iron deficiency anaemia is the commonest nutritional anaemia in India as well as other developing countries. till an effective supplementation is implemented right from the age of 4 months the problem can not be solved. there is an urgent need to develop effective strategy to reach every infant in the country and give iron supplementation to every infant irrespective of class, creed, caste and society.

1. IRON DEFICIENCY ANAEMIA
DR.HARIVANSH CHOPRA
M.D.,DCH
PROFESSOR
DEPT. OF COMMUNITY MEDICINE
L.L.R.M.MEDICAL COLLEGE,MEERUT
harichop@gmail.com

2. Anaemia is the most common public
health problem in India as well as in
other developing countries.
INTRODUCTION

3. Although there are a number of causes of anaemia in young
children but commonly anaemia is classified as :
Microcytic Hypochromic Anaemia
Normocytic Normochromic Anaemia
Megaloblastic Anaemia
INTRODUCTION

4. MICROCYTIC HYPOCHROMIC ANAEMIA
IRON DEFICIENCY ANAEMIA
LEAD POISONING
HEMOLYTIC ANAEMIA

5. NORMOCHROMIC NORMOCYTIC ANAEMIA
BLOOD LOSS (ACUTE OR CHRONIC)
ANAEMIA OF RENAL ORIGIN
ANAEMIA DUE TO CHRONIC DISEASE

6. MEGALOBLASTIC ANAEMIA
VITAMIN B 12 DEFICIENCY
FOLIC ACID DEFICIENCY

7. By far the commonest anaemia is iron
deficiency anaemia and despite of
having a national program for the
control of anaemia it is not been able
to make a dent on the prevalence in
India
INTRODUCTION

8. The main reason for failure of this program is
lack of life cycle approach in the prevention of
iron deficiency anaemia. As per various National
Family Health Surveys, the prevalence of anemia
has been staggering around 70% among the
children below 3 years of age.
INTRODUCTION

9. The main cause of this high prevalence of
anaemia in young children is failure to provide
supplementary iron right from the age of 4
months of life and this results in child becoming
anaemic by the end of first year and then this
anemia remain persistent in pre school, school
going and adolescent age group.
INTRODUCTION

10. INTRODUCTION
Especially it becomes more profound in
adolescent females again due to lack of
therapeutic approach in this particular
age group. the failure to treat anaemia
in adolescent results in propagation of
anaemia in pregnancy.

11. DR.HARIVANSH CHOPRA
What is Iron
Functions
Rich sources
Daily requirement
Public health importance
OBJECTIVES

12. DR.HARIVANSH CHOPRA
Diagnostic features of
deficiency
Treatment of Iron deficiency
anemia
OBJECTIVES

13. DR.HARIVANSH CHOPRA
HIDDEN HUNGER
The term was coined by WHO in 1986 & refers to the problems
associated with the deficiency of 3 essential micronutrients:
IRON
IODINE
VITAMIN A

14. DR.HARIVANSH CHOPRA
IRON IN NATURE
Iron is among the abundant minerals on
earth.
Of the 87 elements in the earth’s crust,
Iron constitutes 5.6% and ranks fourth
behind Oxygen (46.4%), Silicon (28.4%) and
Aluminum (8.3%).

15. DR.HARIVANSH CHOPRA
What is Iron?
•Iron is vital to the health of
the human body, and is
found in every human cell.

16. DR.HARIVANSH CHOPRA
What is Iron?
•The human body contains
approximately 4 grams of
iron.

17. DR.HARIVANSH CHOPRA
What is Iron?
•Iron is an integral part of
many proteins and enzymes
that maintain good health.

18. DR.HARIVANSH CHOPRA
What is Iron?
•In humans, iron is an essential
component of proteins involved
in oxygen transport.

19. DR.HARIVANSH CHOPRA
What is Iron?
• It is also essential for the regulation of cell
growth and differentiation
• It helps cells to "breathe."
• Iron works with protein to make the
hemoglobin in red blood cells.

