Causes of nutritional anemia in adolescent children

INTRODUCTION: Anemia is most commonly seen in 6 months to 2 years of age and adolescence in childhood. According to World Health Organization data, anemia is a common public health problem which causes increasing mortality and morbidity in pregnant women and children especially. Anemia is developing mostly because of rapid growth and inadequate dietary intake in adolescent age group, nutrition-related anemia is common in our society. Problems caused by socio-economic conditions contributes this situation. Therefore, we aimed to determine the causes of nutritional anemia in adolescent age group in this clinical study. MATERIAL AND METHOD: 90 children from applicants of Dokuz Eylul University Department of Child Health and Diseases clinic between 01.01.2014 - 01.07.2015, diagnosed nutritional anemia and age between 10-18 were included to the survey conducted retrospectively. Patient informations was reached by patient's files from the hospital and related departments. Hospital and science section archive files of all cases were scanned and measurements of gender, height, weight, weight for height (W/H) were recorded to patient data registration form. In addition, a questionnaire containing educational status, education level of parents, symptoms and physical examination, history of vegetarianism, red meat, poultry, fish, fruits, legumes, eggs, green leafy vegetables consumption frequency was filled out by cases after diagnosis. Questions related to other causes in the etiology of anemia (tea, coffee consumption, chronic illness and drug use history), menstruation in girls and socio-economic assessment were also asked to the patient and the relatives of the patient. Results were analyzed by using appropriate statistical tests. RESULTS: 90 patients between 10-18 years of age were included in the study. Of the patients participating in the study, iron-deficiency anemia in 87 cases, isolated due to a lack of vitamin B12 anemia was detected in 3 cases, patients diagnosed with anemia due to folate deficiency were not detected. The most common symptoms of the patients were pallor (90%), fatigue (85%), lack of attention (75,8%); physical examination findings were determined as conjunctival/palm/nail beds pallor (90%), papillary atrophy (27,8%), tachycardia (23,3%). In iron-deficiency anemia diagnosed of 27 cases (31%) concurrent vitamin B12 deficiency, in 24 cases (27,5%) folate deficiency was found. 67% of the cases (58 cases) has received a diagnosis of isolated iron deficiency anemia, 33% (29 cases) of the cases, the lack of concurrent vitamin B12 and/or folate deficiency was found. In 5 cases (6%) of iron deficiency anemia diagnosed, concurrent vitamin B12 deficiency, folate deficiency was detected. In laboratory examinations of patients diagnosed iron deficiency anemia the average values and ranges are, respectively; RBC 4,45 ± 0,72 million (2,10-6,63 million), hemoglobin 10,4±0,2 g/dL (4,8-12,9 g/dL), hematocrit level %32,2±0,55 (%16-40), MCV 72,5±1,1 fL (16-89 fL) RDW %17,5±0,4 (%12,3-32,8), the iron level 30,8±2,6 µg/dL (5-134 µg/dL), ferritin level 9,6±1,4 ng/mL (1-88 ng/ml), transferrin saturation %7,9±0,73 (%1,4 -40), serum iron binding capacity 381,6 ± 7,75 µg/dL (145-550 µg/dL), vitamin B12 level 289± 31 pg/mL (25-1471 pg/mL), folate level 9,7±0,68 ng/mL (3,1-24,6 ng/mL) was detected. In laboratory examinations of three cases diagnosed B12 deficiency anemia, the average values and ranges are respectively; RBC 2,97±0,2 million (2,1-3,5 million), hemoglobin 8,6±0,3 g/dL (7,4-10,9 g/dL), hematocrit level %25 ±0,3 (%21-30), MCV 100±0,3 fL (100-103 fL), RDW %18,5 ± 0,03 (%15,8-22,5), vitamin B12 level 50±0,3 pg/mL (25-76 pg/mL) was found. Patients received insufficient iron rich foods, particularly in red meat was found that 91% received inadequate. Fourteen patients has indicated that they are vegetarian (15,6%), there was was no statistical significance between vegetarianism and hemoglobin; transferrin and ferritin values in terms of the depth of anemia in the analysis. In all three cases, the family said that they are vegetarian. 12,2% of the cases (11 cases), anemia was diagnosed after a blood transfusion. When mothers' education level is evaluated, it was detected that 62,2% of mothers had education until high school, 37,8% of mothers had high school and higher education level. When fathers' education level is evaluated, 47,7% of fathers had education until high school, 52,3% of fathers had high school and higher education level. Significant correlation was not detected between educational status of the parents' educational status and anemia depth. There was no significant correlation between hemoglobin, iron parameters and monthly income. However, 75% of patients have moderate-to-poor socio-economic status. There was no significant correlation between between girls in menstrual period and anemi depth. RESULTS: Consequently, nutritional anemia especially iron deficiency anemia can be seen due to the growing needs of adolescent growth, socio-economic factors, inappropriate eating habits and wrong diet. In the follow-up, adolescents should be evaluated in terms of of nutritional anemia risk absolutely and preventive medicine should be given.