ASSESSMENT AND MANAGEMENTOF ANEMIA IN A POPULATION OF CHILDREN LIVING IN THE INDIAN HIMALAYAS: A STUDENT-LED INITIATIVE
Abstract
Objective: To determine the prevalence and etiology of anemia among school-aged children in Spiti Valley, India, and implement an appropriate management plan.
Methods: Hemoglobin levels were measured in 382 Tibetan children (3 to 18 years old) for three consecutive years. Blood smears from the 200 most severe cases of anemia were analyzed. Iron treatments were provided for three-months and hemoglobin levels were measured 6-weeks post treatment initiation.
Results: Pre-treatment, 88.4% were anemic in 2007, 78.3% in 2008 and 71.3% in 2009. Analysis of hemoglobin levels demonstrated a negative skewed distribution. Blood smear results showed that 57% (n=200) displayed normocytic normochromic red blood cells; 30% were hypochromic only; and 11% hypochromic anisocytic. Post-iron treatment prevalence of anemia was found to be 82.9% in 2007, and 84.9% in 2008.
Conclusions: The hypochromic anisocytic anemia suggests iron deficiency or thalassemia. The normocytic normochromic anemia may be due to: 1) mixed iron, B12 and folate deficiencies from a low-meat and fresh vegetable diet in winter months; 2) early iron deficiency; or 3) genetic adaptations in oxygen transport to high-altitude. A negative skewed distribution of hemoglobin levels indicates that the majority of children have anemia, likely of multifactorial etiology and may benefit from iron supplementation. An insignificant improvement in hemoglobin levels post iron-treatment may be explained by the post-supplementation hemoglobin concentrations being measured prior to administration of the full treatment course or by the multifactorial nature of the anemia, which warrants an integrated treatment approach, including iron, multivitamins, zinc and better year-round nutritional intake.