20. DR.HARIVANSH CHOPRA
What is Iron?
Dietary iron comes in two forms:
Heme iron
Non-heme iron

21. DR.HARIVANSH CHOPRA
What is Iron?
• Heme iron is found only in animal flesh,
as it is derived from the hemoglobin and
myoglobin in animal tissues.
• Non-heme iron is found in plant foods
and dairy products.

22. DR.HARIVANSH CHOPRA
•Oxygen Distribution
•Iron serves as the core of the
hemoglobin molecule, which is the
oxygen-carrying component of the red
blood cell.
How it Functions?

23. DR.HARIVANSH CHOPRA
•Red blood cells pick up oxygen
from lungs and distribute the
oxygen to tissues throughout
the body
How it Functions?

24. DR.HARIVANSH CHOPRA
•The ability of red blood cells
to carry oxygen is attributed
to the presence of iron in
hemoglobin molecule.
How it Functions?

25. DR.HARIVANSH CHOPRA
•If we lack iron, we will
produce less hemoglobin,
and therefore supply less
oxygen to our tissues.
How it Functions?

26. DR.HARIVANSH CHOPRA
•Iron is also an important
constituent of another
protein called myoglobin.
How it Functions?

27. DR.HARIVANSH CHOPRA
•Myoglobin, like hemoglobin, is an
oxygen-carrying molecule, which
distributes oxygen to muscles cells,
especially to skeletal muscles and to
the heart.
How it Functions?

28. DR.HARIVANSH CHOPRA
• Energy Production
• Iron also plays a vital role in the
production of energy as a constituent of
several enzymes, including iron catalase,
iron peroxidase, and the cytochrome
enzymes
How it Functions?

29. DR.HARIVANSH CHOPRA
How it Functions?
• It is also involved in the production of
carnitine, a nonessential amino acid
important for the proper utilization of fat.
• The function of the immune system is also
dependent on sufficient iron.

30. DR.HARIVANSH CHOPRA
MAGNITUDE OF PROBLEM
Iron deficiency is the most common micronutrient deficiency in the world
affecting 1.3 billion people i.e. 24% of the world population.

31. DR.HARIVANSH CHOPRA
In developing countries, about 50 percent of
women and young children are anemic.
MAGNITUDE OF PROBLEM

32. DR.HARIVANSH CHOPRA
MAGNITUDE OF PROBLEM
The highest overall rates of anemia are reported in
southern Asia and certain regions of Africa

33. DR.HARIVANSH CHOPRA
PREVALENCE IN WORLD
REGION 6 – 59 MONTHS PREGNANT
WOMEN
NON PREGNANT
WOMEN
AFRICA 60.2 % 44.6 % 37.6 %
LATIN AMERICA AND CARIBBEAN 29.1 % 28.6 % 19.1 %
NORTH AMERICA 07.0 % 17.1 % 12.4 %
ASIA 42.0 % 39.3 % 31.9 %
EUROPE 19.3 % 24.5 % 20.1 %
OCENIA 26.2 % 29.0 % 20.0 %
GLOBAL 42.6 % 38.2 % 29.4 %

34. DR.HARIVANSH CHOPRA
PREVALENCE IN INDIA
ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA
AGE GROUP PREVALENCE
6 – 59 MONTHS 58.4 %
PREGNANT WOMEN (15 – 49 YEARS) 53.1 %
NON PREGNANT WOMEN (15 – 49 YEARS) 50.3 %
ALL WOMEN 15 – 49 YEARS 53.0 %
MEN 22.7 %

35. DR.HARIVANSH CHOPRA
PREVALENCE IN UTTAR PRADESH
ACCORDING TO NFHS 4: PREVALENCE OF ANEMIA
AGE GROUP PREVALENCE
6 – 59 MONTHS 63.2 %
PREGNANT WOMEN (15 – 49 YEARS) 52.5 %
NON PREGNANT WOMEN (15 – 49 YEARS) 51.0 %
ALL WOMEN 15 – 49 YEARS 52.4 %
MEN 23.7 %

