What is anemia in your child means?

It is a condition in which the level of hemoglobin in red cells is low in your child’s blood, resulting in pallor and tiredness. This can be diagnosed by looking at hemoglobin level in your child’s Complete Blood Count (CBC) test result.

What is Microcytic Anemia?

Microcytic Anemia means the presence of small red blood cells in the blood. It is usually identified by a low MCV in the blood test (CBC).

What does Hypochromic Anemia mean?

Hypochromia means a situation in which the red blood cells contain less hemoglobin and it can be identified by low MCH in the blood test (CBC).

What is Microcytic Hypochromic Anemia?

It means when there is small size of red blood cells (low MCV) and low-level of hemoglobin in red blood cells (low MCH).

What are the different causes of Microcytic and Hypochromic Anemia?

Iron deficiency is the most common cause of microcytic anemia. The other cause is thalassemia.

Do Thalassemia and Iron Deficiency Anemia (IDA) are common in the UAE?

Yes, both are very common in the UAE among both nationals and expatriates.

What are the consequences of iron deficiency?

There are detrimental consequences in children due to iron deficiency that includes pallor, tiredness, decreased appetite, behavior issue and learning impairment.

Can these complications of Iron deficiency be treated and prevented?

Yes, these can be treated completely and its consequences can be prevented if identified and treated early. Moreover diet modification can be done to prevent iron deficiency anemia in future.

What is the recommendation of American Association of Pediatrics (AAP)?

It recommends screening of young children for IDA especially in population with high incidence of IDA.

What is thalassemia?

Thalassemia is a genetic blood disorder that causes abnormal hemoglobin. Thalassemia can be major or minor depending on abnormalities in the number defects in these genes.

What is the treatment of thalassemia?

The treatment of thalassemia major includes life-long blood transfusions and removal of excessive iron from the blood stream. However children with thalassemia minor does not need any treatment as such.

What is the importance of differentiating between thalassemia minor and IDA?

Both have similar complete blood count results but they can be identified by further detailed blood tests that include hemoglobin electrophoresis, genetic studies and iron level estimation. If we do not differentiate between them by further tests, thalassemia minor is mistakenly treated quite often as iron deficiency anemia with iron. Therefore, confirming thalassemia minor and holding a thalassemia minor card will avoid this.

How can we identify Iron Deficiency Anemia and Thalassemia in children?

By doing Complete Blood Count (CBC) as a preliminary test, we can identify the possibilities of IDA and thalassemia if there is low hemoglobin, low MCV (microcytosis) and low MCH (hypochromia). By doing further tests we can differentiate between thalassemia and iron deficiency anemia.

Where can these investigations be done?

These investigations, initially Complete Blood Count (CBC) and further tests if needed are commonly available and can be done at Burjeel Hospital. Complete Blood Count (CBC) is done on many children commonly by most of the doctors when they suspect infection.

What do you do if you your child’s blood result shows low hb, low MCV and low MCH?

In this situation, you need to confirm whether you child has either IDA or thalassemia.

Where can these confirmatory tests be done?

Burjeel hospital has a dedicated Anemia clinic run by our specialized doctor who specializes in Hematology (children blood diseases).

What other services are available at Anemia Clinic in Burjeel Hospital?

  • If your child is thalassemia minor, we will provide a card certifying that your child is thalassemia minor. It would help other doctors in other hospitals in future to know that your child has thalassemia minor, which will avoid unnecessary investigations and treatment repeatedly.
  • If your child has thalassemia major or intermedia, our doctor will further discuss with you and plan further treatment.
  • If your child has IDA, our doctor will give a treatment plan and provide you elaborate health education to understand various aspects of preventing IDA in future in your child

What is Iron Deficiency Anemia (IDA)?

Anemia is a condition in which the body does not have enough healthy red blood cells. Red blood cells provide oxygen to our body. Iron is essential for production of healthy red blood cells. The lack of iron in the body may lead to anemia. This is called Iron Deficiency Anemia (IDA).

What are the causes of IDA?

