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It is common for primary care physicians to be faced with children with hematological disorders in everyday practice. The article seeks to provide realistic information for the first-contact physician in handling common hematological diseases in children. Practical step-wise approach to understanding and investigating anemia and bleeding disorders is illustrated. Requirement of iron in normal children and management of iron deficiency anemia (IDA) and thalassemia is explained. The gold standard for IDA continues to be ferrous sulphate which has good bioavailability and is inexpensive. There is emerging concept of delayed clamping of umbilical cord at birth, particularly in regions with widespread IDA, to augment iron stores in infancy. Typical case scenarios of children with immune thrombocytopenia (ITP) and hemophilia are provided to facilitate the understanding of management in day to day practice. The vital role of the medical practitioner in shared care of patients with acute lymphoblastic leukemia and febrile neutropenia is emphasized. A risk based treatment algorithm for febrile neutropenia is provided. [ABSTRACT FROM AUTHOR]

Objective: To assess whether addition of cobalamin (cbl) to iron-folic acid will result in improved response in nutritional anemia.Methods: This study included 150 children aged between 0.5-5 y having nutritional anemia. Anemia was categorized for severity and red cell morphology. Serum levels of ferritin were obtained in all cases while levels of cbl and folic acid (FA) were done only in children having macrocytic or dimorphic anemia. Children were randomized to receive either iron and FA (Group I) or iron, FA and cbl (Group II). Response to treatment was assessed at 2, 4 and 8 wk.Results: Of all the 150 patients, iron deficiency was documented in 111 patients. Of the 41 cases in whom, Cbl and FA levels were done, 97.56% and 53.66% had deficiency of cbl and FA respectively. Patients in group II had higher Hb level at 2, 4 and 8 wk (significant at 4 and 8 wk). Percentage Hb rise from baseline Hb was significantly higher in group II (p 0.00). In group II, increase in Hb among cases with macrocytosis and others were similar although percentage increase in Hb was more pronounced among patients with macrocytic anemia or dimorphic anemia. However, this difference was statistically not significant (p = 0.18).Conclusions: Children receiving cbl in addition to iron and FA showed an improved hematological response. [ABSTRACT FROM AUTHOR]

To evaluate the developmental profile of children with iron deficiency anemia (IDA) and the changes following iron supplementation. Study was conducted prospectively in a tertiary care teaching institution. Subjects were children aged 6 months to 5-years, with IDA, proven by hematological parameters and iron studies. Complete blood counts and iron studies were performed at the beginning and following 3-months therapy with iron. Simultaneously, development was assessed by Developmental profile II (DPII), which was interpreted using IQ equivalent (IQE) scores and ‘fractional months differential’ (FMD). Thirty five children fulfilled predetermined inclusion criteria. The mean-age was 22.3±13.4 months. Majority (71.4%) had moderate, while 5 (14.3%), each had mild and severe anemia. Significant developmental delay was observed in iron deficient children. Maximum delay was observed in academic and communication domains. 6 (17.2%) failed developmental screening, with IQE scores of <70. Significant improvement in DPII scores was noticed following therapy. Although some gain in IQE scores was noticed in the majority (88.6%), significant improvement (e310-point gain) was observed in about half (51.4%). Interpretation of DPII by FMD revealed significant improvement in all the domains as well. Children with IDA have suboptimal developmental scores. The delayed development is variably reversible following oral iron therapy. Hb d£7 g/dl and age >24 months predicts suboptimal outcome. FMD is a useful method of interpreting DPII. [ABSTRACT FROM AUTHOR]

Available studies on prevalence of nutritional anemia in India show that 65% infant and toddlers, 60% 1-6 years of age, 88% adolescent girls (3.3% had hemoglobin < 7.0 g/dl; severe anemia) and 85% pregnant women (9.9% having severe anemia) were anemic. The prevalence of anemia was marginally higher in lactating women as compared to pregnancy. The commonest is iron deficiency anemia. National programmes to control and prevent anemia have not been successful. Experiences from other countries in controlling moderately-severe anemia guide to adopt long-term measures i.e. fortification of food items like milk, cereal, sugar, salt with iron. Use of iron utensils in boiling milk, cooking vegetables etc may contribute significant amount of dietary iron. Nutrition education to improve dietary intakes in family for receiving needed macro/micro nutrients as protein, iron and vitamins like folic acid, B12, A and C etc. for hemoglobin synthesis is important. As an immediate measure medicinal iron is necessary to control anemia. Addition of folate with iron controls anemia and is neuroprotective. Evidence in early childhood suggests vitamin B12 deficiency anemia; thus it may also be given along with iron and folate. [ABSTRACT FROM AUTHOR]

An evaluation of the National Nutritional Anemia Prophylaxis Program was carried out in Andhra Pradesh. About 8,000 respondents from about 5,754 households were interviewed and 487 pregnant women were covered for haemoglobin estimation in six selected districts. Nearly 19 per cent of the pregnant women had received folifer tablets, while about 1 per cent of child beneficiaries were receiving the tablets. The acceptance of the programme by the community appeared to be satisfactory. The reasons for poor coverage were reported to be inadequate and irregular supplies. Results indicated that the health functionaries were not properly oriented towards the programme, as many of them were not aware of all the beneficiaries under the programme. Chemical analysis of the tablets indicated that about 30 per cent of the tablet samples had iron content less than the expected levels, and none of them had expected levels of folic acid content. [ABSTRACT FROM AUTHOR]

This is a cost descriptive study which estimates the cost of providing iron and vitamin A supplementation through the primary health care system in India. The norms for the primary health care workers were taken as per national norms. The costs included the proportionate cost of the building, workers' salary and the cost of the supplements. The total cost of providing iron supplementation through the PHC was estimated at Rs. 43,800. The cost per beneficiary for adult folifer was Rs. 3.60, for paediatric folifer was Rs. 2.90 and for syrup folifer, it was Rs. 15.50. The overall cost of providing iron and folic acid supplements to the "at risk" population was estimated as Rs 4.40 per beneficiary per year. The cost of vitamin A supplementation to under three through the PHC system was estimated at Rs. 3.20 per beneficiary per year. Both iron as well as vitamin A supplementation through the PHC system appear to be low cost interventions. [ABSTRACT FROM AUTHOR]