36. DR.HARIVANSH CHOPRA
ANEMIA IN CHILDREN < 5 YEARS
NORMAL
31%
MILD ANAEMIA
26%
MODERATE
ANAEMIA
40%SEVERE ANAEMIA
3%
ANAEMIA IN CHILDREN 6 - 59 MONTHS (NFHS 3)

37. 74
79
4 5
0
10
20
30
40
50
60
70
80
90
Any anaemia Severe anaemia
NFHS-2 NFHS-3
Percent
10/5/2017 37
Anaemia among Children Age 6-35 Months

38. DR.HARIVANSH CHOPRA
According to the epidemiological data
collected from multiple countries by the
WHO, Some 35 % of women and 43 % of
young children in the world are affected
by anemia.
MAGNITUDE OF PROBLEM

39. DR.HARIVANSH CHOPRA
Whole-grain and enriched breads.
Cereals.
Dark green, leafy vegetables, such as
spinach & dried beans.
FOOD SOURCE

40. DR.HARIVANSH CHOPRA
Milk, yogurt & cheese.
Meat, fish, poultry,
Jaggery
Eggs
FOOD SOURCE

41. DR.HARIVANSH CHOPRA
•The amount of iron needed depends on age, gender, &
activity level.
•Iron needs increase during periods of rapid growth, such as
during pregnancy, childhood, & adolescence when new
tissue is being built.
DAILY REQUIREMENT

42. DR.HARIVANSH CHOPRA
• Women and teenage girls need more iron than
men because of menstrual losses.
• Competitive athletes may also experience an
increased need for iron.
DAILY REQUIREMENT

43. DR.HARIVANSH CHOPRA
Adult male : 17mg/d
Adult female : 21mg/d
Pregnant female : 35mg/d
Lactating female : 21mg/d
Children : 1mg/kg/day
DAILY REQUIREMENT

44. DR.HARIVANSH CHOPRA
IMPACT OF COOKING, STORAGE AND PROCESSING
• Much of the iron in whole
grains is found in the bran
and germ.

45. DR.HARIVANSH CHOPRA
As a result, the milling of grain, which
removes the bran and germ,
eliminates about 75% of the naturally
occurring iron in whole grains.
IMPACT OF COOKING, STORAGE AND PROCESSING

46. DR.HARIVANSH CHOPRA
Impact of Cooking,
Storage and Processing
• Refined grains are often fortified
with iron, but the added iron is
less absorbable than the iron that
naturally occurs in the grain.
IMPACT OF COOKING, STORAGE AND PROCESSING

47. DR.HARIVANSH CHOPRA
•Cooking with iron cookware
will add iron to food, a
practice that can eventually
lead to iron toxicity.
IMPACT OF COOKING, STORAGE AND PROCESSING

48. DR.HARIVANSH CHOPRA
• Iron absorption is increased when there is
an increased physiological need for iron,
as occurs in children during rapid growth
periods and during pregnancy and
lactation.
Predisposing factors for Deficiency

49. DR.HARIVANSH CHOPRA
•Iron absorption is decreased in people with low
stomach acid (hypochlorhydria),
•Iron absorption is decreased by caffeine and
tannic acid found in coffee and tea and by
phosphates found in carbonated soft drinks.
Predisposing factors for Deficiency

50. DR.HARIVANSH CHOPRA
Phytates, found in whole grains, and
oxalates, found in spinach and chocolate,
may also decrease iron absorption by forming
complexes with the mineral that cannot be
absorbed through the digestive tract.
Predisposing factors for Deficiency

51. DR.HARIVANSH CHOPRA
DEMOGRAPHIC FACTORS

52. DR.HARIVANSH CHOPRA
DIETARY FACTORS

53. DR.HARIVANSH CHOPRA
Social/physical factors

54. DR.HARIVANSH CHOPRA
• Use of the following medications may increase the
amount of iron needed :
1) Aspirin and NSAIDS (for eg, ibuprofen)
2) Histamine blockers
3) Neomycin
4) Stanozolol,
5) Warfarin (Coumadin)
DRUG -NUTRIENT INTERACTIONS

