Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Prof. Somashekhar Nimbalkar
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Saraswati Dental College
Lucknow
On Sep 2018




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On Aug 2018




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"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : SC01 - SC05 Full Version

Clinico-aetiological Analysis of Anaemia along with Haematological Parameters in Children and Adolescents: A Retrospective Study from a Tertiary Care Hospital, Chhattisgarh, India


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55522.16293
Gyanesh Mishra, Rinu Dwivedi

1. Associate Professor, Department of Paediatrics, Shri Shankaracharya Institute of Medical Science, Bhilai, Charttisgarh, India. 2. Associate Professor, Department of Paediatrics, Shri Shankaracharya Institute of Medical Science, Bhilai, Charttisgarh, India.

Correspondence Address :
Dr. Rinu Dwivedi,
C-70, Surya Vihar Phase 2, Junwani, Bhilai, Charttisgarh, India.
E-mail: dwivedirinu10@gmail.com

Abstract

Introduction: Anaemia is defined as a decreased concentration of blood haemoglobin. World Health Organization (WHO) estimates that 42% of children less than 5 years of age worldwide are anaemic and prevalence of anaemia in India in children 6-59 months for year 2019 was 53.4%. Childhood anaemia not only affects physical health but cognitive and social development as well.

Aim: To determine various causes of anaemia in children in age groups 1-5 years, 6-12 years and 13 to 18 years and to determine clinical features and haematological investigations in moderate to severe anaemia.

Materials and Methods: This retrospective, observational study was conducted in Department of Paediatrics, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Charttisgarh, India, from September 2021 to December 2021. The data collection was done retrospectively over a period of 2 years, from September 2019 to September 2021 from patients case records which were available from Medical Record Department. A total of 300 patients from age 1 year to 18 years who were admitted in the paediatric ward with anaemia were included for study. Anaemia was defined and severity categorised based on WHO definition. The aetiology of anaemia was analysed based on Complete Blood Count (CBC) and investigations including serum ferritin, vitamin B12 level, bone marrow examination, High Performance Liquid Chromatography (HPLC) and other relevant investigations. Data was entered in a excel sheet and analysed using software Statistical Package for the Social Sciences (SPSS) version 21.0. Statistical test used was student’s t-test for paired and unpaired data for continuous variables. The p-value <0.05 was considered significant.

Results: Out of total 300 patients, 148 (49.3%) were males and 152 (50.7%) were females. Most of the patients were in 1-5 years of age (45.6%), followed by 13-18 years age (29.4%) and 6-12 years (25%). Total 95 (31.6%) patients had mild, 112 (37.3%) had moderate and 93 (31%) had severe anaemia. The three most common causes of anaemia were iron deficiency in 77 patients (37.5%), haemolytic anaemia in 54 patients (26.3%) and vitamin B12 deficiency in 34 patients (16.5%). Mean Red Cell Distribution Width (RDW )(31.1±10.1%) values and mean of Mean Corpuscular Volume (MCV) (98.2±15.2 fL) were higher in vitamin B12 deficiency patients as compared to iron deficiency patients mean RDW (17.2±3.5%) and mean of MCV (58.14±7.3 fL), this difference was found to be significant with p-value <0.001.

Conclusion: Most of the patients had moderate anaemia. Iron deficiency was most common cause of anaemia overall in children and especially below 13 years followed by haemolytic anaemia mainly sickle cell anaemia and Vitamin B12 deficiency anaemia. The MCV and RDW values from CBC can be used to identify two most common causes of nutritional anaemia.

Keywords

Haemoglobin, Iron deficiency, Mean corpuscular volume, Prevalence, Red cell distribution width, Sickle cell disease

Anaemia is defined as a decreased concentration of blood haemoglobin. It is a condition in which the number of red blood cells or their oxygen carrying capacity is insufficient to meet the body’s physiological requirements, which vary by age, sex, altitude, smoking habits, and during pregnancy (1),(2),(3). The clinical features of anaemia include pallor, sleepiness, irritability, decreased exercise tolerance and if it remains untreated it may lead to tachypnea, tachycardia, shortness of breath on exertion, weakness, cardiac dilatation and cardiac failure (3).

