Transforming Childhood Anemia Detection: The Future is Non-Invasive
Childhood anemia is a significant public health concern in the United States, affecting approximately 1 in 6 children under the age of 5. This condition, often resulting from iron deficiency, can have far-reaching consequences on a child’s development, impacting everything from cognitive abilities to physical growth. Detecting anemia early is crucial, yet the traditional method of blood testing poses challenges, particularly for young children. Fortunately, innovations like Monere’s NiADA (Non-invasive Anemia Detection with AI) smartphone app are paving the way for a simpler, less invasive, and more accessible approach to anemia screening.
Understanding the Prevalence of Childhood Anemia in the USA
Anemia is not a rare condition among children in the United States. The Centers for Disease Control and Prevention (CDC) reports that iron deficiency is the most common nutritional deficiency globally and the leading cause of anemia in children. The highest prevalence is seen in toddlers aged 1-2 years, with factors such as inadequate dietary intake of iron, rapid growth, and, in some cases, poverty contributing to this alarming statistic.
Anemia can lead to developmental delays, behavioral disturbances, and poor academic performance due to the brain’s need for sufficient oxygen, which is delivered by iron-rich hemoglobin in red blood cells. Therefore, early detection and treatment of anemia are essential to prevent these adverse outcomes and ensure that children reach their full potential.
The Importance of Early Testing for Iron-Deficiency Anemia
Iron deficiency anemia is particularly concerning in young children because of its potential impact on brain development. Iron plays a vital role in myelination, neurotransmitter production, and overall brain function. Without adequate iron, a child’s cognitive abilities can suffer, leading to long-term consequences.
However, routine screening for anemia in very young children is often underutilized. While the American Academy of Pediatrics (AAP) recommends universal screening for anemia at 12 months, many parents and healthcare providers hesitate due to the discomfort associated with traditional blood tests. This is where the NiADA app can revolutionize the screening process.
Introducing NiADA: Non-Invasive Anemia Detection for Children
Monere’s NiADA app represents a significant advancement in pediatric healthcare, offering a non-invasive, AI-powered solution for anemia screening. The app works by analyzing a simple photograph of a child’s inner lower eyelid (conjunctiva). Using advanced AI algorithms, the app can detect conjunctival pallor, a common sign of anemia, within seconds.
The process is simple:
This method eliminates the need for finger pricks or venous blood draws, making the process pain-free and less traumatic for the child. It also allows for more frequent monitoring, which is particularly beneficial for children at higher risk of anemia or those with chronic conditions that may predispose them to iron deficiency.
Physiological Anemia of Infancy: When Testing is Unnecessary
While the NiADA app offers a groundbreaking solution for anemia screening, it’s important to understand when testing is truly necessary. Physiological anemia of infancy is a normal condition that occurs in all infants between the ages of 6-12 weeks. During this period, hemoglobin levels naturally decline as the infant transitions from fetal to adult hemoglobin and their red blood cells adjust to life outside the womb. This is a transient and self-resolving condition that does not typically require intervention.
For this reason, routine screening for iron deficiency anemia before the age of 9 to 12 months is rarely indicated unless the infant shows symptoms or is at high risk. The focus should be on ensuring that infants receive adequate iron through their diet or supplementation, particularly for breastfed babies and those at risk of iron deficiency. For premature infants, who are at a higher risk of iron deficiency due to lower iron stores at birth, screening is earlier (often between 4 to 6 months of age). Premature infants have more frequent monitoring to ensure timely detection and early intervention.
The Role of Diet in Preventing Childhood Anemia
Ensuring that children receive sufficient iron is critical for preventing anemia and supporting overall health. For breastfed infants, the AAP recommends iron supplementation starting at 4 months of age, as breast milk alone may not provide enough iron to meet the infant’s needs. Formula-fed infants typically receive adequate iron from fortified formulas.