55. DR.HARIVANSH CHOPRA
• Dietary iron may impact the absorption of the following medications:
1) Iron binds with sulfasalazine, decreasing sulfasalazine absorption.
2) Iron decreases the absorption of tetracycline.
3) Iron supplements may decrease absorption of thyroid hormone
medications.
DRUG -NUTRIENT INTERACTIONS

56. DR.HARIVANSH CHOPRA
•Iron supplements may interfere with the action of
carbidopa, a drug used in the treatment of Parkinson's
disease.
•Iron supplements decrease the absorption of methyldopa, a
drug used to lower blood pressure in people with high blood
pressure.
DRUG -NUTRIENT INTERACTIONS

57. DR.HARIVANSH CHOPRA
How do other nutrients interact with iron?
Several nutrients increase iron absorption
including ascorbic acid (vitamin C), copper,
cobalt, and manganese.
NUTRIENT INTERACTIONS

58. DR.HARIVANSH CHOPRA
Amino acids also improve iron absorption by
stimulating the secretion of hydrochloric acid in
the stomach.
High dietary intake of calcium may decrease
absorption of dietary iron.
NUTRIENT INTERACTIONS

59. DR.HARIVANSH CHOPRA
What health conditions require special
emphasis on iron?
HEALTH CONDITIONS
Alcoholism
Attention deficit disorder

60. DR.HARIVANSH CHOPRA
Colitis
Diabetes
Excessive menstrual blood loss
HEALTH CONDITIONS

61. DR.HARIVANSH CHOPRA
Iron deficiency anemia
Leukemia
Parasitic infections
HEALTH CONDITIONS

62. DR.HARIVANSH CHOPRA
Restless leg syndrome
Stomach ulcers
Tuberculosis
HEALTH CONDITIONS

63. DR.HARIVANSH CHOPRA
• Many people with iron deficiency don't have
any signs and symptoms because the body's
iron stores are depleted slowly. As anemia
progresses, following symptoms maybe
recognized:
1) Fatigue and weakness
2) Pale skin and mucous membranes
CLINICAL FEATURES

64. DR.HARIVANSH CHOPRA
Rapid heartbeat or a new heart murmur
Irritability
Decreased appetite
CLINICAL FEATURES

65. DR.HARIVANSH CHOPRA
CLINICAL FEATURES
Hair loss
Dizziness or feeling of
being lightheaded.
Rarely, Pica.

66. DR.HARIVANSH CHOPRA
• Also known as Paterson Kelly syndrome.
Characterized by :
1) Iron-deficiency anaemia,
2) Atrophic changes in buccal,
glossopharyngeal, and esophageal
mucous membranes,
Plummer-Vinson Syndrome

67. DR.HARIVANSH CHOPRA
Plummer-Vinson Syndrome
3) Koilonychia (spoon-shaped finger
nails),
4) Dysphagia. The dysphagia is due to a
web formed in the post cricoid
region.

68. DR.HARIVANSH CHOPRA
CUT OFF POINTS FOR DIAGNOSIS
OF ANAEMIA (WHO)
Adult male 13g/dl (venous)
Adult female (non pregnant) 12g/dl
Adult female (pregnant) 11g/dl
Children (6month-6yr) 11g/dl
Children (6-14yr) 12g/dl

69. DR.HARIVANSH CHOPRA
Hb in IDA

70. DR.HARIVANSH CHOPRA
•A complete blood count (CBC) may
reveal low Hb levels and low
hematocrit.
•The CBC gives information about the
size of the red blood cells (RBCs).
DIAGNOSIS

71. DR.HARIVANSH CHOPRA
•RBCs with low hemoglobin tend
to be smaller and less
pigmented.
DIAGNOSIS

72. DR.HARIVANSH CHOPRA
The reticulocyte count measures the
number of immature red blood cells
being produced. This is a useful test
because it can indicate a problem before
anemia develops.
DIAGNOSIS

