1. iron deficiency anemia pada anak
TRANSCRIPT
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IRON DEFICIENCY ANEMIAIN INFANCY AND CHILDHOOD
Sony Wicaksono
Susanto Nugroho
Departent o! Chi"# Hea"th$Facu"ty o! Me#icine%&ni'ersity o! (ra)i*aya+
Dr, Sai!u" An)ar -enera" Hospita"
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Objectiveo
• To understand the burden of iron
deficiency anemia (IDA)
•To understand the IDA diagnosis andmanagement
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Keypoints
• Introduction
• Iron metabolism
• Iron deficiency anemia• anagement
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Introduction
Iron #e.ciency aneia is the ost coonhaeato"ogic #isease in in!ants / chi"#ren
reains the counity hea"th pro0"ein In#onesia
Se'era" stu#ies iron #e.ciency aneiaassociate# )ith 1 % poor cogniti'e !unction
% "o)er achie'eent scores in schoo"
% ipaire# psychootor #e'e"opent% 0eha'iora" pro0"es
Palti H, Meijer A, Adler B. Early Hum Dev 1985 ; 10 : 2172!"#erri$ A, Em%&d A, Bell '(, )%ldi&* '. Ar+# Di (#ild 2001; 8-; -805
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De'e"openta" an# (eha'iora" E2ectso! Iron De.ciency Aneia 3IDA4 in In!ants
H%lt M(. Devel%me&tal a&d /e#avi%ral e$e+t % ir%& de+ie&+y a&emia i& i&a&t. utriti%& 3%day 1
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ASEAN Human Development Index 2002
&ND5 Report 6778
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Iron defciency anemia 2001underfves children in Indonesia
Household Survey, 2001
&t%r% 6. Pe&i&*ata& ualita Hidu A&a Melalui Pe&+e*a#a& A&emia )ii Bei.Diajia& ada ama&ye A&ti A&emia 20042008. Dee, 'aarta, 1 Maret 2007
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Iron metaolisms
(o#y iron #istri0ution an# transport
Iron a0sorption
Iron re9uireent
A&dre (. Medi+al Pr%*re: Di%rder % r%& Meta/%lim. E&*l ' Med 1999;!-1: 198495
H%$/ra&d A
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(o#y iron #istri0ution
A&dre (. Medi+al Pr%*re: Di%rder % r%& Meta/%lim.
E&*l ' Med 1999; !-1: 198495
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Iron re!uirements
Estiate# #ai"y iron re9uireentsIn chi"#en 3a'erage41
% &rine$ s)eat$ !eces 1 7,: g+#ay
% -ro)th 1 7,; g+#ay
%
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Etiolo"y o# iron defciency
$ess 1 year> $o% iron stora"e &$'( or "emelli)> $ac* o# iron supplements in exclusively reast+
#ed in#ants eyond months o# a"e> -n#ortifed mil* #ormula
A"e 1+2 year> ./il*aholics.> Increased iron needs due to chronic in#ection> /alasorption> 'lood loss e" parasitic in#ection and
/ec*els diverticulum
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Etiolo"y333
A"e 2+4 year> 5oor inta*e o# iron+rich #ood> Increased iron needs due to chronic in#ection> 'lood loss e" 5arasitic in#ection and
/ec*els diverticulum
A"e 4 year 6 adolescence> 'lood loss e" 5arasitic in#ection or
polyposis
Adolescence 6 adult> (oman 7 e" menorrha"ia
=a&%y P. 1995. . !550.)lader B. &: el%& 3e>t/%% % ediatri+. 17t# ed.; 200-. . 141-4.
"a&d%val (, et al. Hemat%l ?&+%l (li& Am 200-;18:1-2!!8.illi ", et al. Am @am P#yi+ia& 2007;75:4718.
"e*el )B, et al. Pediatr 6ev 2002;2!:758-.
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Sta"in" o# iron defciency
6aati H d. A&emia deie&i /ei. Dalam Perm%&% B, d. Edit%r.Buu Ajar Hemat%%&%l%*i a&a 2005: !0-!1.
