背景:全球,缺铁性贫血是儿童最常见的营养缺乏障碍和贫血的主要原因,尤其是在发展中国家。当出现在儿童早期时,特别是如果严重和长时间,缺铁性贫血会导致神经发育和认知缺陷,即使在纠正缺铁性贫血后,也可能并不总是完全可逆的。
目的:本文旨在使医生熟悉临床表现,诊断,评估,预防,和治疗儿童缺铁性贫血。
方法:于2023年2月在临床查询中使用关键术语“缺铁性贫血”进行了PubMed搜索。搜索策略包括所有临床试验(包括开放试验,非随机对照试验,和随机对照试验),观察性研究(包括病例报告和病例系列),和评论(包括叙述性评论,临床指南,和荟萃分析)在过去10年内发表。Google,UpToDate,和维基百科也被搜索以丰富评论。本评论仅包括在英语文献中发表的论文。从搜索中检索到的信息用于本文的汇编。
结果:缺铁性贫血最常见于9个月至3岁的儿童和青春期。缺铁性贫血可能是由于对铁的需求增加,铁摄入量不足,铁吸收减少(吸收不良),失血量增加,很少,有缺陷的等离子体铁传输。大多数患有轻度缺铁性贫血的儿童无症状。苍白是最常见的呈现特征。在轻度至中度缺铁性贫血中,食欲不振,可疲劳性,懒散,嗜睡,锻炼不容忍,烦躁,可能会出现头晕。在严重缺铁性贫血中,心动过速,呼吸急促,排汗,和不良的毛细管再填充可能发生。当出现在儿童早期时,特别是如果严重和长时间,缺铁性贫血会导致神经发育和认知缺陷,即使纠正缺铁性贫血,也可能不总是完全可逆的。低血红蛋白和显示低血色素的外周血膜,微胞嘧啶,和明显的红细胞增多症,应该引起对缺铁性贫血的怀疑。低血清铁蛋白水平可以证实诊断。口服铁剂治疗是缺铁性贫血的一线治疗。这可以通过口服一种亚铁制剂来实现,这是治疗缺铁性贫血的最具成本效益的药物。最佳反应可通过每天3至6mg/kg元素铁的剂量来实现。通常不需要肠胃外铁剂治疗或红细胞输注。
结论:尽管患病率有所下降,缺铁性贫血仍然是幼儿和青少年贫血的常见原因,特别是在发展中国家;因此,它的预防很重要。初级预防可以通过补充铁或主食的铁强化来实现。饮食咨询和营养教育的重要性怎么强调都不为过。二级预防包括筛查,诊断,和治疗缺铁性贫血。美国儿科学会建议对健康儿童在大约1岁时进行普遍的缺铁性贫血实验室筛查。此时应评估与缺铁性贫血相关的危险因素。在确定了缺铁性贫血的危险因素的任何年龄,都应进行选择性实验室筛查。
BACKGROUND: Worldwide, iron deficiency anemia is the most prevalent nutritional deficiency disorder and the leading cause of anemia in children, especially in developing countries. When present in early childhood, especially if severe and prolonged, iron deficiency anemia can result in neurodevelopmental and cognitive deficits, which may not always be fully reversible even following the correction of iron deficiency anemia.
OBJECTIVE: This article aimed to familiarize physicians with the clinical manifestations, diagnosis, evaluation, prevention, and management of children with iron deficiency anemia.
METHODS: A PubMed search was conducted in February 2023 in Clinical Queries using the key term \"iron deficiency anemia\". The search strategy included all clinical trials (including open trials, non-randomized controlled trials, and randomized controlled trials), observational studies (including case reports and case series), and reviews (including narrative reviews, clinical guidelines, and meta-analyses) published within the past 10 years. Google, UpToDate, and Wikipedia were also searched to enrich the
review. Only papers published in the English literature were included in this
review. The information retrieved from the search was used in the compilation of the present article.
RESULTS: Iron deficiency anemia is most common among children aged nine months to three years and during adolescence. Iron deficiency anemia can result from increased demand for iron, inadequate iron intake, decreased iron absorption (malabsorption), increased blood loss, and rarely, defective plasma iron transport. Most children with mild iron deficiency anemia are asymptomatic. Pallor is the most frequent presenting feature. In mild to moderate iron deficiency anemia, poor appetite, fatigability, lassitude, lethargy, exercise intolerance, irritability, and dizziness may be seen. In severe iron deficiency anemia, tachycardia, shortness of breath, diaphoresis, and poor capillary refilling may occur. When present in early childhood, especially if severe and prolonged, iron deficiency anemia can result in neurodevelopmental and cognitive deficits, which may not always be fully reversible even with the correction of iron deficiency anemia. A low hemoglobin and a peripheral blood film showing hypochromia, microcytosis, and marked anisocytosis, should arouse suspicion of iron deficiency anemia. A low serum ferritin level may confirm the diagnosis. Oral iron therapy is the first-line treatment for iron deficiency anemia. This can be achieved by oral administration of one of the ferrous preparations, which is the most cost-effective medication for the treatment of iron deficiency anemia. The optimal response can be achieved with a dosage of 3 to 6 mg/kg of elemental iron per day. Parenteral iron therapy or red blood cell transfusion is usually not necessary.
CONCLUSIONS: In spite of a decline in prevalence, iron deficiency anemia remains a common cause of anemia in young children and adolescents, especially in developing countries; hence, its prevention is important. Primary prevention can be achieved by supplementary iron or iron fortification of staple foods. The importance of dietary counseling and nutritional education cannot be overemphasized. Secondary prevention involves screening for, diagnosing, and treating iron deficiency anemia. The American Academy of Pediatrics recommends universal laboratory screening for iron deficiency anemia at approximately one year of age for healthy children. Assessment of risk factors associated with iron deficiency anemia should be performed at this time. Selective laboratory screening should be performed at any age when risk factors for iron deficiency anemia have been identified.