Hematological profile of children with severe acute malnutrition: a tertiary care centre experience
DOI:
https://doi.org/10.18203/2349-3291.ijcp20173072Keywords:
Anemia, Hematological profile, Severe acute malnutritionAbstract
Background: Severe acute malnutrition (SAM) is associated with various pathophysiological changes in the body including hematological system. This study was done to understand the hematological profile of severely malnourished children.
Methods: This case control study was conducted in the Department of pediatrics, G.S.V.M. Medical College, Kanpur from January 2014 to December 2015. 200 children, aged 6 months- 5years admitted to our hospital with SAM were enrolled as cases. 200 children with normal nutritional status without haematological or infectious conditions attending routine clinic were selected as controls. The hematological parameters were analyzed using an automated blood Analyzer.
Results: 95% of the children with SAM had anemia, out of which 52% were severely anemic and 28% were moderately anemic. Mean value for hemoglobin was lower in test group (7.17±2.265gm/dl) as compared to control group (9.22±3.362gm/dl). Children with SAM had statistically significant lower mean values for red cell indices like RBC counts, MCV, MCH and MCHC compared to controls. The mean value of WBC in SAM children was 12.1±11.5×103, while it was 6.2± 7.8×103 in controls. The cases had higher mean value for neutrophils and lower mean value for lymphocytes.
Conclusions: Children with SAM had lower mean hemoglobin, hematocrit and red cell indices and higher mean value of total leukocyte and platelet counts. This study recommends that more frequent studies should be done to describe the trend of hematopoietic changes in children with SAM to enhance anticipatory care and outcome of the affected children.
References
Work TH, Ifekwunigwe A, Jelliffe DB, Jelliffe P, Neuman CG. Tropical problems in nutrition. Ann Intern Med 1973;79:707-11.
OMS, UNICEF. Community-based management of severe acute malnutrition. Geneva: Joint statement of the World Health Organization, the World Food Program, the Standing Committee on Nutrition of the United Nations System and the United Nations Children's Fund. Available at http:// www.who.int/nutrition/publications/severemalnutriti on/978-92-806-4148-6_fre.pdf.
UNO. Millennium Development Goals. United Nations Organization. New York; 2012
International Institute for Population Sciences (IIPS). National Family Health Survey (NFHS-4), 2015-2016. IIPS, Mumbai, India. 2017.
Black RE, Allen LH, Bhutta ZA, De Onis M, Ezzati M, Mathers C, et al. Maternal and Child under nutrition: global and regional exposures and health consequences. Lancet. 2008;371:243-60.
Lukens JN. Iron metabolism and iron deficiency. In: Miller DR, Bodner RL, Miller LP, eds. Blood diseases of infancy and childhood. Philadelphia:Mosby;1995:193-219.
Warrier RP. The anaemia of malnutrition. In: Suskind RM, Suskind LL, eds. The malnourished child. New York:Lippincott-Raven. 1990;19:61-72.
Nathan DG. Regulation of haematopoiesis. Pediatr research. 1990;27:423-7.
World Health Organization. Management of Severe Malnutrition: A manual for physicians and other senior health workers, WHO, Geneva, 1999.
Available at http://
World Health Organization. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Geneva: World Health Organization. 2001.
IBM SPSS Software. Available at http://www-01.ibm.com/software/analytics/spss.
Graph Pad Software 2015. Available at http://www.graphpad.com/quickcalcs. Accessed 15 Nov. 2015.
Saka AO, Saka MJ, Ojuawo A, Abdulkarim A, Bilamin S, Latubosun L. Haematological profile in children with protein energy malnutrition in North Central Nigeria. Glob J Med Res. 2012;12(4):1-7.
Thakur N, Chandra J, Pemde H, Singh V. Anemia in severe acute malnutrition. Nutrition. 2014;30(4):440-2.
Kumar R, Singh J, Joshi K, Singh HP, Bijesh S. Co-morbidities in hospitalized children with severe acute malnutrition. Ind pediat. 2014;51(2):125-7.
Kraemer K, Zimmermann MB. Nutritional anemia. Sight and life press;2007:228
Laditan AAO, Tindimebwa G. The Protein Energy Malnourished Child in a Nigerian Teaching Hospital. J Trop Pediatr. 1983;29:61-4.
El-Nawawy S, Barakat T, Elwalily A, Deghady AM, Hussein M. Evaluation of erythropoiesis in Protein Energy Malnutrition East Med Health J. 2002;8:2-3.
Abidoye RO, Sikabofori. A study of prevalence of Protein Energy Malnutrition among 0-5 years in rural Benue State, Nigeria. Nutrition and health. 2000;13:235-47.
Uner A, Calişkan U, Oner AF, Koç H, Kasap AF. Platelet functions in patients with protein-energy malnutrition. Clin Appl Thromb Hemost. 2001;7(4):286-8.
Meffat MEK, Longstaffe S, Besant J, Dureski C. Prevention of iron deficiency and psychomotor decline in high risk infants through use of iron fortified infant formula. A randomized clinical trial. J Pediatr. 1994;125:527-34.
Edozien, JC, Khan MAR, Waslien CL. Human protein deficiency: results of a Nigerian village study. J Nutr. 1976;106:312-028.
Fondu P, Hariga-Muller C, Mozes N, Neve J, Van Steirteghem A, Mandelbaum IM. Protein-energy malnutrition and anemia in Kivi. Am J Clin Nutr. 1978;31:46-56.
Cipriano S. Serum ferritin levels in Shetland Ponies with experimentally-induced acute inflammation (commencing day zero) compared to normal control animals. Vet Pathol. 1987;24:354-6.
Üner A, Çalişkan Ü, Öner AF, Koç H, Kasap AF. Platelet functions in patients with protein-energy malnutrition. Clin Appl Thromb Hemost. 2001;7(4):286-8.