Diagnosis Of Anemia In Children Research Articles

Mobile application for the control process of childhood anemia in time of the pandemic

The objective of the research was to implement a mobile application for the control process of childhood anemia in times of pandemic, in order to have better medical control with faster care, better control of the diagnosis of anemia in children, and better performance and satisfaction. The following Scrum method was applied. The research has a quantitative approach, of experimental type. The sample consisted of 40 children. Results were obtained regarding time control in the speed of care, an increase of 10.2% was obtained; regarding the number of diagnoses, control, and follow-up in recovery there was an increase of 33.3% and finally regarding the control of performance and satisfaction with care there was an increase of 73.3%.

Evaluation of Anemia as a Risk Factor for Lower Respiratory Tract Infection in Children

Background: Acute lower respiratory tract infection being a leading cause of death n children less than five years of age and anemia is the commonest cofactor in these patients seeking medical advice, particularly in developing countries. Aim: To determine the association of anemia with lower respiratory tract infection in children by evaluating the frequency of anemia in children with and without LRTI. Methods: A Case Control Study was carried out at department of Pediatrics, Children hospital Lahore, Institute of child health from 20-1-18 to 20-7-19. Blood was drawn by phlebotomist from each patient included in this study by using disposable and sterile syringes and accurate tubes. Blood samples were used to estimate hemoglobin level by using automatic blood cell counter. Anemia was defined as per operational definition. Children were managed as per standard protocol. Results: In this study risk of anemia was significantly higher among cases i.e. Cases: 54% & Controls: 22%, OR= 4.162, p-value=0.001. Although in all age groups frequency as well as risk of anemia was higher in cases. But children among cases in the elder age group showed statistically significant risk for anemia as compared to children in control group i.e. 31-45 Months. OR= 14.00, p-value=0.013 & 46-60 months: 5.60, p-value=0.027. Conclusion: Children presenting with LRTI possesses significant risk for anemia. Thus, early and accurate diagnosis of anemia in children and treatment of anemia will have a positive effect decreasing pneumonia in children. Keywords: Anemia, Lower respiratory tract infection, Children, association, odds ratio

Point-of-Care Testing Using Invasive and Non-Invasive Hemoglobinometers: Reliable and Valid Method for Estimation of Hemoglobin among Children 6-59 Months.

Globally around 47.4% of children and in India, 58% of children aged 6-59 months are anemic. Diagnosis of anemia in children using accurate technologies and providing adequate treatment is essential to reduce the burden of anemia. Point-of-care testing (POCT) devices is a potential option for estimation of hemoglobin in peripheral and field settings were the hematology analyzer and laboratory services are not available. To access the validity of the POCTs (invasive and non-invasive devices) for estimation of hemoglobin among children aged 6-59 months compared with hematology analyzer. The study participants were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. Hemoglobin levels of the study participants were estimated in Sahli's hemoglobinometer and invasive digital hemoglobinometers (DHs) using capillary blood samples. Hemoglobin levels in non-invasive DH were assessed from the finger/toe of the children. Hemoglobin levels measured in POCTs were compared against the venous blood hemoglobin estimated in the hematology analyzer. A total of 120 children were enrolled. The mean (SD) of hemoglobin (g/dl) estimated in auto-analyzer was 9.4 (1.8), Sahli's hemoglobinometer was 9.2 (1.9), invasive DH was 9.7 (1.9), and non-invasive DH was 11.9 (1.5). Sahli's hemoglobinometer (95.5%) and invasive DH (92.2%) had high sensitivity for the diagnosis of anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH had higher specificity (96.7%) compared with invasive DH (83.3%) and Sahli's hemoglobinometer (70%). Invasive DH took the least time (2-3 min) for estimation of hemoglobin per participant, followed by Sahli's (4-5 min) and non-invasive DH (5-7 min). All three POCT devices used in this study are reasonable and feasible for estimating hemoglobin in under-5 children. Invasive DHs are potential POCT devices for diagnosis of anemia among under-5 children, while Sahli's can be considered as a possible option, where trained and skilled technicians are available. Further research and development are required in non-invasive DH to improve accuracy. Lay summaryIn India, anemia is a serious public health problem, where 58% of the children aged 6-59 months are anemic. Point-of-care testing (POCT) using digital hemoglobinometers (DHs) has been recommended as one of the key interventions by the Anemia Mukt Bharat program since 2018 in India. These POCT devices are easy to use, less invasive, can be carried to field, require minimal training and results are available immediately. Therefore this study assessed the validity of POCT devices-invasive DH, non-invasive DH and Sahli's hemoglobinometer among 6-59 months children in facility setting compared with the gold standard hematology analyzer. A total of 120 children under 6-59 months of age were enrolled from the pediatric outpatient department in Haryana, India, from November 2019 to January 2020. The (mean hemoglobin in g/dl) invasive (9.7) and non-invasive DH (11.9) overestimated hemoglobin value, while Sahli's (9.2) underestimated hemoglobin compared with hematology analyzer (9.4). Invasive DH (92.2%) and Sahli's hemoglobinometer (95.5%) reported high ability to correctly identify those with anemia compared with non-invasive DH (24.4%). In contrast, non-invasive DH (96.73%) had higher ability to correctly identify those without the anemia compared with invasive DH (83.3%) and Sahli's (70%).