73. DR.HARIVANSH CHOPRA
•Serum iron directly measures the
amount of iron in the blood, but
may not accurately reflect how
much iron is concentrated in the
body's cells.
DIAGNOSIS

74. DR.HARIVANSH CHOPRA
Serum ferritin reflects total body iron stores. It's one of the earliest
indicators of depleted iron levels, especially when used in
conjunction with other tests, such as a CBC.
Stool test to detect occult blood loss and to detect presence of eggs
of any worms.
DIAGNOSIS

75. DR.HARIVANSH CHOPRA
1) A low MCV (normal-85±8 fl)
2) Low MCH (normal-30±2.5 pg)
3) Low MCHC (normal-33±2.5g/dl), indicate
microcytic anemia.
DIAGNOSIS

76. DR.HARIVANSH CHOPRA
Low serum ferritin (normal 150-2000
ng/dl),
Low serum iron level (normal 80-180
µg/dl),
DIAGNOSIS

77. DR.HARIVANSH CHOPRA
1) Elevated serum transferrin and
2) High total iron binding capacity
(TIBC) (normal 250-450 µg/dl).
DIAGNOSIS

78. DR.HARIVANSH CHOPRA
A definitive diagnosis requires a
bone marrow aspiration, with the
marrow stained for iron.
DIAGNOSIS

79. DR.HARIVANSH CHOPRA
Normal bone marrow is shown here.
Note the erythroid islands where erythropoiesis is occurring.
DIAGNOSIS

80. DR.HARIVANSH CHOPRA
• The diagnosis of iron deficiency anemia requires further
investigation as to its cause. It can be a sign of other
disease, such as
DIAGNOSIS
Colon cancer
Malabsorption
Chronic blood loss

81. DR.HARIVANSH CHOPRA
Diversion of iron to fetal erythropoiesis
during pregnancy,
Intravascular hemolysis &
Hemoglobinuria or other forms of chronic
blood loss should all be considered.
DIAGNOSIS

82. DR.HARIVANSH CHOPRA
Treatment for underlying problem-
• Deworming of patients
• Change in dietary habits
• Wearing of shoes
TREATMENT

83. DR.HARIVANSH CHOPRA
•Iron-rich foods are encouraged.
•Causes of persistent blood loss if any
(polyps, chronic dysentery, ulcerative
colitis etc.) need to be treated.
TREATMENT

84. DR.HARIVANSH CHOPRA
ORAL IRON THERAPY :
The optimal dose of iron is 3-6mg/kg body
weight given orally in 3 doses.
With this, hemoglobin level should rise by
0.4g/dl / day.
TREATMENT

85. DR.HARIVANSH CHOPRA
Oral therapy should be continued
for at-least 8 – 12 weeks.
Vitamin C should be included in
diet and phytate avoided.
TREATMENT

86. DR.HARIVANSH CHOPRA
•If malabsorption is present, it may
be necessary to administer iron
parenterally
•(e.g., iron dextran).
TREATMENT

87. DR.HARIVANSH CHOPRA
•Iron requirement is determined from the following
equation :
IRON (mg) =Wt (kg) X Hb deficit (g/dl) X 80
100 X 3.4 X 1.5
Or, Wt (kg) X Hb deficit (g/dl) X 4
TREATMENT

88. DR.HARIVANSH CHOPRA
Follow up evaluation with CBC is
essential to demonstrate whether
the treatment has been effective.
TREATMENT

89. Children 6 – 60 months
SUPPLEMENTATION
•20 mg of elemental iron and
100 mcg of folic acid in
biweekly regimen
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE

90. Children 6 – 60 months
• MILD ANEMIA (Hb 10 – 10.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of anemia for 2
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE

91. Children 6 – 60 months
• MODERATE ANEMIA (Hb 7 – 9.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of anemia for 2
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE

92. Children 6 – 60 months
• SEVERE ANEMIA (Hb < 7 )
Refer urgently to DH/FRU
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE

93. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 6 MONTHS – 5 YEARS
HISTORY TO BE TAKEN FOR
Duration of symptoms
Usual diet (before current illness)
Family circumstances
Prolonged fever
Worm infestation
Bleeding from any site
Any lumps in the body 93

94. EXAMINATION FOR
Severe palmar pallor
Skin bleeds
Lymphadenopathy
Hepato splenomegaly
Signs of heart failure
DR.HARIVANSH CHOPRA
MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 6 MONTHS – 5 YEARS

95. Investigations Indication for blood
transfusion
Blood transfusion
• Full blood count and
examination of a thin film
for cell morphology
• Blood films for malaria
parasites
• Stool Examination for ova,
cyst, and occult blood
 All children with Hb ≤4gm/dl
 Children with Hb 4-6 gm/dl
with any of the following :
 Dehydration
 Shock
 Impaired Consciousness
 Heart Failure
 Deep and labored Breathing
 Very high parasitemia
If packed cells are available,
give 10ml/kg over 3-4 hours
preferably. If not, give whole
blood 20ml/kg over 3-4 hours
95

96. DOSE OF IFA SYRUP FOR ANEMIC CHILDREN
6 MONTHS – 5 YEARS
AGE OF CHILD DOSE FREQUENCY
6 months – 12 months
(6-10 kg)
1 ml of IFA syrup Once a day
1 year – 3 years
(10 – 14 kg)
1.5 ml of IFA syrup Once a day
3 years – 5 years
(14 – 19 kg)
2 ml of IFA syrup Once a day
96

97. SUPPLEMENTATION
Tablets of 45mg elemental iron
and 400mcg of folic acid
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
CHILDREN 5 – 10 YEARS

98. • MILD ANEMIA (Hb 11 – 11.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of anemia for 2
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
CHILDREN 5 – 10 YEARS

99. • MODERATE ANEMIA (Hb 8 – 10.9 gm/dl)
3mg of iron/Kg/day for 2 months
In case the child has not responded to treatment of anemia for 2
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
CHILDREN 5 – 10 YEARS

100. • SEVERE ANEMIA (Hb < 8 gm/dl )
Refer urgently to DH/FRU
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
CHILDREN 5 – 10 YEARS

101. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 5 – 10 YEARS
HISTORY TO BE TAKEN FOR
Duration of symptoms
Usual diet (before current illness)
Family circumstances
Prolonged fever
Worm infestation
Bleeding from any site
Any lumps in the body 101

102. EXAMINATION FOR
Severe palmar pallor
Skin bleeds
Lymphadenopathy
Hepato splenomegaly
Signs of heart failure
DR.HARIVANSH CHOPRA
MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN CHILDREN 5 – 10 YEARS

103. Investigations Indication for blood
transfusion
Blood transfusion
• Full blood count and
examination of a thin film
for cell morphology
• Blood films for malaria
parasites
• Stool Examination for ova,
cyst, and occult blood
 All children with Hb ≤4gm/dl
 Children with Hb 4-6 gm/dl
with any of the following :
 Dehydration
 Shock
 Impaired Consciousness
 Heart Failure
 Deep and labored Breathing
 Very high parasitemia
If packed cells are available,
give 10ml/kg over 3-4 hours
preferably. If not, give whole
blood 20ml/kg over 3-4 hours
103

104. ADOLESCENTS 10 – 19 YEARS
104

105. SUPPLEMENTATION
100mg elemental Iron and
500mcg folic acid
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
ADOLESCENTS 10 – 19 YEARS

106. • MILD ANEMIA (Hb 11 – 11.9 gm/dl)
60mg of iron/day for 3months
In case the child has not responded to treatment of anemia for 3
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
ADOLESCENTS 10 – 19 YEARS

107. • MODERATE ANEMIA (Hb 8 – 10.9 gm/dl)
60 mg of iron/day for 3 months
In case the child has not responded to treatment of anemia for 3
months, refer the child to the FRU/DH with F-IMNCI trained
MO/Pediatrician/Physician for further investigation
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
ADOLESCENTS 10 – 19 YEARS

