Three cases have been presented to be to review regarding a potential blood disorder:
o Amy, a 4-year-old Caucasian female, has been complaining of being tired all the
time. She is pale and a picky eater. Her mother is a single mom with a small budget
to feed a large family. Amy only eats pasta, breads, and hot dogs, and drinks only
artificial fruit punch.
Certainly, it is possible that Amy may have symptoms of early childhood diabetes, particularly viewing her diet, but it is likely that she is suffering from iron deficiency anemia. Her diet is not varied, it does not include fresh vegetables or meats (mostly carbohydrates), and her fatigue and pale nature make it likely that she is not getting enough iron in her bloodstream to produce healthy blood cells which will transport oxygen and nutrients. Because there is insufficient iron in the bloodstream, hemoglobin cannot be formed, which limits proper blood physiology.
Symptoms include pallor (reduction of oxygenated blood), weakness, and fatigue. Although it develops slowly, untreated it can develop into severe breathing trauma, hair loss, and fainting symptoms.
Fortunately, even on Amy’s mother’s tight budget, turning this around is relatively easy. Increase the amount of available iron in Amy’s diet, through a good quality children’s vitamin that also includes a higher than normal dose of Vitamin C and lecithin. Lower the pasta intake, or at least insist that it be eaten with red meat, increase the amount of eggs in the diet, as well as insisting on salads of green, leafy vegetables, and even adding broccoli, peas, etc. to the pasta. Adding nuts (walnuts especially), blueberries and raisins to a cereal diet will also help Amy.
References:
Garrison, C. (2003), The Iron Disorders Institute Guide to Anemia, Cumberland.
o Marcus is a 5-year-old African-American male who has just moved to New York City,
and is visiting his new pediatrician for a kindergarten physical. His mom tells the
nurse that she carries the “trait” and wants Marcus screened for it.
White Marcus is not presenting any symptoms at present, it is likely his mother wants him screened for sickle cell anemia, a genetic condition very often associated with African Americans. The disease, which changes normal, roundish red blood cells into cells that are shaped like crescent moons, does not allow the red blood cell to move freely through the venous system nor take in the correct amount of oxygen and nutrients. Depending on the severity of the case, it can cause chronic pain, infections, anemia, and ultimately stroke.
Chronic pain is the most common symptom of this disease, usually in the extremities, or abdomen. This pain may last for days, hours, or even weeks. Additionally, patients with sickle cell often have anemia, caused by a shortage of normal shaped (and functioning) red blood cells. They may have a jaundiced look, be listless, and have difficulty moving without great pain.
Sickle cell anemia is diagnosed with a blood test; in fact, in many states, all infants, regardless of ethnicity, are tested for this prior to leaving the hospital.
Fortunately, depending on the severity of the case, and when it is identified and treatment begun, regular proactive care has a positive effect on both the disease and the lifestyle of the individual. Early treatment typically involves daily antibiotics, used from infancy to 5-6 years of age, depending on symptoms. Sometimes blood transfusions help by temporarily increasing the number of healthy cells in relation to the diseased cells. The most important part of treatment, however, is understanding how to deal with the pain events. Warm soaks with baking soda and Epsom salts often ease the pain, sometimes OTC pain relievers are helpful in less severe cases; if the pain events are too pronounced, a hospital visit is advised.
There are six major principles to utilize in diet for sickle cell patients that will contribute to a higher quality of life. 1) Make sure that the patient received a good, balanced diet including plenty of green vegetables (antioxidants), and some (spinach, broccoli) that are high in iron. 2) Fluid balance is critical, in fact, it is often when fluids are low that pain crises hit, 3) Sometimes extra caloric intake is required; up to 20% more, but, 4) Get plenty of exercise and avoid obesity (which is hard on joints and the vascular system). 5) Get plenty of fiber (whole grains and fruit) and adequate supplies of yogurt or other means to recolonize friendly floral in the gut. 6) Take extra folic acid, which helps produce more red blood cells quicker. Folic acid is found in green and leafy vegetables.
References:
Bloom, M. (1995), Understanding Sickle Cell Disease, University of Mississippi.
Hsu, L. et.al., (1/25/01), “Diet and Nutrition in Sickle Cell Disease,” DrSpock.com.
Silverstein, A., et.al. (2006), The Sickle Cell Anemia Update, Winslow.
o Richard has noted over the past several weeks that he is having more bruises, or
ecchymosis, all over his body. After coughing this morning, he noticed tiny red marks
all around his eyes.
Richard may have one of two possibilities: a blood sugar disorder that is causing the bruising and peticia, or a potential for a coagulation factor abnormality, and perhaps even a form of hemophilia.It is apparentthat Richard is, indeed, bleeding internally, and the spots beneath his eyes are indicative of that as well.
It will take a series of blood tests to be sure, but if it is hemophilia, it is an inherited bleeding, or coagulation, disorder. Children with hemophilia lack the ability to stop bleeding because of the low levels, or complete absence, of specific proteins, called "factors," in their blood that are necessary for clotting. Proper clotting of blood helps prevent excessive bleeding.
Depending on the type and severity of the hemophilia, different treatments are available, but it is important to try to prevent childhood injuries, avoid sports and rough contact, and tell a doctor immediately prior to any tooth extraction, or other surgery.
Diets low in calories but high in blood building factors are often successful for hemofilia, again, it depends on the type and severity.
References:
Jones, P. (2002), Living With Hemophilia, Oxford University Press.