Reproducibility and validity of portable haemoglobinometer for the diagnosis of anaemia in children under the age of 5 years.

Portable haemoglobinometers have been used in order to estimate the prevalence of anaemia in diverse settings. However, few studies have been conducted to evaluate their performance in children of different age groups in distinct epidemiological contexts. To evaluate the reproducibility and reliability of a portable haemoglobinometer for the diagnosis of anaemia in children <5 years Hb was measured in the venous blood of 351 children <5 years by an automated system (standard method) and in three capillary blood samples, using a portable haemoglobinometer (HemoCue®; test method). The reproducibility of the device and of the test method was evaluated using the intraclass correlation coefficient (ICC) (Hb in its continuous form), κ and prevalence-adjusted bias-adjusted κ (PABAK) (categorised variable: anaemia: yes/no). For test method validation, Bland-Altman analyses were performed and sensitivity, specificity, accuracy rate, positive predictive value (PPV) and negative predictive values (NPV) were calculated. The haemoglobinometer presented good device reproducibility (ICC = 0·79) and reasonable method reproducibility (puncture, collection and reading) (ICC = 0·71). Superficial and fair agreement (κ) and good agreement (PABAK) were observed among the diagnoses obtained through the test method. The prevalence of anaemia was 19·1 and 19·7% using the standard and the test method, respectively, with no statistically significant differences. The test method presented higher specificity (87·7%) and NPV (88·3%) than sensitivity (50·7%) and PPV (49·3%), and intermediary accuracy rate (57·8%). HemoCue® showed good device reproducibility and reasonable method reproducibility, as well as good performance in estimating the prevalence of anaemia. Nevertheless, it showed a fair reliability and low individual diagnostic accuracy.

Blood Smear and Diagnosis of Anaemia in Children: Experience of the Hematology Laboratory of the Avicenna Hospital in Rabat with Review of the Literature

The discovery of anemia in children requires a rigorous approach to determine its etiology. This approach is essentially based on the biological analysis of the haemogram and the blood smear. The aim of our study is to demonstrate the vital interest of the blood smear in the diagnosis of anemia in children and to sensitize clinicians and biologists to the value of an adequate interpretation of the blood count. It is indeed a prospective study conducted at the Department of Pediatrics in collaboration with the Central Hematology Laboratory of the Ibn Sina University Hospital in Rabat, from May to July 2019. This study involved 100 cases of anemic infants and children who underwent a blood count and a blood smear. Childhood anaemia is predominantly male (56%), the most represented age group is between 1 month and 5 years (34%), according to the Hb rate, moderate anaemia is the most frequent (51%), the type of anaemia most found is 10%, the most common hue abnormality is the presence of annulocytes (37%), the anomalies of the are diverse but the most dominant are the presence of schizocytes (81%) followed by elliptocytes (68%), only basophilic wells are present as intraerythrocytic inclusions (1%). Our results are consistent with those in the literature and illustrate the vital interest of the hematologist in the diagnosis of the child.