As per Comprehensive National Nutrition Survey (CNNS) 2016-2018 data, the prevalence of anaemia in children age 1-4 years was 40.6%, 5-9 years it was 23.5% and 10-19 years it was 28.4% (4). World Health Organization (WHO) estimates that 42% of children less than 5 years of age worldwide are anaemic and prevalence of anaemia in India in children 6-59 months for year 2019 was 53.4% (5). However, as per National Family Health Survey 5 (NFHS-5) which was done on 2019-2021, children age 6-59 months who were anaemic are 67.1% in India (6). It has increased from 58.6% which was as per NFHS-4 in 2015-2016 for for India (7). In Chhattisgarh state it was 67.2% as per NFHS-5, which is even higher than national figure (6). The increase in the prevalence of anaemia is unfortunate in spite of national nutritional anaemia control program and overall growing economy of India (8). The most common causes of anaemia include nutritional deficiencies; mainly iron deficiency, folic acid, and vitamin B12 and vitamin A deficiencies. Others include haemoglobinopathies and infectious diseases, such as malaria, tuberculosis, Human Immunodeficiency Virus (HIV) and parasitic infections (7),(9).

Iron deficiency is the most common nutritional disorder in the world (10). There are enough of studies available on anaemia in children under 5 years of age (11),(12). But very few studies about adolescents are available, who are in their most crucial period of life and are future citizens (13),(14). Childhood anaemia not only affects physical health but cognitive and social development as well (15). Anaemia causes lethargy, lack of concentration, vulnerable to illness and delayed puberty (16),(17). There are few community based studies which analysed prevalence of anaemia in children from few districts of Chhattisgarh but none of the studies analysed clinical features, aetiology or haematological parameters (18),(19),(20).

Thus, the present study being hospital based was conducted to highlight the burden of anaemia among children in Bhilai and nearby areas and also to add to the existing knowledge about clinical features and aetiology of anaemia so that preventive measures and interventions can be taken to build a healthier future. The aim of the present study was to determine various causes of anaemia in children in age groups 1-5 years, 6-12 years and 13 to 18 years; in moderate to severe anaemia cases to determine clinical features and haematological parameters which can help in easy identification of its aetiology.

Material and Methods

This retrospective, observational study was conducted in Department of Paediatrics, Shri Shankaracharya Institute of Medical Sciences, Bhilai, Charttisgarh, India, from September 2021 to December 2021. Institutional Ethical Committee approval was obtained (certificate number SSIMS/IEC/2021/37). Data collection was done for a period of 2 years, from September 2019 to September 2021 from patient’s case records which were available from Medical Record Department.

Inclusion criteria: Paediatric patients from age 1 year to 18 years who were admitted in the paediatric ward with anaemia were included in the study.

Exclusion criteria: Patients presented in Outpatient Department (OPD), patients admitted in Paediatric Intensive Care Unit (PICU) due to serious illness, shock, sepsis, congestive cardiac failure, COVID-19 positive, immunodeficiency or those that died within 48 hours of admission, patients with insufficient case records or investigations and paediatric surgery patients were excluded from the study.

Sample size calculation: Sample size was colculated by using Cochran’s formula (21) n0=z2pq/e2.

As the data for prevalence of anaemia is not known for this region hence ‘p’ is used as 50% in above formula, q is 1-p (50%), z=1.96 for 95% confidence limit and estimated precision(e) was considered as 5%, n=384.

As it was hospital based sample, which has limited number of children, we used Cochran’s formula for limited sample size (21) which is:

n=n0/1+(n0-1)/N

n0 is sample from population which was 384 and N is sample size which is total paediatric admissions in 2 years , which were 1106. Hence, final N=284. Out of 1106 admissions in the study time period between age group 1 year to 18 years, 300 met the inclusion criteria and is higher than required sample size.

Data collection: Data collection included detailed clinical presentation like weakness, fever, yellowish discoloration of eyes, progressive pallor, cough, cold, vomiting, abdominal pain, joint pain and any others. Developmental, immunisation and past history related to blood transfusion were noted. Examination findings included detailed general examination and presence of organomegaly (hepatosplenomegaly). Findings for the following Investigations were included; complete blood picture with peripheral smear and reticulocyte count, High Performance Liquid Chromatography (HPLC), serum ferritin, iron profile, vitamin B12 level, coomb’s test and bone marrow examination findings. Anaemia was defined and severity categorised based on WHO definition as shown in (Table/Fig 1) (22).

Iron Deficiency Anaemia (IDA) was diagnosed based on serum ferritin levels.