As children transition to solid foods, it’s important to introduce iron-rich foods to their diet. Lean meats, poultry, fish, beans, lentils, iron-fortified cereals, and leafy green vegetables are excellent sources of dietary iron. However, many parents struggle with getting their children, especially picky eaters, to accept these foods.
The Emerging Field of Pediatric Culinary Medicine
This is where the emerging field of pediatric culinary medicine comes into play. Pediatric culinary medicine focuses on teaching children and their families how to prepare and enjoy a variety of healthy, nutrient-rich foods, including those high in iron. By making iron-rich foods more appealing and palatable, culinary medicine can help reduce the need for iron supplementation, which can be costly and, in some cases, lead to excessive iron intake.
For example, introducing children to a wider variety of flavors and textures early in life can increase their acceptance of iron-rich foods. Simple strategies like incorporating pureed meats into vegetable-based dishes, adding lentils to soups, or making smoothies with leafy greens can boost iron intake without the need for supplements. Pediatric culinary medicine also encourages family involvement in meal preparation, which can make trying new foods a fun and rewarding experience for children.
Conclusion: A New Era in Anemia Detection, Monitoring, and Prevention
Childhood anemia is a widespread concern that can have serious implications for a child’s development and well-being. Early detection and intervention are key to preventing the long-term effects of iron-deficiency anemia. With the advent of Monere’s NiADA app, parents and healthcare providers now have a powerful, non-invasive tool for anemia screening that can be used easily and frequently without causing distress to the child.
Coupled with a focus on dietary interventions and the growing field of pediatric culinary medicine, we are entering a new era in the fight against childhood anemia—one where early detection, prevention, and treatment are more accessible, effective, and child-friendly than ever before. By embracing these innovations, we can ensure that every child has the opportunity to thrive, free from the limitations of anemia.
Hemoglobin (Hb) estimation is an important parameter in patients suffering from cancer. Cancer-induced anemia, mainly categorized as anemia of chronic disease, is often seen before or during the diagnosis of the underlying malignancy [1]. Up to 39% of cancer patients present with anemia at the time of diagnosis of which 40% have iron deficiency. Also, up to 53% of patients who do not present with anemia at diagnosis develop it during therapy like chemotherapy (CT) and/or radiotherapy (RT) treatment, so up to 67% of cancer patients will have anemia at some time during the evolution of their disease and therapy [2].
Anemia is associated with easy fatiguability, shortness of breath, weakness, lethargy, and reduced quality of life (QoL). Retrospective data analysis from patients with hematological malignancies and solid tumors indicates that a low baseline hemoglobin level is a prognostic marker that is associated with poor outcomes, though there is a dearth of prospective data [3]. Patients planned for surgery need to have an optimized level of hemoglobin to achieve adequate oxygen delivery to tissue due to increased demand, wound healing, and enhanced recovery after surgery.
The pathogenesis of anemia in cancer patients is complex and multifactorial, with iron deficiency (ID) often being a major and potentially treatable entity. ID in cancer patients can be due to multiple overlapping mechanisms, like bleeding (e.g., in gastrointestinal/hepato-pancreaticobiliary cancers or surgery), malnutrition, and medications [4].
However, not all causes are of equal importance in different cancers overt or occult bleeding and iron deficiency are often prominent in gastrointestinal, urogenital, and gynecological tumors, while bone marrow replacement by metastases is relatively frequent in breast and prostate cancer [5].
Given the significant impact of anemia on quality of life (QoL), disease progression, prognostication, and survival in cancer patients, adequate treatment strategies are of paramount importance. Several studies have shown that the treatment of cancer anemia determines a marked improvement in QoL, particularly among patients with mild-to-moderate anemia [6].
References:
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Anemia can be suspected and diagnosed from a thorough history taking and physical examination followed by blood tests. History of frank bleeding- per rectum or heavy menstruation, black stool, particular food habits, fatty stool with foul smell, recent abdominal surgeries, family history of disease like hemoglobinopathies, and any medication intake that can contribute to reduced hemoglobin production.
