Anemia and Foreign Body Aspiration in Pediatrics

Document Type : Original Article

Authors

Associate Professor of Pediatric Surgery,Department of Pediatric Surgery, Mashhad University of Medical Sciences , Mashhad, Iran.

Abstract

Introduction: Foreign body aspiration (FBA) is a life threatening medical condition and considered a surgical emergency in patients with acute symptoms. Eating disorders like pica may increase the rate of foreign body ingestion especially in toddlers with immature airway protective reflexes. Iron deficiency is the common cause of both pica and anemia in infancy and this article evaluates the incidence of anemia among patients with FBA.
Materials and Method: Medical records of 141 children with aspirated foreign body were reviewed. Control group consisted of patients who had been operated because of inguinal hernia considering the same exclusion criteria and age range and sex distribution. RBC indexes were assessed and incidence of anemia was evaluated and compared between FBA patients and control group.
Results: Anemia according to age matched Hemoglobin was observed in 34.8% of FBA cases and 15.6% in control group so anemia in FBA group was significantly more common than control group.
Conclusion: Screening and early detection of IDA in childhood, especially in high risk group should be considered a public health care priority to prevent its direct or indirect life-threatening complications such as foreign body aspiration.

Keywords


  1. Divisi D, Di Tommaso S, Garramone M, Di Francescantonio W, Crisci RM, Costa AM, et al. Foreign bodies aspirated in children: role of bronchoscopy. The Thoracic and cardiovascular surgeon. 2007 Jun;55(04):249-52.
  2. Brkić F, Umihanić Š. Tracheobronchial foreign bodies in children: Experience at ORL clinic Tuzla, 1954–2004. International Journal of Pediatric Otorhinolaryngology. 2007 Jun 1;71(6):909-15.
  3. Roda J, Nobre S, Pires J, Estêvão MH, Félix M. Foreign bodies in the airway: A quarter of a century's experience. Revista Portuguesa de Pneumologia (English Edition). 2008 Nov 1;14(6):787-802.
  4. Kiyan G, Gocmen B, Tugtepe H, Karakoc F, Dagli E, Dagli TE. Foreign body aspiration in children: the value of diagnostic criteria. International journal of pediatric otorhinolaryngology. 2009 Jul 1;73(7):963-7.
  5. Gerber AC, Stocker S, Weiss M. Tracheobronchial foreign body aspiration in children-diagnostic value of symptoms and signs. Swiss medical weekly. 2006 Aug 26;136(3334).
  6. Karakoc F, Cakir E, Ersu R, Uyan ZS, Colak B, Karadag B, et al. Late diagnosis of foreign body aspiration in children with chronic respiratory symptoms. International journal of pediatric otorhinolaryngology. 2007 Feb 1;71(2):241-6.
  7. Ciftci AO, Bingöl-Koloğlu M, Şenocak ME, Tanyel FC, Büyükpamukçu N. Bronchoscopy for evaluation of foreign body aspiration in children. Journal of pediatric surgery. 2003 Aug 1;38(8):1170-6..
  8. DeRowe A, Massick D, Beste DJ. Clinical characteristics of aero-digestive foreign bodies in neurologically impaired children. International journal of pediatric otorhinolaryngology. 2002 Feb 28;62(3):243-8.
  9. Brugnara C, Oski FA, Nathan DG. Diagnostic approach to the anemic patient. In: Nathan and Oski's Hematology and Oncology of Infancy and Childhood, 8th ed, Orkin S, Nathan D, Ginsburg D, et al (Eds), Elsevier 2015. p.293.
  10. Cembrowski GS, Chan J, Cheng C, Bamforth J. NHANES 1999-2000 data used to create comprehensive health-associated race-, sex-and age-stratified pediatric reference intervals for the Coulter MAXM. Lab Hematol. 2004;10:245-6.
