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American Journal of Public Health Research. 2015, 3(4A), 57-61
DOI: 10.12691/ajphr-3-4A-12
Open AccessResearch Article

Microcytic Hypochromic Anemia in Pediatric Age Group: A Hospital Based Study in Nepal

Arnab Ghosh1, , Dilasma Ghartimagar1, Sushma Thapa1, Brijesh Sathian2 and Asis De2

1Department of Pathology, Manipal College of Medical Sciences Pokhara, Nepal

2Department of Community Medicine, Manipal College of Medical Sciences Pokhara, Nepal

Pub. Date: June 26, 2015
(This article belongs to the Special Issue Maternal and Child Health)

Cite this paper:
Arnab Ghosh, Dilasma Ghartimagar, Sushma Thapa, Brijesh Sathian and Asis De. Microcytic Hypochromic Anemia in Pediatric Age Group: A Hospital Based Study in Nepal. American Journal of Public Health Research. 2015; 3(4A):57-61. doi: 10.12691/ajphr-3-4A-12


Iron deficiency is a major global health issue and it causes anemia as well as impaired cognitive and motor development and behavioral abnormalities. In developing countries, 39% children below 5 years and 48% children between 5–14 years suffer from anemia. Children with anemia may present in hospital with anemia related nonspecific or specific symptoms or with other associated diseases. In the current study, we have analyzed all pediatric cases with microcytic hypochromic anemia due to iron deficiency. The study was a hospital based retrospective study conducted over a period from September 2013 to December 2014. All cases with age between 1 month to 15 years who had microcytic hypochromic anemia were included in the study and were evaluated for definite diagnoses. All cases with iron deficiency were collated according to age, sex, social status, clinical features and presentation. A total of 422 cases of microcytic hypochromic anemia including 400 cases with iron deficiency were seen in the study period. Male to female ratio was 1.5:1 and the mean age was 4.9 years. The commonest age group was between 1-6 years (45%), followed by the group below 1 year of age (33.8%) and those above 6 years of age (21.2%). The majority of the patients were in the lower socio economic status (SES) (234 cases, 58.5%) followed by middle SES (118 cases, 29.5%) and higher SES (48 cases, 12%). Most of the cases presented with acute infections (234, 58.5%), followed by chronic infections (103, 25.8%) and chronic non-infectious diseases (43, 10.8%). The commonest clinical feature was pallor followed by nonspecific symptoms like generalized weakness and fever, vomiting, abdominal pain, cough. In the pediatric age group, IDA is the commonest type of anemia and is more common in infant and young children especially in lower SES which is similar to other developing countries. In this hospital based study, most cases presented with acute or chronic infections and very few cases presented with complaints related only to anemia. Community based programs might be carried out to increase the awareness of the society about proper nutrition and early detection of anemia.