Mild anemia is generally asymptomatic; when upstaged to moderate or severe cases it can cause tiredness, lethargy, leg pains especially at night, shortness of breath to near syncope. More severe cases can present with chest pain and reduced exercise tolerance.
To diagnose anemia doctors generally suggest blood test for CBC which includes hemoglobin level measurement and hemoglobin lower than normal for age and sex confirms anemia. Other blood parameters like MCV, MCH, Reticulocyte count, serum ferritin, vitamin B12, or folate level help in further classification. The doctors or health care providers can also estimate hemoglobin levels from lower lid conjunctival examination, the color of the palm, nail, and tongue which is further corroborated by the blood tests.
In the case of management medicines along with proper dietary supplements are prescribed depending on the severity of anemia. A diet consisting of meat in regulated amounts and a vegetarian diet that includes legumes, fortified or whole grains, dried fruit, nuts, seeds, and green vegetables easily provides adequate iron that can improve hemoglobin levels. Vitamin C helps to increase dietary iron absorption and excessive consumption of tea or coffee, as these can decrease iron absorption. correction of anemia requires proper treatment and follow-up under strict supervision of doctors and healthcare providers. Organized collaboration among patients, family members, and healthcare providers including doctors and policymakers can provide promotive, protective, curative, and rehabilitative care for anemia affecting 1.8 billion people worldwide.
Reference:
1. https://www.ncbi.nlm.nih.gov/books/NBK499994/
2. Rizzo NS, Jaceldo-Siegl K, Sabate J, et al. Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet. 2013;113(12):1610-9. [PMID:23988511]
4. https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(23)00171-0/fulltext
45-year-old MNC executive, Evelyn, fell asleep on the steering wheel on her way back home from work, just in time so that she could somehow stop the car avoiding any untoward accident. She felt lethargic for the last 1-2 months, which she felt was due to exertion at work. She was rescued and taken to the nearby hospital by local people. She was examined and advised for a complete blood count the next day by the attending physician. She was taken aback to find that her Hb was 7.0 gm /dl. All this while she had the notion that anemia is attributed to poor diet and is associated with low socioeconomic conditions or seen in only severely sick and debilitated persons. The burden of anemia is widespread, and most of the population can see only the iceberg of the problem. It’s about time that we get our facts right.
Global Prevalence of Anemia in Different Demography As per WHO Global Database on Anemia, globally, anemia affects 1.62 billion people, which corresponds to 24.8% of the population.
The highest prevalence is among preschool-age children. Worldwide, 47.4% of preschool children, 41.8% of pregnant women, and 30.2% of non-pregnant women are anemic. Anemia associated with pregnancy is the leading cause of morbidity and mortality of pregnant women in developing countries affecting both maternal and fetal health outcomes. For pregnant women, in over 80% of the countries, anemia poses a moderate to severe public health problem. Globally, anemia is estimated to cause more than 115,000 maternal and 591,000 perinatal deaths annually.
Common etiological factors of anemia include nutritional deficiencies, infections, inflammatory diseases, and hemoglobinopathies. Iron deficiency anemia was estimated to account for 22% of maternal deaths in 2019. The population groups at risk of developing anemia comprise children under 5 years of age, especially infants and children under 2 years of age, menstruating adolescent girls, and pregnant and postpartum women.
Global estimates state that anemia affects half a billion women between 15–49 years of age and 269 million children aged 6–59 months. In 2019, anemia was estimated to affect 30% (539 million) of non-pregnant women and 37% (32 million) of pregnant women 15–49 years of age. The most affected areas worldwide include WHO Regions of Africa and South-East Asia wherein 106 million women and 103 million children are anemic in Africa and 244 million women, and 83 million children affected in South-East Asia.
The prevalence of anemia in women 15–49 years of age, based on pregnancy status, is indicator numbered 2.2.3 of the UN Sustainable Development Goals, and the aim of reducing the anemia prevalence by half in women of reproductive age by 2030 is a continuation of the 2025 global nutrition targets endorsed by the World Health Assembly (WHA).