  11. Baker RD, Greer FR. Committee on Nutrition American Academy of Pediatrics. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children (0-3 years of age). Pediatrics. 2010;126(5):1040-50.
  12. Staffa SJ, Joerger JD, Henry E, Christensen RD, Brugnara C, Zurakowski D. Pediatric hematology normal ranges derived from pediatric primary care patients. American Journal of Hematology. 2020 Oct;95(10):E255-7.
  13. Tahmasebi H, Higgins V, Bohn MK, Hall A, Adeli K. CALIPER Hematology Reference Standards (I) Improving Laboratory Test Interpretation in Children (Beckman Coulter DxH 900–Core Laboratory Hematology System). American journal of clinical pathology. 2020 Aug 5;154(3):330-41.
  14. Shah SR, Little DC. Ingestion of Foreign Bodies. 6th ed. In: Holcomb III GW. Murphy JP.  Ostlie DJ. Ashcraft's pediatric surgery. FL: Elsevier, 2014: 151-4
  15. Kelly NR, Shank LM, Bakalar JL, Tanofsky-Kraff M. Pediatric feeding and eating disorders: current state of diagnosis and treatment. Current Psychiatry Reports. 2014 May;16(5):1-2.
  16. İslek A, Sayar E, Yilmaz A, Boneval C, Artan R. A rare outcome of iron deficiency and pica: rapunzel syndrome in a 5-year-old child. Turk J Gastroenterol. 2014;25(1):100-2.
  17. Parandavar N, Sobhanian S. A study on the occurrence of iron deficiency anemia referring to health care centers in Jahrom, 1385. J of Jahrom med school 2010; 8(2):41-46
  18. Assis AM, Barreto ML, Gomes GS, Prado MD, Santos NS, Santos LM, Sampaio LR, Ribeiro RD, Oliveira LP, Oliveira VA. Childhood anemia prevalence and associated factors in Salvador, Bahia, Brazil. Cadernos de Saúde Pública. 2004;20:1633-41.
  19. Zhu YP, Liao QK. Prevalence of iron deficiency in children aged 7 months to 7 years in China. Zhonghua er ke za zhi= Chinese journal of pediatrics. 2004 Dec 1;42(12):886-91.
  20. Uijterschout L, Vloemans J, Vos R, Teunisse PP, Hudig C, Bubbers S, et al. Prevalence and risk factors of iron deficiency in healthy young children in the southwestern Netherlands. Journal of pediatric gastroenterology and nutrition. 2014 Feb 1;58(2):193-8.
  21. Tympa-Psirropoulou E, Vagenas C, Dafni O, Matala A, Skopouli F. Environmental risk factors for iron deficiency anemia in children 12–24 months old in the area of Thessalia in Greece. Hippokratia. 2008 Oct;12(4):240.
  22. Jiaqiang S, Jingwu S, Yanming H, Qiuping L, Yinfeng W, Xianguang L, et al. Rigid bronchoscopy for inhaled pen caps in children. Journal of pediatric surgery. 2009 Sep 1;44(9):1708-11.
  23. Midulla F, Guidi R, Barbato A, Capocaccia P, Forenza N, Marseglia G, et al. Foreign body aspiration in children. Pediatrics international. 2005 Dec;47(6):663-8.
  24. Brkić F, Delibegović-Dedić S, Hajdarović D. Bronchoscopic removal of foreign bodies from children in Bosnia and Herzegovina: experience with 230 patients. International journal of pediatric otorhinolaryngology. 2001 Sep 28;60(3):193-6.
  25. Akin F, Solak ES, Kilicaslan C, Boke SB, Arslan S. Iron deficiency anemia among hospitalized children in Konya, Turkey. Anemia. 2013 Dec 18;2013.
  26. Thompson J, Biggs BA, Pasricha SR. Effects of daily iron supplementation in 2-to 5-year-old children: systematic review and meta-analysis. Pediatrics. 2013 Apr;131(4):739-53.
  27. Azab SF, Abdelsalam SM, Saleh SH, Elbehedy RM, Lotfy SM, Esh AM, et al. Iron deficiency anemia as a risk factor for cerebrovascular events in early childhood: a case–control study. Annals of hematology. 2014 Apr;93(4):571-6.
  28. Berglund S, Domellöf M. Meeting iron needs for infants and children. Current Opinion in Clinical Nutrition & Metabolic Care. 2014 May 1;17(3):267-72.