Saturday, December 15, 2012

Anemia in Haiti

Anemia is very common in Haiti. About half of the rural children under the age of 2 years have a hemoglobin less than 100 g/L.

Red blood cells carry oxygen, which is necessary for the optimal function of every cell in the body. Anemia can affect the function of every organ in the body. In children, anemia is reported to affect the ability to learn.  

The reasons for anemia in Haiti are similar to the reasons for anemia everywhere else in the world. A low hemoglobin is caused by decreased red blood cell production, increased red blood cell destruction, or blood loss. 

The most common cause of anemia worldwide, and Haiti is no exception, is iron deficiency anemia. If there is not enough iron, the body cannot produce enough red blood cells.

Blood smear in iron deficiency anemia. Note the RBCs have pale centers.

Iron deficiency in Haiti is much more common than in Canada. Poverty does that. The children are often not supplemented with iron after they are weaned from the breast, and thereafter, the diet of the average Haitian child is not rich in most nutrients, including iron. In Haiti the iron is also low because of intestinal blood loss due to worms and parasites.  

Iron deficiency anemia due to poor nutritional intake can be prevented by starting supplemental iron when an infant is weaned off breast milk. About 1 to 2 mg/kg/day of elemental iron is necessary to prevent iron deficiency anemia.

Another common cause of anemia in Haiti is the presence of hemoglobin S (sickle cell) or hemoglobin C. In these conditions, the red blood cells break down faster than normal red blood cells. These conditions originated in Africa, the ancestral home of the Haitian people. Hemoglobin S is usually seen in populations of central African origin and hemoglobin C in populations of western African origin, and the conditions can co-exist. A study carried out between 2002 and 2009 revealed hemoglobin S in about 15% of the population tested.

Blood smear in Sickle Cell anemia. Note the classic "sickle" cells.

The blood test to diagnose anemia is the Complete Blood Count (CBC). There are likely few individuals in Canada who have not had this basic test on numerous occasions. This is not the case in Haiti where access to modern health care is a chronic social problem. However, there is a laboratory in the Project Medishare Hospital where I will work, and this test will be available.

Treatment of iron deficiency anemia requires supplementation with 6 mg/kg/day of elemental iron for 3 months.  

I expect that most of the children who leave the hospital will have iron supplementation as part of their discharge planning.  

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