Pediatric Microcytic Hypochromic Iron Deficiency Anemia

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[1]  Iron Deficiency Anaemia: Assessment, Prevention and Control, A Guide for Programme Managers, WHO, UNICEF, UNU, Geneva, Switzerland, 2001, Available from URL: deficiency/WHO NHD 01.3/en/index.html.
[2]  Hercberg S, Galan P, Dupin H (Eds) Recent Knowledge on Iron and Folate Deficiencies in the World. Colloque INSERM Vol 197, Paris: INSERM, 1990; 209-15
[3]  Stoltzfus RJ, Mullany L, Black RE. Vol 1. Geneva: World Health Organization Iron deficiency anaemia. Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors; 2005:163-209.
[4]  Department of Health Services (DoHS). Annual Report 2068/2069. Government of Nepal Ministry of Health and Population. Kathmandu, Nepal. 2012.
[5]  Nathan DG, Orkin SH. Nathan and Oski’s Haematology of infancy and childhood. 5th ed. Vol 1. Philadelphia: WB Saunders; 1998: p 375-84.
[6]  Kilbride J, Baker TG, Parapia LA, Khoury SA. Incidence of iron-deficiency anaemia in infants in a prospective study in Jordan. Eur J Haematol. 2000 Apr; 64 (4): 231-6.
[7]  Sathian B, Sreedharan J, Baboo SN, Sharan K, Abhilash ES, Rajesh E. Relevance of Sample Size Determination in Medical Research. Nepal J Epidemiol. 2010; 1 (1): 4-10.
[8]  Hermiston ML, Mentzer WC. A practical approach to the evaluation of the anemic child. Pediatr Clin North Am. 2002 Oct; 49 (5): 877-91.
[9]  Parvez I Paracha, SM Khan, I Ahmad, G Nawab. Effect of iron supplementation on biochemical indices of iron status in selected pre-adolescent schoolgirls in North West Frontier Province, Pakistan.Asia Pac J Clin Nutr. 1993; 2 (4): 177-81.
[10]  Khor GL.Update on the prevalence of malnutrition among children in Asia. Nepal Med Coll J. 2003 Dec; 5 (2): 113-22.
[11]  Bethel DR, Huang J. Recombinant human lactoferrin treatment for global health issues: iron deficiency and acute diarrhea. Bio Metals, 2004; 17: 337-42.
[12]  Pasricha SR, Black J, Muthayya S. Determinants of anemia among young children in rural India. Pediatrics, 2010; 126 (1): e140-e149.
[13]  Alvarez-Uria G, Naik PK, Midde M, Yalla PS, Pakam R. Prevalence and Severity of Anaemia Stratified by Age and Gender in Rural India. Anemia. 2014; Article ID 176182, 5 pages.
[14]  Shively, G., J. Gars and C. Sununtnasuk. 2011. A Review of Food Security and Human Nutrition Issues in Nepal. West Lafayette (IN): Purdue University Department of Agricultural Economics Staff Paper Series No. 11‐05.
[15]  Muhe L, Oljira B, Degefu H, Jaffar S, Weber MW. Evaluation of clinical pallor in the identification and treatment of children with moderate and severe anaemia. Tropical Medicine & International Health, 2000 (5): 805-10.
[16]  Wharton BA. Iron deficiency in children: detection and prevention. British Journal of Haematology. 1999; 106: 270-80.
[17]  Verma M, Chhatwal J, Kaur G. Prevalence of anemia among urban school children of Punjab. Indian Pediatr. 1998 Dec; 35 (12): 1181-6.
[18]  Sinha AK, Majumdar B, Yadav SK. Prevalence and significance of iron deficiency of anaemia among people of Mornag District of Nepal. Journal of Nobel Medical College. 2011; 1 (1): 40-4.
[19]  Vasanthi G, Pawashe AB, Susie H, Sujatha T, Raman L. Iron nutritional status of adolescent girls from rural area and urban slum. Indian Pediatr. 1994; 31: 127-32.
[20]  Ali NS, Zuberi RW. Late weaning: the most significant risk factor in the development of iron deficiency anaemia at 1-2 years of age. Journal of Ayub MRMedical College. 2003; 15 (2): 3-7.
[21]  Lozoff B, Lu Angelilli M, Zatakia J, Jacobson SW, Calatroni A, Beard J. Iron status of inner-city African-American infants. Am J Hematol. 2007; 82: 112-21.
[22]  Osório Mônica M, Lira Pedro IC, Batista-Filho M, Ashworth A. Prevalence of anemia in children 6-59 months old in the state of Pernambuco, Brazil. Rev Panam Salud Publica [serial on the Internet]. 2001 Aug; 10 (2): 101-07.
[23]  Thavraj VK, Reddy V. Serum Ferritin in healthy school children. Indian Pedlatr. 1985; 22: 51-7.
[24]  Halileh S, Gordon NH. Determinants of Anemia in Pre-School Children in the Occupied Palestinian Territory. J Trop Pediatr. 2006 February; 52 (1): 1218.
[25]  Greer JP, Foerster J, Lukens JN, Rodgers GM, Parashewas F, Gladder B, editors. Wintrobe’s clinical hematology. 11 ed. Philadelphia. Lippincott Williams and Wilkins; 2003: p 980 (vol 1)
[26]  Bhaskaran P, Madhavan Nair K, Balakrishnan N. Serum transferrin receptors in children with respiratory infections. Eur J Nutr. 2003; 57: 75-80.
[27]  De-Silva A, Atukorola S, Weerasinghel. Iron supplementation improves iron status and reduces morbidity in childrenwith or with out URTI. Am J Clin Nutr 2003; 77: 234-41.
[28]  Fleming AF. Iron deficiency in the tropics. Clin Haematol. 1982 Jun; 11 (2): 365-88.
[29]  Pisacane A, Sansone R, Impagliazzo N, Coppola A, Rolando P, D'Apuzzo A, Tregrossi C. Iron deficiency anaemia and febrile convulsions: case-control study in children under 2 years. BMJ. 1996 Aug 10; 313 (7053): 343-43.
[30]  Nepal Government National Nutrition Program to reduce anemia in pediatric age group Department of Health Services (DoHS). Annual Report 2070/2071. Government of Nepal Ministry of Health and Population. Kathmandu, Nepal. 2014.