Introduction
Hemoglobin is a protein molecule in red blood cells that supplies oxygen to body tissues and organs. For children aged between 6 and 12 months, haemoglobin level should range from 11.3 g/dL to 14.1 g/dL, a drop in this amount leads to anemia, which is associated with iron deficiency (Roganović & Starinac, 2018). In this case study, Josiah’s amount of 10.2 is below the normal level according to the reference card (El Gendy et al., 2018). This implies that this baby’s diet lacks iron needed by red blood cells or there is low absorption of nutrients in the guts due to infections.
The pale skin and conjunctiva could be signs of developing anemia, finger stick blood test is used to diagnose blood disorders. This procedure counts the number of red blood cells and shows their morphology. Low red blood cells (RBCs) numbers indicate low hemoglobin levels. Other symptoms associated with anemia include fatigue, malaise, generalized weakness, pale skin, cold hands and feet, dizziness, reduced immunity, and shortness of breath.
Diagnosis
The laboratory test results are expected to indicate iron deficiency anemia in the child, this condition is linked to a decrease in the total body iron amount to a level that does not support the synthesis of hemoglobin. The anticipated clinical findings include small and pale erythrocytes, less mean corpuscular volume and mean corpuscular hemoglobin concentration, thrombocytosis, and lower cell count. Hemoglobin is located in red blood cells; thus, lower cell count signifies lower hemoglobin and lower hematocrit level.
The peripheral smear is an important test that can be used for the diagnosis of this condition. Microcytosis, hypochromia, anisochromia, anisocytosis, and pencil cells are expected for patients with anemia. Iron studies also detect red blood cell credential abnormalities, which include a serum ferritin level below 12 ng/mL, total iron-binding capacity greater than 480 mcg/dL, and transferrin saturation (Iron/TBC x 100), which is less than 16%.
Differential Diagnosis
The differential diagnosis for Josiah condition is microcytic hypochromic anemia. However, blood disorders such as anemia due to lead poisoning, beta-thalassemia minor, and anemia caused by chronic infections and inflammations are also a possible cause of the child’s sickness. The beta- thalassemia minor is usually accompanied by an increase in the number of blood cells relative to iron deficiency anemia and below 13 Mentzer index of red blood cells.
Anemia caused by lead poisoning is differentiated from iron deficiency anemia by red blood cell basophilic stippling. Chronic infection lowers the serum level although the ferritin level is either raised or normal. Iron deficiency anemia reduces the child’s attention span, which can be measured by Bayley’s infant behavior record and mental development index. A screening test is done to ascertain infections caused by a blood disorder. The likely diagnosis for this condition is iron deficiency anemia.
Desired Treatment Outcome and Pharmacological Intervention
Treatment of anemia depends on the results of a blood test, physical examinations, and medical history of the patient. An increase in the amount of iron in red blood cells and hemoglobin level is the desired outcome for all the treatments given. Antianemia pills are mostly used to treat iron deficiency, in presence of inflammation or infection, a medication for the causative pathogen has to be administered. Pediatric patients such as Josiah are treated using iron replacement therapy, which is given through parenteral routes or orally.
Non-Pharmacological Treatment
Iron deficiencies in the toddler can be reversed by feeding the child with diet rich in vitamin c and iron. Food containing phosphates, milk, phytates, and cereals has to be avoided because it reduces the absorption of iron in the guts. Thus, the diet of the child will be changed to include lean red meat, or lentils, beans, chickpeas, fish, poultry, and nuts paste. Vitamin C is critical for children because it helps in the absorption of minerals in the body, thus, fruits and vegetables such as broccoli, lemons, oranges, tomatoes, and cabbages should be given to the child. Additionally, solid food rather than pureed meals will be encouraged, and also frequent snacking on crackers and teething biscuits will be stopped to hinder filling up before mealtimes.
Intestinal parasites and chronic diarrhea depletes the baby’s iron store, thus, deworming Josiah is critical. Folic acid is essential for new blood cell formation, it is found in food such as lentils, whole wheat products, spinach, asparagus, and sprouts. In some patients, absorption of folic acid or conversion to active forms in the body does not take place. For this reason, it is critical to provide the acid supplement to the baby. A dose of 5mg is administered to the child on the first day followed by 0.3mg each day.
Pharmacotherapeutic Plan
Josiah’s blood hemoglobin levels have to be raised by the use of oral iron therapy for at least 3 months. The supplements given can be ferrous sulphate, which contains 200 mg tablets, or ferrous gluconate of 250-mg doses. Iron therapy is expected to raise hemoglobin by about 0.4 g/dL/day. However, some factors such as poor tolerance, malabsorption, inadequate absorption due to phosphates and phytates, and poor compliance may lead to poor response to iron ingested orally.
Parenteral route can be used to administer iron to children having difficulties with taking drugs orally. It is administered intravenously (IV) or intramuscularly (IM) based on body weight, the iron amount required, and hemoglobin deficit. For instance, the iron-sorbitol (Jectofer) and iron dextran complex are administered through intramuscular injection while iron-sucrose injection (Venofer) and iron-dextran complex (Imferon) are administered intravenously.
The formulae for calculating doses for parenteral route is; iron required = 2.5 × body weight (kg) × Hb deficit (Allali et al., 2017). In this case, the Hb deficit is the difference between the required value and the present value. Iron may cause poisoning in children; thus, a dose should be given according to the body’s needs. A person with hemolytic anemia, hemochromatosis, and autoimmune hemolytic anemia should not take iron supplements. In addition, individuals with ulcerative colitis, Crohn’s disease and intestinal ulcers should avoid the supplements.
The clinically significant adverse effects induced by iron supplements are intestinal and stomach problems including diarrhea, constipation, cramps, and vomiting. The severity and frequency of these side effects increase with the doses. The pill interacts with tetracycline and quinolone antibiotics to reduce its effectiveness (Muleviciene et al., 2018). It also interacts with trisilicate, magnesium, and penicillamine, which are used for arthritis treatment.
Ferrous sulphate is the supplement to be utilized in treating Josiah because it offers the greatest amount of iron as compared to ferrous gluconate. Vitamin C increases iron absorption, thus, it will be considered in the management plan. The success of this regimen is ascertained by frequent blood tests. Finger stick technique will be used to gauge improvement of the patient’s condition, this is because it determines the improvement of red blood cell count and hemoglobin level. Iron and vitamins help in the synthesis of hemoglobin in the body, Josiah’s guardian will be advised to provide a balanced diet, which is fortified with iron.
References
Allali, S., Brousse, V., Sacri, A. S., Chalumeau, M., & de Montalembert, M. (2017). Anemia in children: Prevalence, causes, diagnostic work-up, and long-term consequences. Expert Review of Hematology, 10(11), 1023-1028.
El Gendy, F. M., EL‐Hawy, M. A., Shehata, A. M., & Osheba, H. E. (2018). Erythroferrone and iron status parameters levels in pediatric patients with iron deficiency anemia. European Journal of Haematology, 100(4), 356-360.
Muleviciene, A., Sestel, N., Stankeviciene, S., Sniukaite-Adner, D., Bartkeviciute, R., Rascon, J., & Jankauskiene, A. (2018). Assessment of risk factors for iron deficiency anemia in infants and young children: A case–control study. Breastfeeding Medicine, 13(7), 493-499.
Roganović, J., & Starinac, K. (2018). Iron deficiency anemia in children. Current Topics Anemia, 47, 47-71.