What to do if your child has low hemoglobin

To do or not to do, to take or not to take medicine, to take a test or not to take a test. We are always faced with a choice and are often afraid of making a mistake. Iron can be said that you can’t go wrong with iron.

The adult human body contains about 3–4.5 g of iron. More than half of the iron is represented by heme in the composition of hemoglobin, a third is stored in the depot in the form of ferritin and hemosiderin. Moreover, iron deficiency is the most common deficiency condition worldwide, silently leading to anemia.

The main causes of iron deficiency:

Reduced intake of iron into the body due to impaired absorption due to diseases of the gastrointestinal tract, fasting, refusal, or reduced consumption of foods containing iron.

Increased iron loss during chronic, repeated blood loss (uterine, gastric, intestinal, etc.), as well as during acute massive bleeding.

Increased consumption of iron by the body in children during periods of growth, in women during pregnancy and subsequent breastfeeding of the child.

What to do if your child has low hemoglobin

Low hemoglobin in a child under one year old may be a sign of iron deficiency anemia. When to start monitoring hemoglobin levels, is it possible to prevent anemia and correct health indicators without administering medications, said pediatrician and perinatal psychologist Polina Aleksandrovna Kizino.

— Polina Aleksandrovna, red blood cells and hemoglobin are often mentioned in the diagnosis of anemia. How are these three concepts related to each other?

— Hemoglobin is a protein that is found inside an erythrocyte (blood cell). Its main function is to transport oxygen from the lungs to all organs and tissues of the body. The fewer red blood cells, the less hemoglobin, which means the saturation of the body with oxygen is worse. A decrease in the level of hemoglobin, and therefore oxygen in the blood, is called anemia. There are a huge number of types of anemia, and they are caused by different reasons, it is important to understand this.

Causes of anemia

• Low content of red blood cells, increased destruction, slow rate of formation.
• Inability of hemoglobin to bind oxygen.
• Copious blood loss.
• Insufficient amounts of iron, folic acid or vitamin B12 in the body due to an inappropriate diet or malabsorption due to diseases of the gastrointestinal tract.
• Hereditary and others associated with a large number of factors.

— Why does a baby have low hemoglobin?

— The reasons for decreased hemoglobin levels in children are very diverse. More often, hemoglobin falls due to a deficiency of microelements and vitamins, in most cases iron. Iron deficiency anemia is most common in children.

Some of the rarest situations in which low hemoglobin may occur

• Bone marrow pathology.
• Chronic or acute bleeding.
• Hemolysis.

In addition, it has been noted that anemia can occur in children who receive whole milk as their main diet instead of formula. This can be avoided if whole milk is included in baby products - adapted formula, milk porridge, cottage cheese and others.

— How to understand that a child has low hemoglobin?

— External manifestations of anemia are nonspecific. And it is impossible to make a diagnosis without laboratory tests.

The very first signs of low hemoglobin in a child that parents can pay attention to

• Sleep disturbance, shallow sleep.
• Lethargy.
• Fast fatiguability.
• Tearfulness, irritability.
• Paleness, peeling of the skin.
• Less commonly, brittle nails and hair.

Upon examination, the pediatrician can detect a decrease in blood pressure, rapid heartbeat, and sometimes heart murmurs.

Advice: If you suspect anemia in your child, consult your pediatrician. Make a list of questions. Write down your symptoms. Show your food diary for breastfeeding and complementary feeding.

— Why is low hemoglobin dangerous in a child?

— A low level of hemoglobin indicates a low level of oxygen in the blood, that is, hypoxia, which leads to disruption of the functioning of all organs and systems. Of course, the decrease can be of varying degrees, and its manifestations are different, but the closer the hemoglobin level is to normal, the less pronounced the condition.

Degrees of anemia in children

— A mild degree of the disease is more common, since in most cases, babies in the first year of life are constantly monitored by a doctor. And if the baby does not suffer from some serious chronic disease, then, as a rule, it is possible to suspect and begin treatment for mild anemia.

— When is anemia diagnosed?

— The main criterion for diagnosing anemia is a hemoglobin level below 110 g/l. Anything higher is the norm. The disease is diagnosed based on the results of a clinical (general) blood test, which is impossible at home. In this case, the doctor evaluates not only the hemoglobin level, but also other laboratory test indicators. This allows you to determine whether there is anemia or not, as well as to suggest its cause.

