Causal-Investigative Analysis of the Formation of Anemia in Children
Authors:   State Institution National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, 53, Illenka St., Kyiv 04050, Ukraine, Bebeshko V. G. , Bruslova K. M. , Tsvietkova N. M. , Gonchar L. O. , Aleksieiev O. G. 
Published: November 2020

The purpose of the study was to determine the main causal factors in the formation of anemia in children of Ukraine, depending on the morphometric changes in erythrocytes of blood, indicators of iron metabolism for the formation of a risk group for oncohematological diseases. Material and methods. 770 children were examined: 724 with anemia, 46 with acute lymphoblastic leukemia. We studied the parameters of the erythrocyte lineage of hematopoiesis, morphometric parameters of erythrocytes, indicators of iron metabolism (serum iron, ferritin, transferrin, the transferrin saturation with iron, hematocrit, the content of δ-aminolevulinic acid and coproporphyrin in urine, pituitary thyroid stimulating hormone depending on the type of somatic pathology. Anemic states were distributed taking into account the average erythrocyte volume and the average hemoglobin content in the erythrocyte, and dividing diagnoses microcytic-hypochromic or normocytic-normochromic anemia, respectively. Results and discussion. The study showed that in children with normocytic-normochromic anemia, the number of erythrocytes and hematocrit were lower than in patients with microcytic-hypochromic anemia, while average erythrocyte volume, average hemoglobin content, serum iron, serum ferritin and transferrin saturation with iron were higher. The number of reticulocytes in the peripheral blood in all the examined subjects was standard. That is, the anemic conditions in children differed in ferrokinetic parameters, in particular, with and without iron deficiency. Taking into account the age of the children and the reasons for the development of anemia, a third of the girls of puberty with microcytic-hypochromic anemia had menorrhagias. In children under 6 years of age with normocytic-normochromic anemia, diseases of the gastrointestinal tract were more often registered; in the older 6 years – gastrointestinal diseases, helminthiasis and allergic reactions compared with patients with microcytic-hypochromic anemia. The development of normocytic-normochromic anemia in children and the functioning of the gastrointestinal tract were influenced by drug treatment for chronic pathology in the body. All children with anemia had an irrational diet. Porphyria was diagnosed in 3.8% of children with microcytic-hypochromic anemia. In 12.7% of children with normocytic-normochromic anemia, the serum thyroid stimulating hormone level was at the upper limit of the reference value (mean 3.3±0.6) mU/L), which correlated with a reduced number of erythrocytes in blood (r = -0.65) and increased values of average erythrocyte volume (r = 0.41) and average hemoglobin content (r = 0.35), and indicates changes in the erythrocyte lineage of hematopoiesis associated with the initial manifestations of thyroid hypofunction. An excess of iron was observed in 7.1% of older boys with normocytic-normochromic anemia, which requires additional examination. In patients with acute lymphoblastic leukemia were diagnosed with normocytic-normochromic anemia of varying severity. The serum ferritin level was (272.1±28.4) ng/ml and was significantly higher than in children with normocytic-normochromic anemia. In 12 of 46 patients, transferrin saturation with iron was increased and amounted to (70.2±2.3)%. Moreover, the higher the level of serum iron and serum ferritin, the higher was the transferrin saturation with iron (rs = 0.5; rs = 0.85). An inverse correlation was established between transferrin saturation with iron, patient survival (rs = -0.45) and a higher probability of death (rs = -0.46). Conclusion. Children with normocytic-normochromic anemia require in-depth examination and constitute a risk group for the development of myelodysplastic syndrome and leukemia