• In Children aged 1-4 years serum ferritin <12 μg/L.
• In Children aged >5 years serum ferritin <15 μg/L was considered iron deficiency (23).
• Vitamin B12 deficiency was defined as serum vitamin B12 <200 pg/mL (24).

HPLC was used for diagnosis of haemoglobinopathies (25). After data collection patients were classified based on severity of anaemia as mild, moderate and severe based on haemoglobin report (22). Clinical features and aetiology was analysed for moderate and severe anaemia cases only. The aetiology of anaemia was analysed based on Complete Blood Count (CBC) and peripheral smear report and other investigations as mentioned above.

Statistical Analysis

Data was entered in a excel sheet and analysed using software Statistical Package for the Social Sciences (SPSS) version 21.0. Variables were expressed as mean, standard deviation, and percentage as appropriate. Statistical test used was student’s t-test for paired and unpaired data for continuous variables. The p-value <0.05 was considered significant.

Results

Total of 300 patients between 1 year to 18 years of age were studied, out of which 148 (49.3%) were males and 152 (50.7%) were females. The patients were divided into three age groups. A 45.6% were 1-5 years of age, 29.4% were 13-18 years of age and 25% were 6-12 years of age, as shown in (Table/Fig 2). There were more number of female patients in 13-18 years age group and more male patients in 1-5 years age group.

Anaemia patients were divided into 3 groups based on severity. Overall 95 (31.7%) patients had mild anaemia, 112 (37.3%) had moderate and 93 patients (31%) had severe anaemia.

As shown in (Table/Fig 3) and for age group 1-5 years most patients had moderate anaemia (53.3%), for 6-12 years age most cases had mild anaemia (36%) however severe anaemia cases was more in 13-18 years age group (55.7%).

Aetiology of anaemia was analysed in moderate and severe anaemia cases only which were 205 out of 300. The most common cause of anaemia was found to be IDA in total 77 patients (37.5%), followed by haemolytic anaemia in 54 patients (26.3%), Vitamin B12 deficiency anaemia in 34 patients (16.5%) and other causes as shown in (Table/Fig 4). Dimorphic anaemia had both iron and Vitamin B12 deficiency. Out of total 54 haemolytic anaemia cases 10 were sickle cell anaemia heterozygous, 29 were sickle cell anaemia homozygous, five were thalassaemia major, four were sickle thalassaemia, one was thalassaemia intermedia, two were sickle cell with iron deficiency and three were sickle cell with vitamin b12 deficiency patients.

Anaemia aetiology could not be evaluated in total 21 patients, as complete investigations were not available to conclude the aetiology, could be due to financial reason or early discharge. Iron deficiency was most common and haemolytic anaemia were second most common aetiology of anaemia in children 1-5 years and 6-12 years age group, however vitamin B12 deficiency anaemia was most common cause in adolescent age group 13-18 years.

The most common clinical feature was fever in 242 (80.6%), followed by cough and cold or breathing difficulty in 150 (50%), loose stools and vomiting in 98 (32.6%), generalised weakness and loss of appetite in 106 (35.3%), bleeding manifestation in 11 (3.6%) joint pains in 11 (3.6%) other causes in 10 (3.1%) which include pain in abdomen in eight and seizures in two patients. Examination findings were pallor (67.3%), icterus (7%), hyperpigmentation (6%) and organomegaly (hepatomegaly or splenomegaly or both in 45%) (Table/Fig 5).

Mean haemoglobin was analysed in 205 moderate to severe anaemia cases and it was found to be 7.06±1.2 gm/dL and minimum value was 1.9 gm/dL (Table/Fig 6).

MCV and RDW values were compared for two most common types of nutritional deficiency anaemia. Mean Corpuscular Volume (MCV) was 58.14±7.3 fL for iron deficiency and 98.2±15.2 fL for vitamin b12 deficiency anaemia patients as shown in (Table/Fig 7). Using student’s t-test for independent means for MCV values there was significant difference in MCV values for IDA and vitamin B12 deficiency anaemia with p-value <0.001.

The difference in Red cell Distribution Width (RDW) between iron deficiency and vitamin b12 deficiency anaemia was also significant with p-value <0.001. The mean RDW value for Vitamin b12 deficiency anaemia was 31.1±10.1% which is significantly high as compared to IDA patients which was 17.2±3.5% (Table/Fig 7).

