Disorders Presenting as Anaemia among Paediatric Population at a Tertiary Care Centre, Kerala, India: A Cross-sectional Study

Introduction: Anaemia is a condition marked by low Haemoglobin (Hb) concentration and is an important risk factor for the poor health and development of children and adolescents. Anaemia is not a diagnosis, but merely an objective sign of disease. The correct treatment requires an understanding of the pathogenesis of the condition. Aim: To identify disorders presenting as anaemia in paediatric population. Also to analyse the data by grading of anaemia and to calculate the proportion of anaemia in various paediatric age groups. Materials and Methods: This cross-sectional study was conducted at Government Medical College, Ernakulum, Kerala, India, from September 2017 to February 2018, on 211 paediatric patients of age groups from newborn upto 18 years. After a detailed clinical history and examination, Complete Blood Count (CBC), peripheral smear preparation, reticulocyte count, renal function tests, liver function tests, and if necessary, radiological and bone marrow examination were done. The mean haemoglobin in the categories were compared with Comprehensive National Nutritional Survey Data. The data obtained were entered in Microsoft excel 365 and further analysed. Categorical variables were analyzed by Fisher’s- exact test and continuous variables by Analysis of Variance (ANOVA) and Kruskal-Wallis test and the significance level was set at p-value ≤ 0.05. Results: Of the 211 patients, 120 (56.87%) were males and 91 (43.13%) were females. The average haemoglobin level varies across age groups and sex. In the case of newborns, average Hb was 9.31 g/dL in males and 10.4 g/dL in females. A total of 211 patients presented with 339 disease conditions, with respiratory disorders in 98, followed by 83 nutritional diseases, 49 infections and 35 systemic diseases. Total of 132 patients in age group of 6 months to 4 years, presented with maximum disorders (206). A total of 186 (54.8%) cases presented with Microcytic Hypochromic Anaemia (MHA), 149 (43.95%) with Normocytic Normochromic Anaemia (NNA) and only 4 (1.18%) with Haemolytic Anaemia (HA). No cases of macrocytic anaemia were noted. Conclusion: Total of 76.8% cases of MHA (42.1% of total anaemia cases) are associated with Nutritional, Respiratory and Infectious conditions which can be managed by public health measures. The haemoglobin levels in neonates and less than 6 months age group were significantly less than population mean which needs to be addressed. In similar manner, girls in school going age group had significantly lower Hb than boys.