A clinical blood test is performed starting at 2 months. It is important to remember about the calendar of examinations for children under one year old and not to miss trips to the clinic in order to see in time and not start the pathological process.

— Polina Aleksandrovna, if a child has low hemoglobin, what should be done to bring the level back to normal?

— The hemoglobin level will not rise to normal levels on its own. We need to work on the cause of anemia. And since the causes are different, the methods of treatment are different. For example, in the most common situation, when a baby’s hemoglobin is low due to iron deficiency, this deficiency is compensated with the help of iron-containing drugs. Everyone knows that hemoglobin is a protein that contains iron. Therefore, by replenishing iron reserves in the body, you can achieve the required hemoglobin level.

You can increase hemoglobin at home without drugs when there is no anemia. For example, a hemoglobin level of 115 g/l is within the normal range, and if it needs to be maintained, a diet will help not to go negative. But iron deficiency anemia can only be treated with medications, not diet. The doctor prescribes medicine and determines how often and in what quantity to take iron, based on data on the level of hemoglobin in the blood of a small patient.

— What myths are the most dangerous when treating anemia in children?

1 myth. The only reason for low hemoglobin is low iron levels.

— Low hemoglobin levels do not always mean low iron levels. Iron deficiency can be associated with completely different conditions.

2 myth. Hemoglobin levels can be raised by diet.

— The daily intake of iron from food is not enough to produce hemoglobin at pathologically low levels. If, according to the results of the examination, the child has low hemoglobin, it is necessary to contact a pediatrician to find out the cause and receive specific treatment depending on the form and extent of the disease.

— Is it possible to prevent iron deficiency anemia in children under one year of age?

— Diet is important. You should not delay the introduction of complementary foods, because the baby’s endogenous iron reserves are gradually depleted, and by six months it is already difficult to replenish them exclusively with breast milk or formula. So prevention is an adequate varied diet, including through the first complementary foods, the introduction of which is allowed at 4–6 months.

Hemoglobin is not the only indicator by which anemia is diagnosed. It is important not to self-diagnose or self-medicate. If you suspect anemia in your child, consult a doctor for examination. Based on laboratory data, the doctor will confirm anemia or a tendency towards iron deficiency and prescribe the correct therapy.

Pediatrician Polina Aleksandrovna Kizino

*The ideal food for an infant is mother's milk. WHO recommends exclusive breastfeeding for the first 6 months. MAMAKO® supports this recommendation. Before introducing new foods into your baby’s diet, consult a specialist.

What tests show iron deficiency?

• Be sure to look at a general blood test with a leukocyte formula, since iron deficiency ultimately leads to the development of anemia. Iron deficiency anemia is indicated by a decrease in hemoglobin levels, an indicator of MCV (erythrocyte hypochromia). Often, the examination begins when there are symptoms of anemia (pallor, weakness, dizziness, loss of strength, decreased performance and attention, brittle nails and hair, etc.).
• Decreased serum iron concentration
• Increasing the total iron-binding capacity of serum
• Decreased transferrin saturation coefficient with iron
• Decreased serum ferritin concentration

It is recommended to take tests in the morning, from 8 to 11 am, since the level of iron in the serum is higher in the morning. They should also be taken in the absence of inflammation, which helps lower transferrin levels and increase ferritin levels.

The iron content in the serum is checked 5-7 days after taking vitamin-mineral complexes and dietary supplements containing iron, or short-term use of iron supplements.

Increased hemoglobin

An increased level of hemoglobin in the blood can be due to various reasons, but often it is due to an excess number of blood cells in the body. This condition is called erythrocytosis. It can lead to a number of disruptions in the functioning of the body, since increased hemoglobin leads to poor blood clotting and circulation.

The main reasons for the increase in the number of red blood cells:

1. Decrease in blood plasma volumes.
2. Bad habits. Smoking can cause high hemoglobin due to lack of oxygen in the body.
3. Moving to a mountainous area. The reason is the same as with smoking.
4. Dehydration. Lack of water also leads to an increase in hemoglobin. But when the water balance in the body normalizes, the level will return to normal.
5. The use of anabolic agents and certain medications can also lead to an increase in the number of red blood cells and hemoglobin.

How is iron deficiency treated?