Discussion

In the present study, 300 patients of anaemia were analysed out of which 148 (49.3%) were males and 152 (50.7%) were females. Most of the patients (45.6%) were 1-5 years of age, followed by 29.4% were 13-18 years of age and 25% were 6-12 years of age.

A similar study done by Prakash A et al., also found that most of the children were below 5 years with overall predominance of moderate anaemia cases. They included total of 150 hospitalised children with anaemia and divided them based on age groups, children below 5 years were 61 (40.7%), 46 (30.7%) were 5-11 years age group, 13 (8.7%) were in 12-14 years and 30 (20%) were 15 years and above. Out of total 150 patients, 30 (20%) children were graded as having mild, 98 (65.3%) moderate and remaining 22 (14.7%) were graded as having severe anaemia (26).

Similar to the present study, Saba F et al., also found that moderate anaemia cases were dominant in their study. They found mild in 12.7%, moderate in 75.82% and severe grades of anaemia in 11.43% patients (27). However, another study done among children of age group 6 months to 12 years found that 8 out of 100 children had mild, 44 had moderate and 48 had severe anaemia (28).

Balci YI et al., in their study of total of 1120 patients (672 girls and 448 boys) aged 12-16 years admitted to paediatric outpatient found that 63 of 1120 (5.6%) children were anaemic. When the gender was considered, 8.3% of the girls and 1.6% of the boys had anaemia (29). This was similar to our study as we also found more number of female (61.4%) patients in adolescent age group 13-18 years age group as compared to male (38.6%) with anaemia. However, few studies showed male predominance, but most of them were conducted below 14 years age group (30),(31). In the present study, among 205 cases of moderate and severe anaemia most common aetiology of anaemia was found to be iron deficiency in total 37.6%, followed by haemolytic anaemia in 26.3% and vitamin B12 deficiency in 16.6%. In children below 13 years the most common cause of anaemia was iron deficiency, but in 13-18 years vitamin B12 deficiency was most common. Among haemolytic anaemia’s sickle cell homozygous was more common (14.1%) than heterozygous (4.8%), this could be due to inclusion of moderate and severe cases only in aetiology analysis (3). The increasing trend of fast food in India might be adding to the nutritional deficiencies (32),(33),(34). This emphasises the need for early screening and genetic counselling for haemoglobinopathies. Also nutrition counselling not only for small children but also for adolescent age group, which are usually neglected, should become part of daily practice for health care provider.

Marken P et al., in their study also found that IDA was the most common aetiology with 104 (41.6%) patients. Out of 104 IDA patients, 71 (68.2%) were found in age group 1-6 years. Vitamin deficiencies (Vit. B12, Folic acid or both) were found in 34 patients. Most of the (26.4%) Vit B12 deficiency anaemia patients were from 13-18 age group whereas most of the (17.6%). Folic acid deficiency was found in 7-12 years (13).

Similar findings were seen in the study done by Madoori S et al., in Telangana. The common causes of anaemia in their study were iron deficiency (58%), sickle cell disorders 27%, thalassaemia 9%, 5% cases had megaloblastic anaemia and 2% aplastic anaemia (31). Another study done among children aged 5-12 years, observed that, iron deficiency was predominant 80/110 (72.7%) followed by megaloblastic anaemia 20/110 (18.1%). Least were aplastic and haemolytic anaemia, five cases each (4.5 %). The Incidence of IDA was greater in females i.e., 60 (75%) in comparison to males 20 (25%) whereas for megaloblastic anaemia the Incidence was found to be grater in males i.e., 15 (75%) when compared to females 5 (25%) (35).

Prakash A et al., analysed clinical features of patients between 6 months to 18 years with anaemia and found major presenting complaint as pallor (64%), koilonychias (35.2%), palpitation (35.3%), dysphagia (32.7%), dyspnoea (28.7%) and lack of concentration (27.3%) (26). Another similar study found that the chief presenting symptoms of anaemia as easy fatigability (34%), loss of appetite (36%), pallor (26), and irritability (24%). The chief clinical signs were pallor of mucosa (76%), pallor of skin, palms, and soles (64%), tachycardia (23%), cheilitis (13%), and hemic murmur (9%) (35). Clinical features in the present study were similar to above studies. In the present study, higher values of both MCV and RDW were seen in vitamin B12 deficiency and lower MCV and lower RDW values were seen in IDA. This could be helpful if facility is not available everywhere for investigations like serum ferritin, iron profile, vitamin B12 and folic acid Levels, which are costly.

