Early Detection and Referral of Children with Malnutrition

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Recognition, Detection and Referral of Micronutrient Deficiencies

Detection and Referral of Severe Anaemia

Severe anaemia is defined clinically as a low hemoglobin concentration leading to the point that the heart cannot maintain adequate circulation of the blood. A common complaint is that individuals feel breathless at rest.

Severe anaemia may be defined by using a hemoglobin or hematocrit cutoff or by extreme pallor.

First choice: If the hemoglobin or hematocrit can be determined, cutoffs of hemoglobin below 7.0 g/dL or hematocrit below 20% should be used to define severe anaemia.

Second choice: a method is available for evaluating the color of a drop of blood on a special filter paper. This method (formerly called the Talqvist method) requires standard blotting or filter paper and color comparison charts, which are available from the World Health Organization (Haemoglobin Colour Scale).

Third choice: assessment of pallor. Three sites should be examined: the inferior conjunctiva of the eye, the nail beds, and the palm. If any of these sites is abnormally pale, the individual should be considered to be severely anemic. This method will detect most but not all of people who are truly severely anemic (i.e., hemoglobin below 7.0 g/L) and will rarely identify a healthy person as severely anemic.

Iron deficiency is not the only cause of severe anaemia. Other possible causes include malaria, folate deficiency, hemoglobinopathies such as sickle cell anaemia or thalassemias, and the anaemia of chronic disorders such as HIV infection, tuberculosis, or cancer.

In primary health care settings, health care workers should know when to refer individuals who do not respond to oral iron therapy or who are at urgent risk of serious complications.

The following categories of people need to be timely referred to hospitals or facilities with appropriate treatment in place:

• Children with severe malnutrition
   
• Pregnant women in the last month of pregnancy
   
• People with respiratory distress or cardic abnormalities
   
• People that have started the oral iron and folate therapy but have their conditions worsening at the first follow-up visit
   
• People that are doing the oral iron and folate therapy but show no improvement at 4-week follow-up visit.

View Management of Iron Deficiency Anaemia

02 January, 2009