The body gets iron through certain foods. A diet that does not have enough iron is the most common cause of this type of anemia in children. Toddlers who drink too much cow's milk may also become iron deficient if they are not eating other healthy foods that have iron. Other rare causes may be:

  • Food digestive pipe is not able to absorb iron well, even though your child is eating enough iron containing food.
  • Slow blood loss over a long period, often due to menstrual periods or bleeding in the digestive pipe.

What are the symptoms and signs of IDA?

Mild anemia may have no symptoms. As the iron level and blood counts become lower. Your child may:

  • Become irritable
  • Have short of breath
  • Eat less food
  • Feel tired or weak all the time
  • Have a sore tongue
  • Have headaches or dizziness
  • Very pale whites of eyes
  • Develop brittle nails
  • Get pale skin

What are the blood tests that measure iron level in the body?

Hb, MCV, Serum Ferritin, Serum Iron, Total Iron Binding Capacity (TIBC), and Iron Saturation.

What are the treatments for Iron Deficiency Anemia (IDA)?

Treatment for iron deficiency anemia in your child usually involves giving iron medicine and modifying your child diet to increase iron levels in the blood.

Iron Medicine

Doctor will prescribe an iron medicine to restore the iron missing from your child's body. This is taken as a tablet or syrup, usually twice a day. Some child can experience side effects when taking iron treatment, which includes:

  • Abdominal (tummy) pain
  • Constipation or diarrhea
  • Heartburn
  • Feeling sick
  • Black stools

These side effects should settle down over time. However, it is better to give medicine with food or shortly after eating if child has troublesome side effects. Iron injections may be recommended instead of syrup, in rare situations.

Which are the iron-rich foods?

Below is the list of foods rich in iron:

  • Dark-green leafy vegetables
  • Iron-fortified cereals or bread
  • Brown rice
  • Pulses and beans
  • Nuts and seeds
  • White and red meat
  • Fish
  • Eggs
  • Dried fruit, such as dried apricots, dates and raisins

What other precautions should you take?

Your child's diet should include foods from all the major food groups to ensure it's healthy and balanced. In particular, food and drink containing vitamin C are important as vitamin C helps your child food pipe absorb more iron.

What are the foods, which decreases the iron level in the body?

Consuming large amounts of following foods and drinks may reduce absorption of iron:

  • Tea and coffee
  • Calcium (found in dairy products, such as milk)
  • Wholegrain cereals – although wholegrains are a good source of iron themselves, they contain phytic acid, which can stop your body to absorb iron from other foods and pills

How do we monitor your child with iron deficiency anemia?

It is important that you bring your child to the clinic in two to four weeks after you've started giving iron treatment. We will check how well your child is responding to the treatment. Your child will have a blood test to check the hemoglobin levels. You can discuss blood results with doctor over the phone after 2 days of blood test. If the blood test results shows an improvement, your child should continue taking iron supplements and return to anemia clinic in 3 months for another blood test. Once your hemoglobin levels and iron levels are normal, your child should be able to stop taking the treatment. Your child condition will be monitored every three months over the course of a year, and again a year later.

What can we do if treatment is ineffective?

If your child iron levels still haven't improved, in spite of taking the supplements as prescribed, then we may need to do further investigations to find out the reasons.

Instructions on how to give iron medicine to children with Iron Deficiency Anemia (IDA)

Iron medicine is available as a syrup and tablet that can be given to your child by mouth. Rarely, iron also can be given by injection. It improves anemia by helping to increase the iron level in the blood.

When and how should I give iron medicine?

The dose and time will be shown on the medicine label. Usually it works best when given on an empty stomach. Try to give it 30 minutes before or 2 hours after food. However, if this upsets your child's stomach, give it with a little food. Shake the bottle well and measure out the right amount using an oral syringe.

How long you should give this iron medicine?

Your child will need to take iron medicine regularly for at least 3 months for it to have its full benefits.

What if my child vomits?

If your child vomited within 30 minutes after taking the medicine, give him/her the same dose again. If your child vomited 30 minutes after having a dose of iron medicine, you do not need to give them another dose.

What if I forget to give medicine to my child?

You would be required to give iron medicine twice a day. If you remember within 4 hours of scheduled time, give your child the missed dose. If not, skip the dose.

Are there any possible side effects?

Your child may feel like vomiting. He/She might get indigestion, constipation or loose stools. Their vomit or stools might be black or red colored. If these side-effects are a problem or do not go away, contact your doctor.