Stage I 1 Iron #ep"etion 3)ithout aneia4
Stage II 1 Iron #e.ciency 3)ithout aneia4
Stage III 1 Iron #e.ciency 3)ith aneia4 IRON DEFICIENCY ANEMIA
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Iron defciency%ith and %ithout anemia
Anemia &Iron Defciency %ith Anemia &ID 8 A) + Serum hemo"loin 7 elo% normal + Depleted #erritin stores + Disturin" co"nitive 9 ehavior development
Iron Defciency %ithout Anemia &ID 6 A) + Serum hemo"loin 7 normal + Deplete #erritin stores + Decrease iron concentrations in some tissues
+ Stron"ly potential disturin" co"nitive andehavior development
+ :ritical periode 7 1 6 2 years o# a"e
'%y+e ( M+(a&& '(, Ame B. Am ' (li& utr 2007;85:9!1 -5
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Dia"nosis
> History fndin"s 7+ onset 9 severity o# anemia, a"e+ parasitism, lood loss ´ or chronic)+ inade!uate diet &!uantity 9 !uality)+ poor asorption
+ increased re!uirements
> :linical #eatures 7→ symptoms 9 si"ns &"eneral 9 specifc)
> $aoratory fndin"s 7→ hematolo"ic 9 iochemical mar*ers
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:linical #eatures
> Depend on speed o# onset, severity &de"rees o# iron
defciency), a"e 9 H;2 dissociation curve
> +10 "?d$)
+ tachycardia, cardiome"aly, a oundin" pulse,
a systolic @o% murmur at apex
> A painless "lossitis, angular stomatitis, rittle,
rid"ed or spoon nails (koilonychia), dyspha"ia as
result o# pharyn"eal %e &5aterson+elly or
5lummer+Binson syndrome)
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La0oratory .n#ings !or i#enti!ying iron#e.ciency
6aati H d. A&emia deie&i /ei. Dalam Perm%&% B, d. Edit%r.Buu Ajar Hemat%%&%l%*i a&a 2005: !0-!1.
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Creatment
Elemental e
+ Do7 + m"?*"'(?d &2+ dosa"es)+ It may ta*e up to 2 mo a#ter hemo"loin has
een corrected+ Adverse eFects 7
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In#ication !or routine iron supp"eentationchi"#ren ? : yrs o"#
=a&&%tti ==, 3iel+# 'M, Bla+ MM, a&d Bla+ 6E,Am ' (li& utr2004;8-:124174
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Lan@ko)sky 5, =:, p, B:%:7,-"a#er (, In1 Ne"son
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Indication 7 I# hemo"loin levels = "?d$
Crans#usion
=a&%y P. 1995. . !550.)lader B. el%& 3e>t/%% % ediatri+. 17t# ed.; 200-. .
141-4.
Dept o# :hild Health Dr Sai#ul An%ar Hospital7H = ?d$ "?d$
H "?d$, %ith cardiorespiratory disturances,severe in#ection, dehydration, sur"icalprocedures
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Diet
/il* 7 2 oJ?day
Iron rich #ood &fsh, liver, meat) rather than rice,
spinach, %heat, soyean
K asorption7 tanin, calsium, phytates
L asorption7 vitamin :, H:l, amino acid,
#ructosa,
meat
=a&%y P. 1995. . !550.)lader B. el%& 3e>t/%% % ediatri+. 17t# ed.; 200-. .
141-4."a&d%val (, et al. Hemat%l ?&+%l (li& Am 200-;18:1-2!
!8.
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5revention
5rimary prevention Exclusive reast#eedin"
+ Che asorption o# iron #rom reast mil* ishi"her than that #rom %hole co%s mil* &40M
vs10M)
+ Iron+#ortifed co%s mil* 7 M
/il* consumption 7 2 oJ?day &other7 1 oJ?day)
=a&%y P. 1995. . !550)lader B. el%& 3e>t/%% % ediatri+. 17t# ed.; 200-. .
141-4"a&d%val (, et al. Hemat%l ?&+%l (li& Am 200-;18:1-2!!8
illi ", et al. Am @am P#yi+ia& 2007;75:4718"e*el )B, et al. Pediatr 6ev 2002;2!:758-
?i @A. E&*l ' Med 199!;!29:190!
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5rimary prevention3
Alle& =H. ' utr 2002;1!2:81!"9"=a&%y P. 1995. . !550
"a&d%val (, et al. Hemat%l ?&+%l (li& Am 200-;18:1-2!!8?i @A. E&*l ' Med 199!;!29:190!
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:onclusions
IDA is a maor prolem in developin" countries
Iron supplementation resulted in a similar rate o# success#ul
treatmento# anemia &H 9 #erritin)
Iron supplementation+ Che increases in H concentration %erecomparale
+ Improvement o# co"nitive #unction+ :ost eFective+ No or #e%er side+eFect
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