How to detect anemia: Early detection is indispensable to tackle this grave public health problem which affects populations in both developed and developing nations. Anemia can be suspected and diagnosed from a thorough clinical history and physical examination followed by blood tests. History of frank bleeding- per rectum or heavy menstruation, black stool, particular food habits, fatty stool with foul smell, recent abdominal surgeries, family history of diseases like hemoglobinopathies, and any medication intake that contributes to reduced hemoglobin production.
When to suspect: Mild anemia is generally asymptomatic; when upstaged to moderate or severe cases it can cause tiredness, lethargy, leg pains especially at night, shortness of breath to near syncope. More severe cases can present with chest pain and reduced exercise tolerance.
To diagnose anemia doctors generally suggest a Complete Blood Count (CBC) which includes hemoglobin level measurement and hemoglobin lower than normal for age and sex confirms anemia. Other blood parameters like MCV, MCH, Reticulocyte count, serum ferritin, vitamin B12, or folate level help in further classification. The doctors or health care providers can also estimate hemoglobin levels from lower lid conjunctival examination, the color of the palm, nails, and tongue which is further corroborated by the blood tests.
A novel smartphone-based application NiADA developed by Monere Corp. strives to employ Artificial Intelligence technology to detect anemia, by capturing inner eyelid images to give instant results on hemoglobin estimation. Early detection of anemia using a non-invasive technique promises to go a long way in reducing the burden of anemia prevalence among different age groups worldwide.
Management of anemia: Therapeutic interventions along with proper dietary supplements are prescribed depending on the severity of anemia. A diet that comprises meat, of course in regulated amounts, and a vegetarian diet that includes legumes, fortified or whole grains, dried fruit, nuts, seeds, and green vegetables easily provides adequate iron and thereby can improve hemoglobin levels. Vitamin C helps to increase dietary iron absorption while excessive consumption of tea or coffee can decrease iron absorption. Correction of anemia requires proper treatment and follow-up under strict supervision of doctors and healthcare providers. Organized collaboration among patients, family members, and healthcare providers including doctors and policymakers can provide promotive, protective, curative, and rehabilitative care for anemia which has affected 1.8 billion people worldwide.
REFERENCES:
[1] WHO/CDC. Worldwide Prevalence of Anemia 1993–2005: WHO Global Database on Anemia. Geneva, Switzerland: WHO Press; 2008.
[2] Akhtar M, Hassan I. Severe Anemia during late pregnancy. Case Reports in Obstetrics and Gynecology. 2012;2012:3 pages.485452
[3] Vivek RG, Halappanavar AB, Vivek PR, Halki SB, Maled VS, Deshpande PS. Prevalence of Anemia and its epidemiological. Determinants in Pregnant Women. 2012;5(3):216–223.
[4] Salhan S, Tripathi V, Singh R, Gaikwad HS. Evaluation of hematological parameters in partial exchange and packed cell transfusion in treatment of severe anemia in pregnancy. Anemia. 2012;2012:7 pages.608-658
[5] Chaparro CM, Suchdev PS. Anemia epidemiology, pathophysiology, and etiology in low- and middle-income countries. Ann NY Acad Sci. 2019;1450:15–31.
[6] Murray CJL, Aravkin AY, Zheng P, et al. Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396:1223–1249.
[7]Anaemia [website]. Geneva: World Health Organization; 2023 (https://www.who.int/ healthtopics/anaemia).
[8] UNGA Global indicator framework for the Sustainable Development Goals and targets of the 2030 Agenda for Sustainable Development. March, 2020.
[9] https://www.ncbi.nlm.nih.gov/books/NBK499994/
[10] Rizzo NS, Jaceldo-Siegl K, Sabate J, et al. Nutrient profiles of vegetarian and nonvegetarian dietary patterns. J Acad Nutr Diet. 2013;113(12):1610-9. [PMID:2398851
[12] https://www.thelancet.com/journals/lanhae/article/PIIS2352-3026(23)00171-0/fulltext