Accuracy of Pallor in the Diagnosis of Anemia in Children Aged 6 Months to 5 Years

Background: The diagnosis and management of anemia largely depends on clinical assessment for pallor. Pallor is explained as decreased colour of the skin and mucous membranes. Aims and Objectives: To study sensitivity, specificity and predictive value of pallor at palpebral conjunctiva, tongue, nail bed and palm in diagnosing anemia and correlate pallor with hemoglobin. Subjects and Methods: 400 children aged between 6 months to 5 years out of which 200 having pallor (Cases) and 200 no pallor (Controls), admitted at Department of Pediatrics, D.Y.Patil Medical college and hospital, Kolhapur from 1st October 2016 to 31st March 2018 were included in this study. Palpebral conjunctiva, tongue, nailbed and palms were examined for pallor. Hemoglobin estimation were done by Drabkin’s method in all children. Anemia was defined according to WHO criteria (Hb &lt; 11g/dl). Data was analyzed statistically. Results: Among 200 children with pallor, tongue pallor was identified in maximum (79%), palmar pallor in minimum (61%). Mean hemoglobin in pallor group ranged from 8.7 to 9.04g/dl and 10.96 to 11.1g/dl in no pallor group. Hemoglobin was lowest with tongue pallor (8.7g/dl). Children with pallor group, 160(71%) had anemia and no pallor group 140 (77%) had no anemia. Maximum sensitivity and specificity were for tongue pallor (59.5%) and palmar pallor (92.2%) respectively and maximum predictive value was for palmar pallor (88.2%). Conclusion: Pallor was found to be very useful in detecting anemia, also it had more specific than sensitive value. The best predictor site for pallor for diagnosing anemia was palm.

Approach to Diagnosis of Anemia in Children

Abstract not availableNorthern International Medical College Journal Vol.9(1) July 2017: 248-251

Diagnosis of Anemia in Children via Artificial Neural Network

In this paper, a neural network algorithm, which diagnosis of anemia for children under 18 years of age, is presented. The network is trained by using data from hemogram test results from 30 patients and an expert doctor. The network has 5 inputs (HGB, HCT, MCV, MCH, MCHC) and an output. Simulations on 20 different patients show that the artificial neural network detects disease with high accuracy. In this paper, it is shown that anemia diagnosis can be made via neural network methods.

Use of iron supplements in children aged 1-2 years with iron deficiency anemia: A cross-sectional study.

Objectives:Iron deficiency (ID) is the most common nutritional problem in the world and is the most common cause of childhood anemia. In this study, our aim was to find out about the state of usage of iron preparation, which is distributed free of charge by the Ministry of Health, for the infants between 4-12 months in our country, as well as detecting the awareness degree of families those who are informed about iron-deficiency anemia (IDA), prophylaxis of the drug and to determine the drug’s effectiveness.Methods:It was a cross-sectional survey. The laboratory values from the files of the children aged 1-2 those who visited our hospital’s department of pediatrics, between January 2010 to August 2013, were collected. The survey included families who have children diagnosed with IDA. Questions included about families’ sociodemographic characteristics, the state of the usage of the iron drug, how much information received in terms of the side effects- consumption period and dosage.Results:A total of 139 children were enrolled in our study. While 77.7% of the families who participated stated that (n = 108) iron medicine was prescribed other 43.2% of families stated (n = 60) was prescribed and they were informed about iron pills and IDA. 25.9% of families had received information about drug’s side effects, 74.8% of them had information about period of consumption and 77.7% said they were given information about the drug dose. The average duration of use of iron medicine was 6.98±4.52 (min: 1, max: 24) months. It has been noted that; parent’s education level, mother’s occupation, child’s gender, how the child was born and receiving information about how to use the medicine had no effects on usage of the drug in children. Nevertheless, it has been noticed that, when the families were given proper information the drug use increased and the patients compliance with medications also increased.Conclusion:We believe that, due to frequent diagnosis of anemia in children, prophylaxis iron supplementation should be continued for up to the age of two years.