Aulakh R et al., did a study among 151 children with microcytic anaemia (MCV<75 fl) and found that the mean RDW value was 18.37±2.22% in IDA group (97 children) compared to 16.55±1.51 % in the non IDA group (54 children) (p-value <0.001, unpaired t-test) (36). The results were comparable to the present study.

One more study found the sensitivity of RDW at cut-off of 18% to detect IDA was 76.5% and specificity 73.1%. At a cut-off of RDW 16.4%, the sensitivity was found to be 94%, however at a cut-off of 21%, the specificity was 95%. Using combination of haemoglobin ≤10 g/dL and RDW >15%, maximum sensitivity (99%) and specificity (90%) was obtained. Thus, simple coulter analysis for estimating haemoglobin and RDW can be employed for identification of children with IDA who might need iron therapy (37).

A study done by Patel S et al., concluded the sensitivity and specificity of MCV to screen out B12 deficiency were 10.14% and 92.82%, respectively. Accuracy of MCV as an indicator for B12 deficiency was estimated to be 45.05%. The mean MCV value for vitamin B12 deficiency patients was found to be 86.94±10.41 fl (38). In the present study mean MCV for vitamin b12 deficiency was 98.2±15.2 fL.

Clinicians can discern definitive diagnoses for the type of anaemia based on the MCV value. Microcytic anaemia is where MCV is less than 80 fL while normal MCV is between 80 to 100 fL. It is commonly seen in chronic iron-deficient, anaemia of chronic disease, sideroblastic anaemia, and thalassaemias. Macrocytic anaemia has MCV over 100 fL. Megaloblastic anaemia is commonly secondary to folate (also known as folic acid or vitamin B9) deficiency, cobalamin/vitamin B12 deficiency, and oroticaciduria. Normocytic anaemia is anaemia with a low haemoglobin and haematocrit range but MCV in the normal range of 80 to 100 fL. This type of anaemia is found in haemolytic causes (39).

Limitation(s)

Limitations of the present study were that being a single medical college hospital based study from Bhilai, though it has wide flow of patients from the state, the results cannot be generalised to entire Chhattisgarh state or country. Authors also could not analyse other causes of anaemia like folic acid deficiency, vitamin A deficiency due lack of facility at our centre.

Conclusion

Moderate anaemia was most common; however severe anaemia was common in adolescent children. Anaemia is more in adolescent females then males. Iron deficiency was most common cause of anaemia overall in children and especially below 13 years but in adolescent age group B12 deficiency was more common than iron deficiency. Sickle cell anaemia was most common haemolytic anaemia in this region. The use of basic CBC parameters, MCV and RDW can be used to identify two most common causes of nutritional anaemia’s if facility is not available for all investigations. Further research can be done which includes the socio-economic background and dietary pattern also as contributing factor for anaemia.