108. • SEVERE ANEMIA (Hb < 8 gm/dl )
Refer urgently to DH/FRU
DR.HARIVANSH CHOPRA
THERAPEUTIC APPROACH THROUGH THE
LIFE CYCLE
ADOLESCENTS 10 – 19 YEARS

109. MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN ADOLESCENT
HISTORY TO BE TAKEN FOR
Duration of symptoms
Usual diet (before current illness)
Family circumstances
Prolonged fever
Worm infestation
Bleeding from any site
Any lumps in the body 109

110. EXAMINATION FOR
Severe palmar pallor
Skin bleeds
Lymphadenopathy
Hepato splenomegaly
Signs of heart failure
DR.HARIVANSH CHOPRA
MANAGEMENT OF SEVERE ANEMIA AT FRU/DH
(as per F-IMNCI) IN ADOLESCENT

111. Investigations Indication for blood
transfusion
Blood transfusion
• Full blood count and
examination of a thin film
for cell morphology
• Blood films for malaria
parasites
• Stool Examination for ova,
cyst, and occult blood
 All children with Hb ≤4gm/dl
 Children with Hb 4-6 gm/dl
with any of the following :
 Dehydration
 Shock
 Impaired Consciousness
 Heart Failure
 Deep and labored Breathing
 Very high parasitemia
If packed cells are available,
give 10ml/kg over 3-4 hours
preferably. If not, give whole
blood 20ml/kg over 3-4 hours
111

112. PREGNANT AND LACTATING WOMEN
112

113. • Hb level 9 – 11gm/dl
• IFA tablets 100mg iron and 500
mcg folic acid
• 2 IFA tablets per day for at least
100 days
2 IFA tablets
Hb estimation
monthly
If stores do not
improve: Referral
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN

114. • Hb 8 – 9 mg/dl
Cause of IDA must be investigated
• 2 tablet IFA to be given daily
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN
2 IFA tablets
Hb estimation
monthly
If stores do not
improve: Referral

115. • Hb 7 – 8 mg / dl
• Before starting the treatment, the
women should be investigated to
detect the cause of anemia
• Injectable IM preparations
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN

116. • Hb 5 – 7 mg / dl
• Continue Parenteral iron therapy
as for Hb level between 7-8mg/dl.
• Hb testing to be done after 8
weeks
Parenteral iron
Hb estimation at 8
weeks
Hb 9-11
2 tablets / day
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN

117. • Hb < 5 gm /dl
• injectable IV sucrose preparations
• Immediate Hospitalization irrespective
of period of gestation in hospitals for
blood transfusion
DR.HARIVANSH CHOPRA
PREGNANT AND LACTATING WOMEN

118. 118
LEVEL OF Hb TREATMENT FOLLOW UP REFERRAL
MILD ANEMIA
(11 -11.9 gm/dl)
60mg of elemental
iron daily for 3 months
Follow up every month
Hb estimation after completing 3
months of treatment to assess if
Hb estimates are >12 gm/dl
In case the child has no
improvement in Hb levels after
3 months of treatment,
adolescent will be referred to
DH/FRU for further
investigation
MODERATE
ANEMIA
(8 – 10.9 gm/dl)
60mg of elemental
iron daily for 3 months
Investigation
Follow up every month
Hb estimation after completing 3
months of treatment to assess if
Hb estimates are >12 gm/dl
In case the child has no
improvement in Hb levels after
3 months of treatment,
adolescent will be referred to
DH/FRU for further
investigation
SEVERE ANEMIA
(<7gm/dl)
Refer urgently to
DH/FRU
Severely Anaemic adolescents
would be line listed by ANM

119. DR.HARIVANSH CHOPRA
Prevention of iron deficiency can be achieved
by following measures :
Dietary changes
Fortification of foods
Supplementation
PREVENTION

