185 g of succinic acid. At a clinical use at adults the high effect is noted.
Haemostimulinum — domestic drug, contains 0,25 g of ferrous lactate (50 mg of iron), 0,12 g of dry hematogen and 0,05 g of copper sulfate. Drug is highly effective, however is transferred by many patients badly (causes dispepsichesky frustration). It is desirable for children of early age not to apply.
Ferramid — contains compounds of iron (15 mg of iron) with niacin amide. It is rather effective, it is well transferred. Due to the small content of iron it is convenient for a dosage to children of early age.
Ferroceronum — contains 40 mg of iron, represents sodium орто-карбоксибензоил-биоциклопентадиенилжелеза salt. Drug is highly effective, however quite often causes dispepsichesky disturbances and dysuric frustration.

Aloe syrup with iron — drug of a domestic production which part ferric chloride, Acidum hydrochloricum, citric acid and syrup of an aloe is. 1 ml of drug contains 20 mg of iron. The liquid form is convenient for use for children of early age. According to V. P. Bisyarina and L. M. Kazakova (1979) data, drug has quite good therapeutic effect and seldom causes side reactions. Content of iron in a protoxidic bivalent form and availability of citric acid promote good absorption. Dispepsichesky frustration are possible.
Orferon — let out in Yugoslavia, glycine-ferrous sulfate represents connection, it is well soaked up. The liquid form of drug is convenient for treatment of children of early age.
Drugs of the prolonged action are very perspective for treatment: ferrogradumt, feospan, tardiferon, etc. They are effective at reception of small daily doses, are well soaked up, are almost deprived of side effects.
Considering possible side reactions of ferriferous drugs (nausea, vomiting, anorexia, an abdominal pain, a diarrhea or a lock), at children it is always necessary to begin treatment with a smaller dose and to gradually increase it to individually transferable. It is reasonable to appoint iron preparations with ascorbic acid as the last improves absorption. When determining a dose of drug proceed from a medical daily dose of iron which makes at children of the first year of life 5 — 8 mg on 1 kg of body weight, 1 years — 3 years — 100 mg, 3 — 6 years — 100 — 200 mg and for children of advanced age — 200 — 300 mg a day. Approximately daily dose of drug can be calculated on a formula:

where T — quantity of tablets, ZhS — a daily medical dose of iron, ZhP — the content of iron in drug. So, for the child weighing 10 kg, at easy degree of anemia the daily medical dose of iron makes 5 mgkh 10=50 mg. Content of iron Conferonum or Haemostimulinum is equal in drug to 51 mg. From here:
~ 1 tablet.
To the child at the age of 6 flyings with medium-weight degree of anemia the necessary medical daily dose of iron makes 200 mg. In a tablet ferrokalya the content of iron is 44 mg.
~ 5 tablets.
The daily dose of drug is divided into 3 — 4 receptions and given for 1 h to food. Prolonged treatment. Clinical signs of improvement can be observed much earlier, than hematologic. Normalization of indicators of peripheral blood comes in 1,5 — 2 months of a ferroterapiya, however the recovered level of amount of hemoglobin does not demonstrate recovery of reserves of iron yet. Therefore the ferroterapiya is continued, but the dose of drug is reduced half, V. P. Bisyarina and L. M. Kazakova (1979) recommend to continue a ferroterapiya within 6 months at the full-term children and until the end of the 2nd year — at premature. Children of advanced age accept ferriferous drugs not less than 3 months. If development of an iron deficiency anemia is connected with chronic blood loss (menorrhagias at girls of the pubertal period), then 2 — 3 times a year for 1 month or within 6 — 7 days monthly recommend to repeat a course of treatment (L. I. Idelson, 1981). Ferroterapiya cancel only after recovery of reserves of iron. Serve as criteria of saturation of an organism as iron: optimum indicators of composition of red peripheral blood, normalization of level of serumal iron it is higher than 18 µmol/l, the general iron-binding ability of blood serum is lower than 54 µmol/l, the saturation coefficient transferrin is higher than 30%, and also positive takes of desferalovy test. Efficiency of a ferroterapiya is also estimated on an average daily gain of hemoglobin which normal makes 1 — 2           g/l. If the ferriferous drugs intended for intake do not render therapeutic effect during 2 — 3 weeks, it is necessary to resolve an issue of correctness of diagnosis of an iron deficiency anemia and in case of confirmation of the diagnosis to begin treatment with drugs for parenteral administration.
Indications for purpose of parenteral iron preparations the following: intolerance of peroral iron preparations, existence of a syndrome of the broken intestinal absorption, the continuing chronic blood loss, diseases of a digestive tract.
It is necessary to observe extreme care at purpose of parenteral iron preparations as they can give the expressed allergic reactions, up to development of an acute anaphylaxis, especially at intravenous administration. In places of injections development of abscesses is possible. There are data on activation of opportunistic "ferrozavisimy" bacteria of guts. For parenteral administration use drugs in which iron contains in a trivalent form.
At children most often use the following drugs.
Ferrum-lek — it is made in Yugoslavia. Release ampoules on 2 ml (100 mg of iron) for intramuscular introduction and on 5 ml (100 mg of iron) for intravenous administration. Drug represents compound of oxide of trivalent iron with sugar. For calculation of a course dose use the following formula: 0,66 X body weight of the child (100 — 0,6 • Hb of g/l).
The drug is administered every other day. The maximum single dose at children of the first year of life makes 3 — 5 mg/kg of weight a day, after a year — no more than 100 mg, adult — to 200 mg of iron a day. At intramuscular introduction for elimination of a pain syndrome it is possible to enter iron with novocaine. Children should carry out intravenous administration slowly, better kapelno.
Ferbitol — domestic drug, represents complex compound of trivalent iron with sorbite. Let out 2 ml (100 mg of iron) in ampoules. Enter intramusculary every other day in the same doses, as ferrum-lek.
Ektofer — is made in Yugoslavia, contains iron, citric acid, sorbite and as the stabilizer a dextrin. Let out 2 ml (100 mg of iron) in ampoules. Enter intramusculary, calculation same. Side effect, is connected with development of an allergy, less expressed, than at ferrum-lek, however the ektofer in some cases can provoke heavy allergic reactions.
Now there are iron preparations containing a course dose of iron which the patient receives in one step. Imferon let out in England; at one-time intravenous drop administration of drug about 3000 mg of iron come to an organism. There are messages on successful use of an imferon in pediatric practice, In the central scientific research institute of hematology and hemotransfusion similar drug dekstrafen is developed. Positively proved domestic drug ferral which represents complex chelate compound of iron with albumine. On speed of increase in a hemoglobin content ferral is the best iron preparation (Yu. G. Miterev, 1979).
Now indications for appointment at iron deficiency anemias of drugs of copper, cobalt, vitamins of group B are revised. In particular, purpose of B12 vitamin as stimulation of a haemo cytopoiesis does not solve a problem of a gemoglobinization of erythroidal cells is inexpedient and in the conditions of a hyposiderosis only leads to the raised products of hypochromia erythrocytes. At a number of patients in the presence of a true iron deficiency anemia the refrakternost to a ferroterapiya is noted. In these situations it is possible to include microelements in a medical complex — copper sulfate, Coamidum, cobalt-ferrolitsit, Bi vitamins, Centuries. It is also possible to appoint iron preparations in a complex with Prednisolonum to 2 — 3 weeks. The maximum dose of Prednisolonum, equal 1       mg/kg of body weight, give 1 week, then reduce it (V. P. Bisyarina, L. M. Kazakov, 1979).
The question of hemotransfusions at iron deficiency anemias deserves separate consideration. Results of clinical supervision testify to inexpediency of hemotransfusion at this form of anemia. The hemotransfusion gives the single-step short-term effect caused by the poured erythrocytes. Exert negative impact on marrow of a hemotransfusion, oppressing an erythrocytopoiesis and suppressing activity of synthesis of hemoglobin in normocytes. Besides, repeated transfusions are fraught with hemotransfusionic complications. Therefore at iron deficiency anemias it is necessary to resort to hemotransfusions only according to vital indications, and the main criterion is not the amount of hemoglobin, but the general condition of the patient. As urgent indications for a hemotransfusion serve heavy degree of anemia with sharply expressed hypoxia phenomena, the anemic coma and a prekoma, intolerance of all iron preparations. If necessary it is better to apply a packed red cells.
Prevention of iron deficiency anemias deserves attention. In our country the wide complex of actions within the gemoglobinovy program of improvement of the population is developed. Prevention of anemias at children of early age has to begin with the antenatal period. During this period it is reduced to observance of the correct mode and food of the pregnant woman, the measures sent against not wearing out, elimination of toxicoses, to early detection and treatment of iron deficiency anemias at pregnant women. Under WHO recommendations, throughout the entire period of pregnancy women can appoint iron preparations in a dose of 40 — 60 mg of alimentary iron in days. According to L. M. Kazakova (1984), the good preventive effect is gained at iron administration of drugs only in the last trimester of pregnancy.
Prevention of anemia needs to be carried out to the post-natal period taking into account specific constitutional features of the child. Measures of prevention include: observance of hygienic living conditions of the child, use of natural factors (air, the sun, water), systematic physical culture, since early age, breastfeeding and timely introduction of vegetable and fruit feedings up, especially meat dishes, the prevention of rickets and hypotrophy. The children who are on the mixed and artificial feeding have to receive only the adapted milk mixes — "Baby" (content of iron of 7 mg/l in liquid mix), "Kid" (8 mg/l — with rice flour, 10 mg/l — with buckwheat flour).
It is established that already with the first feeding up (4 — 5 months) children can give meat dishes. Especially it concerns the children who are on the artificial and mixed feeding. The healthy children of chest age who are on the balanced feeding do not have need for carrying out a ferroprofilaktika. There is a sense to appoint iron preparations to babies from risk group: premature, given rise from polycarpous pregnancy, and also the pregnancy complicated by toxicosis in the second half, to large children with the high rate of an increase of weight and growth having the allergic diathesis which is on the artificial or mixed feeding by the simple, but not adapted mixes. To children of advanced age iron preparations are appointed after blood losses, surgical interventions. Premature and to the children who were born from the polycarpous or adversely proceeding pregnancy, the ferroprofilaktika is recommended to begin with 2-month age, continuing it until the end of the first year, to the full-term children from risk group — from 4 months within 3 — 6 months. The preventive dose of iron preparations makes 2 mg/kg of weight a day, usually it is given once. Children from risk group need constant hematologic control, including a monthly double blood analysis.
The children of early age suffering from an iron deficiency anemia can carry out preventive inoculations not earlier than in 6 months after permanent normalization of indicators of red blood.



 
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