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Anemia

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AnemiaA condition where blood is deficient in:

• # of Red blood cells

• Hemoglobin concentration

• Total blood volume

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Anemia Definition

Hemoglobin [Hgb] concentration is 2 {std} deviations below the mean [Hgb] for a normal population for the same gender and age range.

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Hemoglobin (Hgb) Function• Transports O2 from the lungs to the tissues

• Transports CO2 back to the lungs & exhaled

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Hemoglobin (Hgb)

• Influenced by age, sex, altitude, & smoking

• Normal ranges:

New born babies: 17- 22 gm/dL Children: 11-13 gm/dL Adult women: 12-16 gm/dL

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Causes of Anemia• Blood cell loss from the body

- surgery, hemorrhage, Menstruation

• Decreased lifespan of the red blood cell- Hemolytic anemia i.e., sickle cell anemia

• Growth spurts

• Pregnancy: - Inability of mom to keep up with red blood cell production for the growing fetus

(should get 30mg of iron per day.)

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Other Causes of Anemia

• Chronic illness or infection can cause the body to make fewer red blood cells

• Some drugs & medical treatments• Aplastic anemia: the inability for bone

marrow to produce enough RBC (could be side effect of chemo, etc.)

• Renal Disease, cancer

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Most Common Causeof Anemia

Iron Deficiency

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• Infants: not receiving adequate iron in their diet

• Children: rapid growth spurts where iron available cannot keep up with RBC production

• Women: blood loss during menstruation

• Pregnant women: growing fetus has a high demand for iron

Populations at Risk for IronDeficiency

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• Not receiving adequate iron in their diet (watered down formula)

• Infants at 6 months require dietary iron(iron stores have become depleted from birth)

• Premature infants may require supplementation (They do not get all of their iron from mom during the 3rd Trimester due to incomplete gestation)

Infants at Risk for IronDeficiency

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Children at Risk for Iron Deficiency

• Not receiving adequate iron in Diet

• Drinking more than 24 oz. of milk/day

• Rapid growth spurts where iron available cannot keep up with RBC production

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Symptoms of Iron Deficiency

• Pallor (paleness of the skin)• Tiredness, weakness or fatigue• CNS symptoms in severe anemia–

Faintness–Dizziness–Tinnitus (ringing in the ears)–Headache–Spots before the eyes

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Less O2 in Blood:

Heart must work harder to pump enough oxygen to organs. Cardiac-related symptoms include:

- Arrhythmia (abnormal heart rhythm)- SOB/shortness of breath- Chest pain

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PICA

• “Pica” - a craving to eat unusual substances such as ice or dirt (may also occur with high lead levels)

• Numbness and tingling• Burning or sore tongue• Sores at the corner of the mouth• Chronic gastritis

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Lead ToxicityAnemia increases the risk lead absorption more than normal, placing individuals at risk for lead toxicity

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Iron Deficiency Anemia

• Treatment begins with finding the underlying cause and correcting it.

• Monitoring is best done by measuring the Hemoglobin concentration (Hgb).

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Pernicious Anemia• Vitamin B-12 Deficiency (Cobalamin)• Megaloblastic Anemia (Large cells)• Caused by gastritis, parietal cell loss

(cells in the stomach) & lack of IF (Intrinsic Factor)

• Symptoms: anemia, fatigue, GI distress, neurological complications

• Tx: B-12 injections, Oral suppl or diet

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Sickle Cell Anemia•Sickling from mutation of the hemoglobin gene•Occludes small bv and causes tissue damage•RBC lifespan is shortened from 120 days to 20 days => Anemia

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Sickle Cell Anemia

•10% American blacks & 25% of Africans are Heterozygotes (recessive/carrier)•Helps protect against malaria•1970s: 20 year life expectancy•Today: 45 year life expectancy•Still required to check Hgb in WIC

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Diagnosis

A complete blood count test will check your levels of red blood cells, white blood cells, platelets, and hemoglobin.

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Red blood cells:

• Average size • Variability in size • Volume• Hemoglobin concentration

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Michigan WIC Low Hemoglobin

9/14 11/16 3/20• PG Women 13.8% 17.5% 12.5%• BF Women 29.0% 33% 30.5%• NPP Women 36.5% 42% 41.0%• Children 12.4% 13.9% 10.4%• Infants 0.2% 0.3% 0.2%

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To Access Report: Clinic Module, Reports, Nutrition & Health Summary, Client Risk Factors by Category

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2.16 Hematological Risk Determination Policy

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Hematological Risk200 Series

• Iron Status

• Lead Status

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Low Iron Risk Category 201

• Criteria (PG, BE, BP, NPP, IBE, IBP, IFF, C1 –C4)

• Low hematocrit (hct.)/ low hemoglobin (hgb.) cutoff value: At the time the blood test was taken, any value less than (<) the blood values listed in the following chart.

• Note: Women who smoke, the blood value criterion based on: #of cigarettes smoked and trimester of pregnancy.

(One pack of cigarettes = 20 cigarettes)

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Cut-off values are available for reference from this button

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When Do I Need To Do Bloodwork?

Infants• One test between 7 and

13 months

• At the ONE YEAR CERTvisit if added to WIC BEFORE 7 MONTHS of age

• If added to WIC AFTER 7 months, take the blood at the INITIALcertification visit

**Guidance for Infant TestingA hematological test prior to the 9-12 month recommended period may be appropriate when there are indications that the infant is at risk for low serum iron, as described below:

• Low birth weight or preterm infant.• Has not been fed iron-fortified formula

(10-12 mg. Fe/liter) or breastmilk.• Has a known diagnosis of anemia.• Has undergone surgery that resulted in

excessive blood loss.

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When Do I Need To Do Bloodwork?

• Children Under Two

• Once between 13 and 24 months (prefer 6 mos. after first test)

• For most C1’s, this will be at the 18 month CEVAL

• Two Before Two• 7-12 months• 13-24 months

When Do I Need To Do Bloodwork?

Children Two - Five• Once after two years of age,

THEN:• Once every 12 months if the

previous result is above the cutoff level

• Once every 6 months if the previous result is below the cutoff level

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When Do I Need To Do Bloodwork?

Pregnant Women• Once during pregnancy

Postpartum Women• Once after delivery,

preferably at least six weeks postpartum

Exemptions to Hematological Testing

• Medical Condition Prohibits Draw

• Religious Objections

• Severe Risk to Staff

• Pending (must have State approval)• Pandemic (Currently)

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Add a row when no test is required/performed and select Exemption Reason

Adding a row is NOT required for infants less than 7 months of age

Client Agreement

Consent to WIC health screening:

I will allow a WIC health screening for all WIC applicants in my family. WIC health screening includes answering health and diet questions, measuring height, weight and head size, and testing blood for iron level.

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Referral Data• Must be within

specified time period for the client’s status(6 month cut off)

• Must be presented at the time of the appointment

• The date of the test must be recorded in MI-WIC

Non-WIC Dataenter the date blood work was done

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To enter Referral (Non-WIC) Data, use the date the test was

performed, check the Non-WIC Data checkbox

andnter Hgb value.

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RetestingLocal Agency Procedure

• Testing levels that are outside the cutoff values in policy

• A critical hemoglobin result <8 or >17

• Testing levels that have been specified as critical values established by local agency

Retest: explain reason

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Follow-up Testing• One follow-up test is allowed when

deemed necessary for health monitoring by CPA

• Should be at least 60 days from previous test

MI-WIC: Lab Hx screen

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