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Hematologic and bone marrow changes in children with protein-energy malnutrition
1Department of Pediatrics, Faculty of Medicine, Baskent University , Adana , Turkey.
Insights
Severe protein-energy malnutrition (PEM) in children often causes anemia, primarily due to iron deficiency. Vitamin B12 and folate levels remain normal, but bone marrow changes indicate nutritional deficiencies.
Area of Science:
- Pediatrics
- Hematology
- Nutritional Science
Background:
- Protein-energy malnutrition (PEM) significantly impacts the hematopoietic system.
- PEM is a critical health issue in developing nations.
- This study investigates clinical, hematological, and bone marrow changes in severe PEM cases.
Purpose of the Study:
- To examine the relationships between clinical features and hematological/bone marrow changes in severe pediatric PEM.
- To identify the primary causes of anemia in children with severe PEM.
- To assess the status of iron, vitamin B12, and folate levels in these patients.
Main Methods:
- Evaluation of 34 pediatric patients (3-20 months) with severe PEM, classified using the Wellcome-Trust criteria.
- Analysis included full blood count, iron studies (serum iron, TIBC, ferritin), vitamin B12, folic acid, complement levels, and bone marrow examination.
- Patients were categorized into Marasmic-Kwashiorkor (M-K), Kwashiorkor (KW), and Marasmic (M) groups.
Main Results:
- Anemia was prevalent in 97% of patients.
- Iron deficiency was a major contributor, with low serum iron (67.6%), low transferrin saturation (76.4%), and absent marrow iron (58.8%).
- Bone marrow showed erythroid hypoplasia and megaloblastic/dysplastic changes in a significant proportion of patients.
Conclusions:
- Anemia, largely due to iron deficiency, is the most common hematologic finding in severe PEM.
- Vitamin B12 and serum folate levels were normal, suggesting iron deficiency as the primary cause of anemia.
- Bone marrow abnormalities in severe PEM are linked to inadequate protein and energy intake.
Background:
All systems in an organism are affected by protein-energy malnutrition (PEM), but one of the worst affected is the hematopoietic system. Today PEM remains a very serious problem in developing countries. We examined the relationships between clinical features, hematological, and bone marrow changes with severe PEM from Turkey.
Method:
We evaluated 34 (11 females and 23 males) consecutive cases of severe PEM, with no underlying diseases aged 3-20 months. The clinical nutritional conditions of the patients were determined using the Wellcome-Trust PEM classification. Ten of the patients were in the Marasmic-Kwashiorkor (M-K) group, 10 were in the Kwashiorkor (KW) group, and 14 were in the Marasmic (M) group. Full blood count, protein, albumin, serum iron (SI), iron-binding capacity (TIBC), ferritin, vitamin B12, folic acid, complement-3 (C3), complement-4 (C4), and bone marrow were investigated in all groups.
Results:
Anemia was detected in 97% of patients. We determined serum iron levels were low in 67.6% of the patients, TS levels were low in 76.4% of the patients and ferritin levels were low in 20.5%. The level of vitamin B12 was normal in all patients. Bone marrow analysis showed erythroid series hypoplasia in 28.5% of patients in the M group, 50% in the KW group, and 30% in the M-K group. Marrow iron was absent in 58.8% of patients.
Conclusion:
The most common hematologic change in the children with PEM was anemia and major cause of anemia was iron deficiency in this study. Patients with severe PEM have normal Vit B12 and serum folate levels. Most of the patients with severe PEM had normal cellularity with megaloblastic and dysplastic changes in bone marrow due to the inadequate and imbalanced intake of protein and energy.
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