What is thalassemia minor (trait)?

This is a form of thalassemia. It does not affect the health of the person who has thalassemia minor. It will not impair your work or your life style. A thalassemia trait (minor) will always be a trait. It will never turn in to a severe form of thalassemia major. It is due to genetic defect. Although they are completely normal but they carry the defective gene and pass it on to the next generation. Therefore they are also called thalassemia carrier. There are two types of thalassemia traits (minor): Alpha thalassemia trait (minor) and Beta thalassemia trait (minor).

Does the child with thalassemia minor need treatment with iron medicine?

Complete blood count (CBC) of children with thalassemia carrier (minor) may be similar to iron deficiency anemia. Therefore, they are being prescribed iron medicine believing that they are having iron deficiency anemia. Therefore, they often get excess iron supplements unnecessarily, which can cause organ damage. Children with thalassemia should only take iron medicine if a blood test confirms there is iron deficiency. Knowing the fact that your child has thalassemia carrier (minor), your child can avoid unnecessary intake of iron medicine.

What is the long term effect of thalassemia minor on my child's life?

Thalassemia minor does not affect health of your child; however, there is a possibility that their children can have thalassemia minor. There is also a possibility that their children can get thalassemia major disease (a severe form of thalassemia), if their husband or wife is also a thalassemia carrier.

What are the investigations to confirm thalassemia minor in a child?

The following tests identify most types of thalassemia trait. It can all be done by one-time blood test.

  • Complete blood count
  • Hemoglobin electrophoresis
  • Thalassemia Alpha and Beta gene study
  • Iron studies
  • Family screening for thalassemia.

How can I help my family members if I know that I have a child with thalassemia carrier (minor)?

If you know that your child has a thalassemia trait (minor), you may have questions about how this will affect your family members. Informing other family members of the possibility that they may also have thalassemia minor (carrier) will be useful. Burjeel hospital has created specific information leaflet that describes all the information they needed.

Instructions on how to give iron medicine to children with Iron Deficiency Anemia (IDA)

Iron medicine is available as a syrup and tablet that can be given to your child by mouth. Rarely, iron also can be given by injection. It improves anemia by helping to increase the iron level in the blood.

When and how should I give iron medicine?

The dose and time will be shown on the medicine label. Usually it works best when given on an empty stomach. Try to give it 30 minutes before or 2 hours after food. However, if this upsets your child’s stomach, give it with a little food. Shake the bottle well and measure out the right amount using an oral syringe.

How long you should give this iron medicine?

Your child will need to take iron medicine regularly for at least 3 months for it to have its full benefits.

What if my child vomits?

If your child vomited within 30 minutes after taking the medicine, give him/her the same dose again. If your child vomited 30 minutes after having a dose of iron medicine, you do not need to give them another dose.

What if I forget to give medicine to my child?

You would be required to give iron medicine twice a day. If you remember within 4 hours of scheduled time, give your child the missed dose. If not, skip the dose.

Are there any possible side effects?

Your child may feel like vomiting. He/She might get indigestion, constipation or loose stools. Their vomit or stools might be black or red colored. If these side-effects are a problem or do not go away, contact your doctor.

As you may already know, you have a family member, who has been diagnosed as Thalassemia Minor (carrier). This letter is to give you information about what this may mean for you and other family members. Although thalassemia minor (carrier) does not cause any health problems for anyone who has it but following information would be useful.

1. Blood result of a person with thalassemia carrier (minor) may be similar to iron deficiency anemia. But they should only be given iron medicine if further blood test shows that there is low iron in their blood. However, children with thalassemia minor are being prescribed iron medicine believing as having iron deficiency anemia. Therefore, they often get excess iron unnecessarily, which can cause organ damage. Knowing the fact that you or your child has thalassemia carrier (minor), your child can avoid unnecessary intake of iron medicine.

2. If both father and mother have thalassemia minor (carrier), there is a chance that their child will have thalassemia major disease. UAE law states that they should have medical report certifying thalassemia carrier status before getting married. But it's always better to know the fact much earlier before talking about marriage.

We hope you find this information helpful.

For more information, please contact our pediatric anemia clinic.