Low Hemoglobin Level a Risk Factor for Acute Lower Respiratory Tract Infections (ALRTI) in Children.

Acute lower respiratory tract infection is a major cause of death in under five years of age, and anemia is the commonest co-factor in pediatric patients seeking medical advice especially in developing countries. To analyze whether a low hemoglobin level is a risk factor for acute lower respiratory tract infections (ALRTI) in children. Prospective case control study on 220 children (110 cases and controls each) was carried out in our children's hospital (G.B. Pant Hospital), an associated hospital of Government Medical College Srinagar, of Kashmir Northern India. All patients between the age of 1 month to 5 years of age who fulfilled the inclusion criteria were included. We used WHO criteria to diagnose ALRTI among the cases, and age and sex matched patients who did not have respiratory complaints were kept as controls. Patients who had congenital heart diseases, tuberculosis, malignancies, or dysmorphic features were excluded from the study. All patients were subjected to detailed history and through clinical examination followed by investigations like complete blood count (CBC), peripheral blood film (PBF) smear, blood culture and sensitivity test, X-ray chest, serum iron and iron binding capacity were done in all cases. Our study had slightly male preponderance 57.3% in study group and 59.1% in control group. Maximum number of children were between 3 months and 23 months both in the study (80.9%) as well as in the control (81.8%) group. In this study hemoglobin level <11 gm/dl was considered low. Mean Hb level was 8.8 gm/dl in the study group and 11.6 gm/dl in the control group. Anemia was found in 71 (64.5%) cases in the study group and in 31 (28.2%) cases in the control group. Anemic patients were found to be 4.6 times more susceptible to ALRTI in our study (Odds Ratio was 4.63), p-value <0.01. Iron deficiency was found in 78.9% of total anemic cases in the study group, p-value <0.01. In the study group, the mean serum iron level was 35.3 mcg/dl in the anemic cases and 57.1 mcg/dl in the non-anemic cases. while in the control group, these values were 52.4 mcg/dl and 62.6% mcg/dl respectively, (p-value ,<0.01). Anemia, predominantly iron deficiency anemia, was significantly found in ALTRI patients, and these patients were found to be 4.6 times more susceptible to ALRTI. Early and accurate diagnosis of anemia in children suffering from various ailments in particular to ALRTI will serve the mankind in a better way.

Hemocue Validation for the Diagnosis of Anaemia in Children: A Semi- Systematic Review

Background: Numerous methods are endorsed for Haemoglobin (Hb) estimation and anaemia assessment. The Hemocue is being introduced for routine use in clinics and hospitals in many developing nations. There are a number of illustrative cases that establish a clinical connection readily, but these have mainly been with adults. This study seeks tore view literature on the diagnostic accuracy of the Hemocue among children. Methodology: This is a semi-systematic review of studies analysing the Hemocue device’s diagnostic accuracy determining haemoglobin levels among children aged zero to fifteen years. Results: 18 studies were included. The main finding of this investigation is that the Hemocue system is a good screening test, being sensitive and reliably projecting necessity of a full blood count. It is not likely that diagnosis of a clinically significant condition can be overlooked by this investigation. Thus it would seem to be a useful method to use for Hb screening in appropriate situations. The studies reviewed generally reported a difference between the means obtained by Hemocue Laboratory analyser, though these did not reach statistical significance. A trend for underestimation of Hb values was reported with most studies. The Hemocue had a sensitivity range of 75-91%, specificity range of 88-100% and positive predictive values ranging from 75-80% for the detection of anaemia. The mean difference in Hb from paired samples ranged from 0.2- 0.35 g/dl (0.7%). Conclusion: The Hemocue is comparable to usual laboratory methods for determination of Hb level in children. It is well appropriate for use in care of healthy paediatric patients and children with hematologic disorders. A full blood count is recommended when anaemia is identified or in suspected non-anaemic iron deficiency.