References

1.
WHO | Anaemia. WHO [Internet]. 2018 [cited 2019 MARCH 20]. Available from: http://www.who.int/topics/anaemia/en/.
2.
Schnall SF, Berliner N, Duffy TP, Benz EJ Jr. Approach to the adult and child with anaemia. In: Hoffman R, Benz EJ Jr, Shattil SJ, Furie B, Cohen HJ, Silberstein LE, McGlaveP, eds. Hematology Basic Principles and Practice. 3rd ed. Philadelphia: Churchill Livingstone, 2000:367-82.
3.
Kliegman RM, Behrman RE, Joseph W. ST Geme, Nathan J. Blum. Nelson Textbook of Pediatrics: the anaemias .21th edition, Vol 2. Chap 474 Philadelphia: Elsevier; 2020: Pp. 2505-2508.
4.
Ministry of Health and Family Welfare (MoHWF), Government of India, UNICEF and population council. Comprehensive national nutritional survey (CNNS) national report. New Delhi. 2019. Available from https://www.unicef.org/india/media/2646/file/CNNS-report.pdf
5.
WHO|Anaemia. WHO. 2018 [cited 2019 MARCH 20]. Available from: http://www.who.int/topics/anaemia/en/
6.
Government of India, ministry of health and family welfare. National family health survey 5.key indicators: 2019-2021. cited sept 2022; available from http://rchiips.org/nfhs/factsheet_NFHS-5.shtml
7.
Government of India, ministry of health and family welfare. National family health survey 4.key indicators: 2015-2016. Cited 2016; available from http://rchiips.org/nfhs/factsheet_nfhs-4.shtml
8.
Kumar A. National nutritional anaemia control programme in India. Indian J Public Health. 1999;43(1):03-05, 16. PMID: 11243085.
9.
Balarajan Y, Ramakrishnan U, Ozaltin E, Shankar AH, Subramanian SV. Anaemia in low-income and middle-income countries. Lancet. 2011;378(9809):2123-35. doi: 10.1016/S0140-6736(10)62304-5. Epub 2011 Aug 1. PMID: 21813172. [crossref]
10.
Khambalia AZ, Aimone AM, Zlotkin SH. Burden of anaemia among indigenous populations. Nutr Rev. 2011;69(12):693-719. Doi: 10.1111/j.1753- 4887. 2011.00437.x. [crossref] [PubMed]
11.
Saranappa S, Wu J. A clinical study of anaemia in children aged 6 months-5 years in a tertiary care center, Bengaluru, Karnataka, India. Indian J Child Health. 2021;8(10):367-70. [crossref]
12.
Gebreweld A, Ali N, Ali R, Fisha T. Prevalence of anaemia and its associated factors among children under five years of age attending at Guguftu Health Center, South Wollo, Northeast Ethiopia. PLoS One. 2019;14(7):e0218961. doi: 10.1371/journal.pone.0218961. PMID: 31276472; PMCID: PMC6611584. [crossref] [PubMed]
13.
Marken P, Bharat V, Chawla S, Singhal P. Clinicohaematological and biochemical profile of anaemia in pediatric age group. International Journal of Research and Review. 2020;7(1):552-56.
14.
Al-Sharbatti SS, Al-Ward NJ, Al-Timimi DJ. Anaemia among adolescents. Saudi Med J. 2003;24(2):189-94. PMID: 12682686.
15.
Soliman AT, De Sanctis V, Kalra S. Anaemia and growth. Indian J Endocrinol Metab. 2014;18(Suppl 1):S1-5. Doi: 10.4103/2230-8210.145038. PMID: 25538873; PMCID: PMC4266864. [crossref] [PubMed]
16.
Grantham-McGregor, Sally M, Baker-Henningham H. Iron deficiency in childhood: causes and consequences for child development. Annales Nestle (English ed). 2010;68(3):105-19. [crossref] [PubMed]
17.
Lozoff B. Iron deficiency and child development. Food and nutrition bulletin. 2007;28(4_suppl4):S560-S71. [PubMed] [Google Scholar]
18.
Agrawal S, Jain KK, Sharma M, Verma N, Gupta SA, Gaikwad M. Assessment of Anaemia status among school going adolescent of Raipur and Jashpur district of Chhattisgarh. International Journal of Community Medicine and Public Health. 2019;6(7):2905-09. DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20192823 . [crossref]
19.
Varoda A, Chakravarty M, Venugopal R, Kumar A. Prevalence of Anaemia among Adolescent girls of Baiga (PVTGs) of Chhattisgarh, India. Human Biology Review. 2021;10(2):129-39.
20.
Mishra H, Neralwar A. Prevalence of sickle cell disease among school-age children in Chhattisgarh, India: Predictions, implications and interventions. Journal of Health Management. 2019;21(4):601-11. https://doi.org/10.1177/0972063419868553 [crossref]
21.
Kasiulevi.ius V, .apoka V, Filipavi.i.t. R. Sample size calculation in epidemiological studies. Gerontologija. 2006;7(4):225-31.
22.