It is necessary to identify and eliminate the cause of iron deficiency and adjust nutrition.
If these measures do not help, and iron loss is significant, your doctor may prescribe iron-based medications. Duration of treatment with iron preparations for the purpose of restoration and replenishment of iron reserves in the depot:

• for hidden iron deficiency 1-2 months,
• for mild anemia 3 months,
• with moderate anemia 4.5 months,
• for severe anemia 6 months.

Of course, first of all, iron supplements are used in the form of tablets, drops, capsules, syrups. If your doctor has prescribed you iron supplements, you need to be prepared for long-term and comfortable treatment. This will help by following simple rules.

The dosage of the drug is also determined by the presence of anemia (this is the full therapeutic dose) and the type of iron ion that is included in the drug.

What iron supplements are there?

Iron in preparations can be represented by a di- or trivalent ion, designated Fe2+ or Fe3+, which is part of salts or complex complexes (for example, polymaltose complex hydroxide).

When using iron salts, you may encounter problems with its absorption. Unfortunately, not all iron from the drug is absorbed in the gastrointestinal tract. Moreover, this process is poorly controlled, since it depends on the state of the gastrointestinal tract, food taken, and other medications. Therefore, both a lack of incoming iron and an overdose are possible. In addition, not all forms of medication are convenient to use; if some tablets are chewed, the enamel of the teeth is often stained and a metallic taste remains in the mouth for a long time. Trivalent iron preparations usually do not have these side effects.

How to increase the effectiveness of treatment

To reduce the likelihood of side effects, iron salts are taken before meals.

The absorption of iron is higher when taken simultaneously with ascorbic and succinic acids, fructose, and cysteine. This property is used in some combination drugs.

Iron absorption is reduced by certain substances from food or medications. Thus, it is reduced by tannin (strongly brewed tea), calcium salts (in milk or medications), magnesium and manganese (in mineral complexes or antacid preparations, such as phosphalugel), tetracycline antibiotics, phosphoric and phytic acids (cereal seeds, legumes). This effect is smoothed out when using preparations based on ferric iron.

Iron absorption is increased in severe iron deficiency. Therefore, you should be more careful about the prescribed dosage. Doctors often rely on a therapeutic dose of 200 mg of iron ion/day. If you understand that an iron supplement is not suitable for you due to the development of adverse reactions, difficulties in taking it, or lack of improvement in your well-being, tell your doctor about this. Under no circumstances should you change the dosage of the drug yourself. Exceeding the dose can lead to overdose and poisoning, reducing the dose can lead to useless use and lack of effect.

Reduced hemoglobin

The first symptoms of low hemoglobin are general weakness, constant drowsiness, fatigue, dizziness and headaches, low blood pressure, and irregular heartbeat. In some cases, the patient faints.

If the amount of protein decreases due to lack of iron, then the patient experiences dystrophic symptoms:

• hair and nails become brittle and grow poorly;
• microcracks appear in the corners of the mouth;
• the skin becomes dry;
• Possible hair loss.

In some cases, the patient's sense of taste and smell are impaired.

Most often, reduced hemoglobin is a sign of some disease. The most common ones are:

• blood loss;
• iron deficiency anemia in chronic form;
• thinning of the gastric mucosa;
• dysbiosis, chronic intestinal inflammation;
• iron deficiency anemia that occurs in the postoperative period;
• rheumatoid arthritis;
• lupus;
• glomerulonephritis;
• long-term course of infectious diseases;
• malignant tumors, especially of the digestive system;
• malignant blood pathologies.

How is the effectiveness of treatment assessed?

During the first days of treatment with iron supplements, physical sensations are assessed.

When treating anemia, on the 5-8th day of treatment, a reticulocyte crisis is determined (an increase in the number of reticulocytes compared to the initial value, usually by 2-3% or 20-30‰).

After 4 weeks of treatment, the increase in hemoglobin is assessed. An increase in hemoglobin concentration by 10 g/l by the end of the first month of treatment with iron preparations indicates that the dose has been correctly selected and the effectiveness of therapy. After hemoglobin is restored, therapy is continued to saturate the iron depot, while the dose of the drug is reduced by 2 times.

For hidden iron deficiency, half doses of the drugs are used for 4-8 weeks. Depot saturation is determined using a comprehensive biochemical study (ferritin, transferrin, TLC).

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