Iron Deficiency Anemia and Thalassemia in Children

Iron deficiency anemia and thalassemia?

Dear Sir/Madam,
Recently, I noticed that my child (2-3 years old) has a slightly pale complexion and cold hands and feet at night.
After a blood test, the doctor diagnosed iron deficiency anemia.
Upon further investigation, it was found that the mother has mild thalassemia, while the father is normal.
The nursing staff mentioned that it can still be inherited by the next generation.
I am writing to inquire about the following:
1.
What do HbF, HbA2, MCV, and Hb represent in the blood? What are their normal values?
2.
Is iron deficiency anemia and thalassemia currently treatable with medical intervention?
3.
Since my child is a premature infant and exhibits these symptoms, what precautions should we take in daily life?
Thank you.

CAT, 30~39 year old female. Ask Date: 2005/02/23

Dr. Lin Wenxian reply Pediatrics

Dear CAT,
Hello.
The issues of iron deficiency anemia and thalassemia can be discussed for hours.
However, I would like to start with a brief explanation based on your questions.
Hb is an abbreviation for hemoglobin, which is the main component in red blood cells responsible for carrying oxygen.
Anemia is determined by the levels of hemoglobin.
The average normal value for adult males is approximately 14.5 g/dL, while for children aged 2 to 6 years, the average is 12.5 g/dL, typically not falling below 11.5 g/dL.
MCV stands for mean corpuscular volume, indicating the average volume of each red blood cell, essentially reflecting the size of the red blood cells.
Different causes of anemia can result in varying red blood cell sizes.
For instance, red blood cells in iron deficiency anemia and thalassemia are usually smaller than normal red blood cells, while those in vitamin B12 and folate deficiency anemia are typically larger.
The average MCV for normal adult males is about 90 fL, and for children aged 2 to 6 years, it is around 81 fL, generally not falling below 75 fL.
Hemoglobin (Hb) is composed of four protein chains.
Different combinations of these chains result in different types of hemoglobin.
For example, HbA consists of two alpha chains and two beta chains (α2β2), HbA2 consists of two alpha chains and two delta chains (α2δ2), and HbF consists of two alpha chains and two gamma chains (α2γ2).
In normal adults, the majority of red blood cells contain HbA, with a small portion being HbA2 (1.5-3.4%).
However, the majority of fetal red blood cells contain HbF, which decreases from about 77% at birth to approximately 4.7% at six months, and then to less than 2% in adults.
This indicates that red blood cells containing HbF are gradually replaced by those containing HbA after birth.

This transition occurs because the gamma genes in the chromosomes gradually stop producing gamma chains and instead, beta genes start producing beta chains.
Since the lifespan of red blood cells is about 120 days, this allows for the gradual replacement with red blood cells composed of HbA.
However, humans have four alpha genes and two beta genes; if there are defects in these genes that hinder the production of alpha or beta chains, it can lead to problems in hemoglobin production and result in anemia, known as thalassemia (initially identified in patients primarily along the Mediterranean coast).

If only one of the four alpha genes is defective, symptoms may not be apparent, and there may be no anemia.
If two alpha genes are defective, mild microcytic anemia may occur, but transfusion treatment is usually not necessary, and HbF and HbA2 levels may be lower.
If one of the two beta genes is defective, there are typically no clinical symptoms or only mild anemia, which also does not require treatment, and HbF and HbA2 levels may be higher (3-8% and 2-4%, respectively).
Iron deficiency anemia is the most common type of anemia in children.
By identifying the cause—whether it is due to insufficient dietary iron, iron loss (such as from chronic gastrointestinal bleeding or hookworm infection), or absorption issues—appropriate treatment can lead to recovery.
In contrast, thalassemia is caused by genetic defects and is considered congenital, thus it cannot be emphasized that it can be cured.
Fortunately, mild thalassemia (for example, when only one or two of the four alpha genes are affected, which does not impact alpha chain production) typically presents with no symptoms and does not require transfusion treatment.
However, the importance of premarital health screenings should be emphasized.
Regarding premature infants, if they are not extremely premature or do not have other complications associated with prematurity, generally speaking, by the age of three, they have caught up in growth and development with full-term infants.
The care for anemia in these cases is similar to that for full-term infants.
Of course, it is essential to maintain a balanced diet and avoid picky eating to prevent deficiencies in hematopoietic elements.
Wishing you good health and all the best from the Tainan Hospital of the Department of Health!

Reply Date: 2005/02/23

More Info

Understanding iron deficiency anemia and thalassemia in children is crucial, especially when there are family histories of these conditions. Let's break down your questions and concerns regarding your child's health.

1. Understanding Hemoglobin Types and Blood Parameters:
- Hb (Hemoglobin): This is the protein in red blood cells that carries oxygen. Normal values for children can vary, but generally, for toddlers (1-3 years), normal hemoglobin levels are around 11.0 to 14.0 g/dL.

- HbF (Fetal Hemoglobin): This is the type of hemoglobin present in fetuses and newborns. It usually decreases after birth. Normal values for infants can be around 60-80% at birth, decreasing to less than 2% by 6 months.

- HbA2: This is a minor component of adult hemoglobin, typically making up about 2-3% of total hemoglobin in adults. In children, it may be slightly lower.

- MCV (Mean Corpuscular Volume): This measures the average size of red blood cells. Normal values for toddlers are typically between 70-86 fL. In iron deficiency anemia, MCV is often low, indicating smaller red blood cells (microcytic anemia).

- Normal Values: It’s important to refer to the specific reference ranges provided by the laboratory that performed the tests, as these can vary slightly.

2. Iron Deficiency Anemia vs. Thalassemia:
- Iron Deficiency Anemia: This condition is often treatable and can be managed with dietary changes, iron supplements, and addressing any underlying causes of iron loss (like gastrointestinal bleeding or poor absorption). In many cases, children can fully recover with appropriate treatment.

- Thalassemia: This is a genetic blood disorder that affects hemoglobin production. While it cannot be "cured" in the traditional sense, it can be managed effectively. Children with thalassemia may require regular blood transfusions and chelation therapy to manage iron overload from transfusions. The severity of thalassemia varies; some individuals may have mild forms that require little intervention, while others may need more intensive care.

3. Considerations for Preterm Infants:
- Since your child is a preterm infant, they may be at a higher risk for anemia due to lower iron stores at birth and potential feeding difficulties. It's essential to monitor their growth and development closely.

- Ensure that your child is receiving adequate nutrition, including iron-rich foods as they begin to eat solids (like pureed meats, beans, and fortified cereals).

- Regular follow-ups with your pediatrician are crucial to monitor hemoglobin levels and overall health. If your child shows signs of fatigue, pallor, or other concerning symptoms, seek medical advice promptly.

In summary, understanding the differences between iron deficiency anemia and thalassemia is vital for managing your child's health. Regular monitoring and appropriate interventions can lead to positive outcomes. If you have further concerns or questions, don’t hesitate to consult with your healthcare provider for personalized guidance.

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