120. DR.HARIVANSH CHOPRA
Iron Supplementation v/s Iron Therapy – Cost
Iron Supplementation, 30
Iron Therapy, 70

121. DR.HARIVANSH CHOPRA
PREVENTION
Infection control
Research & monitoring
Programme implementation.

122. DR.HARIVANSH CHOPRA
•Launched in 1970 to prevent nutritional
anaemia in mother & children.
•This program is now a part of RCH II
program.
NATIONAL NUTRITIONAL ANAEMIA
PROPHYLAXIS PROGRAM

123. DR.HARIVANSH CHOPRA
NATIONAL NUTRITIONAL ANAEMIA
PROPHYLAXIS PROGRAM
• Under this program, prophylactic treatment
for expected and nursing mothers are given
one tablet containing 100 mg elementary iron
and 0.5 mg folic acid.

124. DR.HARIVANSH CHOPRA
NATIONAL NUTRITIONAL ANAEMIA
PROPHYLAXIS PROGRAM
• Children are given one tablet containing 20mg
elemental iron and 0.1 mg folic acid for a
period of 100 days.
• For therapeutic purpose, number of tablets is
increased to 2 daily.

125. NATIONAL IRON + INITIATIVE
Launched to bring existing
Programmes together and
establish new age groups
125

126. Bi weekly iron supplementation for pre school
children 6 months to 5 years
DR.HARIVANSH CHOPRA
Weekly Supplementation for children from
1st to 5th grade in Govt. and Govt. aided
school
NATIONAL IRON + INITIATIVE

127. Weekly supplementation for out of school
children (5 – 10 years) at Anganwadi Centers.
DR.HARIVANSH CHOPRA
Weekly Supplementation for adolescents (10
– 19 years)
NATIONAL IRON + INITIATIVE

128. Pregnant and lactating women
DR.HARIVANSH CHOPRA
Weekly Supplementation for women in
reproductive age
NATIONAL IRON + INITIATIVE

129. LACK OF AWARENESS IN MASSES AND PERIPHERAL HEALTH WORKERS
REGARDING ANAEMIA
LACK OF STRATEGY TO REACH EVERY CHILD
LACK OF STRATEGY TO SUPPLEMENT IRON FROM AGE OF 4 MONTHS
LACK OF ADEQUATE SUPPLY OF IRON SYRUPS AND DROPS
FAILURE TO ADDRESS SOCIAL FACTORS RELATED TO HIGH FERTILITY AND MORE
STRESS ON POPULATION CONTROL

130. DR.HARIVANSH CHOPRA
CONCLUSION
Iron deficiency is the commonest deficiency disorder.
If not treated in time, it results in mortality in the vulnerable
period of life.
Despite having a technically good programme for its prevention,
cost effective supplementation is still not implemented..!!

131. DR.HARIVANSH CHOPRA
• Normal requirement of iron in children is-
1. 0.1mg/kg/day
2. 0.5mg/kg/day
3. 1mg/kg/day
4. 5mg/kg/day ANS. 3

132. DR.HARIVANSH CHOPRA
• The prevalence of anaemia in pregnancy in India is –
1. 10-20%
2. 20-30%
3. 30-40%
4. 40-50% ANS. 4

133. DR.HARIVANSH CHOPRA
• WHO Cut off point for diagnosis of anaemia for children (6month-
6year) is :
1) 11g/dl
2) 12g/dl
3) 13g/dl
4) 10g/dl
ANS. 1

134. DR.HARIVANSH CHOPRA
• Normal serum iron level is :
1. 30-80 µg/dl
2. 80-180 µg/dl
3. 150-250 µg/dl
4. 250-450 µg/dl ANS. 2

135. DR.HARIVANSH CHOPRA
• The content of a tablet used for prevention of Nutritional Anaemia in
Pregnant female is :
1. 50mg iron, 0.1mg folic acid
2. 50mg iron, 0.5mg folic acid
3. 100mg iron, 0.1mg folic acid
4. 100mg iron, 0.5mg folic acid
ANS. 4

136. DR.HARIVANSH CHOPRA