Evaluation of the WHO Haemoglobin Colour Scale for diagnosis of anaemia in children and pregnant women as used by primary health care nurses and community health workers in western Kenya

To evaluate the diagnostic accuracy of the WHO Haemoglobin Colour Scale (HCS) for anaemia in three groups of children aged 2 months to 2 years (sick children, those visiting an immunization clinic and a community-based random sample of children) and a sample of pregnant women. Finger-prick blood samples were taken from all consenting participants. Haemoglobin (Hb) levels from the HCS were compared with results from a HemoCue portable haemoglobinometer. Sensitivity, specificity and positive and negative predictive values for the HCS were calculated. A total of 457 sick children, 336 children visiting immunization clinics, 454 children from the community at large and 643 pregnant women participated. The prevalence of anaemia (Hb<11 g/dl) in these groups was 87%, 79%, 74% and 52%, respectively. The prevalence of severe anaemia (Hb<7 g/dl) was 24%, 11%, 10% and 2%, respectively. The sensitivity of the HCS for anaemia ranged from 60% to 79% and specificity from 59% to 94%. The sensitivity of the HCS for severe anaemia ranged from 24% to 63% and the specificity from 97% to 100%. Through use of the HCS, the proportion of sick, anaemic children visiting peripheral health facilities diagnosed and treated for anaemia would increase from 3% to 65%. In an area with high prevalence of anaemia among sick children, use of the HCS has the potential to significantly increase the proportion of sick, anaemic children who are diagnosed with anaemia and given appropriate treatment. Further evaluations of the effect of the use of the HCS on treatment practices at the health facility level are required.

Diagnostic accuracy comparison between clinical signs and hemoglobin color scale as screening methods in the diagnosis of anemia in children

OBJECTIVES: to compare the validity and reproducibility of clinical signs with the World Health Organization hemoglobin color scale. METHODS: Two hundred six children in the age range of 6-23 months, at the Instituto Materno Infantil Prof. Fernando Figueira, IMIP, were assessed. Two examiners evaluated the clinical signs and the hemoglobin color scale of each child at the different times. The hemoglobin value was used as a standard for validation. RESULTS: in more than 90% of cases the agreement between the values of the color scale and the laboratorial hemoglobin was &lt;2 g/dL. Between the clinical signs the highest sensitivity level for diagnosing Hb&lt;11 g/dL was presented by the hemoglobin color scale (75.7%). For moderate/severe anemia Hb&lt;9g/dL the highest sensitivity was shown by combined palmar or conjunctival pallor (74.3%) and by the color scale (52.5%), according to the first and second observer, respectively. The highest specificity level for Hb&lt;11 g/dL was presented by palmar pallor in comparison with the mother's palm and conjunctival pallor (100%). For Hb&lt;9 g/dL the highest specificity was presented by the hemoglobin color scale (91.9%). CONCLUSIONS: this study suggests that moderate/severe anemia can be diagnosed either by clinical signs or by the color scale, while, in cases of mild anemia, the better diagnosis tool appears to be the color scale.

Accuracy of clinical pallor in the diagnosis of anaemia in children: a meta-analysis.