Anaemia Mukt Bharat, Operational Guidelines, Intensified National Iron Plus Initiative, released on April 2018 by Ministry of Health and Family Welfare, GOI. Available from: http://www.aadivasiaarogyam.com/wpcontent/ uploads/2018/06/PoshanAbhiyan..NHM.pdf
23.
WHO. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.2). (http://www.who.int/vmnis/indicators/serum_ferritin. pdf.
24.
Oh R, Brown DL. Vitamin B12 deficiency. Am Fam Physician. 2003;67(5):979-86. PMID: 12643357.
25.
Tyagi S, Saxena R, Choudhry VP. HPLC-how necessary is it for haemoglobinopathy diagnosis in India? Indian J Pathol Microbiol. 2003;46(3):390-93. PMID:15025281.
26.
Prakash A, Kumar A, Awasthi S, Dutta S, Mittal A. Clinico-pathological pattern of anaemia in children in age group upto 18 year. Int J Med Res Prof. 2018;4(1):262-65. Doi:10.21276/ijmrp.2018.4.1.052
27.
Saba F, Poornima S, Balaji PAR, Varne SRR, Jayashree K. Anaemia among hospitalised children at a multispecialty hospital, Bangalore (Karnataka), India. J Family Med Prim Care. 2014;3(1):48-53. [crossref] [PubMed]
28.
Jasima Nilofer FKK, Lilly RVM. Clinicohematological study of different patterns of anaemia in infancy and childhood. Journal of Pharmaceutical Research International. 2021;3(20A):44-55. [crossref]
29.
Balcý YI, Karabulut A, Gürses D, Çövüt IE. Prevalence and risk factors of anaemia among adolescents in Denizli, Turkey. Iran J Pediatr. 2012;22(1):77-81.
30.
Ramanasastry CPV. Study on clinical and hematological profile of Anaemia in children aged 5 t0 12 years in rural Telangana. J Pediatr Res. 2017;4(07):488-93. doi:10.17511/ijpr.2017.i07.09. [crossref]
31.
Madoori S, Ramya C, Valugula S, Sandeep G, Kotla S. Clinicohematological profile and outcome of anaemia in children at tertiary care hospital, Karimnagar, Telangana, India. Int J Res Med Sci. 2015;3(12):3567-71. [crossref]
32.
Chaturvedi D, Chaudhuri PK, Priyanka, Chaudhary AK. Study of correlation between dietary habits and anaemia among adolescent girls in Ranchi and its surrounding area. Int J Contemp Pediatr 2017;4(4):1165-68. Doi: http://dx.doi.org/10.18203/2349-3291.ijcp20172022 [crossref]
33.
Joseph N, Nelliyanil M, Rai S, Babu RYP, Kotian SM, Ghosh T, et al. Fast food consumption pattern and its association with overweight among high school boys in Mangalore City of Southern India. J Clin Diagn Res. 2015;9(5):LC13-LC17. Doi:10.7860/JCDR/2015/13103.5969 [crossref] [PubMed]
34.
Altaf B, Khan MB, Aftaab RK, Jawed S, Salam RMT, Amir F. Nutritional Deficiency Anaemia: Role of junk food in nutritional deficiency anaemia among youngsters. The Professional Medical Journal. 2018;25(7):1018-23. Doi: https://doi.org/10.29309/TPMJ/2018.25.07.115 [crossref]
35.
Madhusudan SR, Devi MK, Ahuja S, Nagaraj N. Clinical profile of anaemia among 6-60-month children living in South Karnataka- A cross-sectional study. Indian Journal of Child Health. 2018;5(2):133-36. Available from: https://doi.org/10.32677/IJCH.2018.v05.i02.015 [crossref]
36.
Aulakh R, Sohi I, Singh T, Kakkar N. Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anaemia. Indian Journal of Pediatrics. 2009;76(3):265-67. [crossref] [PubMed]
37.
Sazawal S, Dhingra U, Dhingra P, Dutta A, Shabir H, Menon VP, et al. Efficiency of red cell distribution width in identification of children aged 1-3 years with iron deficiency anaemia against traditional hematologicalmarkers. BMC Pediatr. 2014;14:8. Published 2014 Jan 15. Doi:10.1186/1471-2431-14-8 [crossref] [PubMed]
38.
Patel S, Dhupar P, Bhattar A. Diagnostic accuracy of mean corpuscular volume in delineating Vitamin B12 deficiency. Ann Clin Lab Res. 2017;5(3):195. Doi: 10.21767/2386-5180.1000195 [crossref]
39.
Maner BS, Moosavi L. Mean Corpuscular Volume. [Updated 2021 Jul 10]. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK545275/

DOI and Others

DOI: 10.7860/JCDR/2022/55522.16293

Date of Submission: Feb 08, 2022
Date of Peer Review: Feb 24, 2022
Date of Acceptance: Mar 29, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? No
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Feb 11, 2022
• Manual Googling: Mar 15, 2022
• iThenticate Software: Mar 28, 2022 (15%)

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