Evaluation of severe anemia in patients hospitalised in Düzce Üniversity Medical Faculty Pediatrics Clinic

Objektive: Severe anemia is one of major health problems in the world. The aim of this study was to evaluate cases hospitalized in the Department of Pediatrics, Duzce University Hospital with severe anemia. Material and Method: In this study, we examined 119 patients with severe anemia, were hospitalized between years 2012-2014. Patients with the diagnosis of severe anemia were investigated for etiologic reasons with evaluation according to age, gender, physical examination and laboratory findings. The inclusion criteria were WHO's severe anemia diagnosis criteria for children. Results: Out of 119 patients, 49 (41,2%) were male, 70 (58,8%) were female. Female patients were proportionally more than males. The ages of study group was between 0,25 and 18 years with a mean of 6,7±6,23 years. When all cases were evaluated with respect to definitive diagnosis of anemia; Iron Deficiency Anemia (IDA) in 52 (43,7%), Chronic Disease Anemia (CDA) in 29 (24,4%), bleeding in 21 (17,6 %), otoimmun hemolytic anemia in 5 (4,2%), leukemia in 3 (2,5%), hereditary spherocytosis in 3 (2,5%), transient erytroblastopenia of childhood in 2 (1,7%), megaloblastic anemia in 1 (0,8%), thalassemia major in 1 (0,8%), sideroblastic anemia in 1 (0,8%), were found. It has been determined that, 52 (43,7%) of all cases were with IDA, and 27 (51,9%) of patient group that aged in 5-18 years was with IDA. We examined erythrocyte indexes in cases with IDA and CDA in our study. When MCV (Mean Corpuscular Volume), MCH (Mean Corpuscular Hemoglobin), ferritin, blood serum iron were significantly low in IDA group than others (p<0,05). In addition to primary diagnosis, 14 (11,8%) patients had iron deficiency, 8 (6,7%) patients had vitamin B12 deficiency, 1 (0,8%) had folat deficiency. In the group of ıron deficiency anemia, it was demonstrated that there is moderate positively correlation between Hb and ferritin (r=0,457, p=0,001), weak positively correlation between ferritin and leukocyte count (r=0,315, p=0,029). The sensitivity and specifity of RDW (Red Cell Distribution Width) in the diagnosis of iron deficiency anemia was found to be 71,2% and 74,6%. The sensitivity and specifity of RDW was found to be 92,4% and 86,6% in the diagnosis of iron deficiency anemia. When RDW and MCV were evaluated together in the diagnosis of iron deficiency anemia, the sensitivity was found to be 75,1%, the spesifity was found to be 85%. In the iron deficiency group, 7 (13,3%) patients had pulmonary diseases (bronchiolitis, pneumonia, tuberculosis), 6 (11,5%) patients had neurologic diseases (migraine, epilepsy, meningites, cerebral palsy, mental retardation). 42 (80%) cases with ıron deficiency anemia were transfused with packed red blood cells. Conclusion: The proportions of severe anemia amenable to iron were larger and more than 50% of children worldwide. Nutritional anaemia should ideally be treated by dietary diversification, and improved by access to foods that have high iron bioavalibility, including animal products. Wheat flour fortification with folic acid and iron is recommeded to reduce the rate of nutritional anemia. Keywords: Severe anemia, child, hematologic parameters, concominant diseases, iron deficiency anemia