BackgroundAnaemia is highly prevalent in children of developing countries. It is associated with impaired physical growth and mental development. Palmar pallor is recommended at primary level for diagnosing it, on the basis of few studies. The objective of the study was to systematically assess the accuracy of clinical signs in the diagnosis of anaemia in children.MethodsA systematic review on the accuracy of clinical signs of anaemia in children. We performed an Internet search in various databases and an additional reference tracking. Studies had to be on performance of clinical signs in the diagnosis of anaemia, using haemoglobin as the gold standard. We calculated pooled diagnostic likelihood ratios (LR's) and odds ratios (DOR's) for each clinical sign at different haemoglobin thresholds.ResultsEleven articles met the inclusion criteria. Most studies were performed in Africa, in children underfive. Chi-square test for proportions and Cochran Q for DOR's and for LR's showed heterogeneity. Type of observer and haemoglobin technique influenced the results. Pooling was done using the random effects model. Pooled DOR at haemoglobin <11 g/dL was 4.3 (95% CI 2.6–7.2) for palmar pallor, 3.7 (2.3–5.9) for conjunctival pallor, and 3.4 (1.8–6.3) for nailbed pallor. DOR's and LR's were slightly better for nailbed pallor at all other haemoglobin thresholds. The accuracy did not vary substantially after excluding outliers.ConclusionThis meta-analysis did not document a highly accurate clinical sign of anaemia. In view of poor performance of clinical signs, universal iron supplementation may be an adequate control strategy in high prevalence areas. Further well-designed studies are needed in settings other than Africa. They should assess inter-observer variation, performance of combined clinical signs, phenotypic differences, and different degrees of anaemia.

Validação e reprodutibilidade de sinais clínicos no diagnóstico de anemia em crianças

This study aimed to assess the validity and reproducibility of clinical signs (palmar and conjunctival pallor) in the diagnosis of anemia in children 6-23 months of age in Northeast Brazil. This was a cross-sectional study with a sample of 421 children in the child care and pediatric outpatient wards at the Mother and Child Care Institute of Pernambuco. Two examiners evaluated clinical signs using the Kappa coefficient, and validation (sensitivity and specificity) was performed using hemoglobin as the standard. Clinical signs demonstrated low reproducibility (kappa 0.24-0.25). The highest sensitivity for diagnosing anemia (Hb < 11 g/dl) and moderate/ severe anemia (Hb < 9 g/dl), respectively, was provided by combining palmar and conjunctival pallor (39.7% and 53.5%), followed by palmar pallor alone (29.9% and 40.0%). The highest specificity was provided by palmar pallor in the child as compared to the mother (95.5% and 90.1%, Hb < 11 g/dl and Hb < 9 g/dl, respectively). Sensitivity of clinical signs was better in diagnosing moderate/severe anemia, especially when combining palmar and conjunctival pallor, suggesting that their utilization does not provide a good instrument for diagnosing mild anemia.

The value of red cell distribution width in the diagnosis of anaemia in children.

The red cell distribution width index (RDW) was determined in 103 normal children, 69 iron-deficient (ID) patients, 73 with the thalassaemia trait, and 71 with other haemoglobinopathies. Elevated RDW values were found in anaemic patients, the highest values in ID anaemia, sickle thalassaemia, sickle cell anaemia, and beta-thalassaemia trait in decreasing order. The normal RDW in children was 13.2 +/- 0.9 and an elevated RDW reflects active erythropoiesis. The RDW was elevated and the MCV low in all 69 patients with ID anaemia. The RDW was also elevated in 11/13 children with sickle cell anaemia, in 25/29 patients with sickle cell-thalassaemia, and in all patients with thalassaemia major. The ID anaemia could be differentiated from the thalassaemia trait by the markedly elevated RDW in ID anaemia (mean = 20.7 +/- 3.2) and the mildly elevated RDW (mean 15.4 +/- 1.4) in thalassaemia trait. The RDW index discriminated better than Mentzer's index, discriminant function or the Shine Lal index. Thus the RDW is a good indicator of anisocytosis, and a good screening index especially for ID anaemia and the thalassaemia trait.