CHILDREN WITH SEVERE ACUTE MALNUTRITION: AN EVALUATION OF THEIR HEMATOLOGICAL PARAMETERS: A STUDY CONDUCTED IN LARKANA

Abstract

Background: Severe acute malnutrition (SAM) remains a critical public health issue, particularly in resource-limited settings, significantly impacting child morbidity and mortality. Malnutrition adversely affects hematopoiesis, leading to anemia, leukocyte abnormalities, and thrombocytopenia, which further compromise immune function and increase susceptibility to infections. Understanding the hematological alterations in children with SAM is essential for early detection, appropriate management, and improved clinical outcomes. This study aimed to assess the hematological profile of children with SAM and identify specific abnormalities associated with the condition.

Objective: To evaluate the hematological parameters of children with severe acute malnutrition and compare them with healthy controls.

Methods: This descriptive cross-sectional study was conducted over nine months, from January to September 2023, at the Nutrition Unit of PEDS Shaikh Zayed Hospital, Larkana. A total of 216 children aged 7 months to 5 years were included, with 108 diagnosed with SAM based on WHO criteria and 108 healthy controls. Hematological parameters, including red blood cell (RBC) count, hemoglobin (Hb), hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), white blood cell (WBC) count, and platelet count, were analyzed using an automated hematology analyzer (XN-350). Socioeconomic and demographic data were collected through structured questionnaires.

Results: Among the 108 children with SAM, 56 (51.8%) were male, and 52 (48.1%) were female. The majority, 68 (49.2%), were aged 7–24 months. Rural residency was reported in 67 (62%) cases, and 74 (68.5%) belonged to low-income families. Normochromic normocytic anemia was the most prevalent type, affecting 42 (38.88%) children, followed by iron deficiency anemia in 28 (25.9%) and megaloblastic anemia in 2 (1.85%). Hemoglobin levels were significantly lower in SAM cases (8.13±1.09 g/dL) than in controls (9.80±1.21 g/dL) (p=0.0005). Hematocrit was also reduced in cases (25.07±3.34%) compared to controls (30.88±4.02%) (p=0.0005). RBC count was lower in cases (3.99±0.71 ×10⁶/µL) than controls (4.10±0.51 ×10⁶/µL) (p=0.0003). MCV, MCH, and MCHC were all significantly reduced in cases (60.45±4.93 fL, 18.75±2.15 pg, and 30.11±1.74 g/dL, respectively) compared to controls (70.35±6.14 fL, 24.39±2.99 pg, and 32.94±1.72 g/dL, respectively) (p<0.05). WBC count was lower in the SAM group (6.99±1.64 ×10³/µL) compared to controls (8.24±4.28 ×10³/µL) (p=0.005), and platelet count was also significantly reduced (262.36±85.22 ×10³/µL vs. 302.11±128.15 ×10³/µL) (p=0.002).

Conclusion: Children with severe acute malnutrition exhibited significant hematological abnormalities, including anemia, leukocyte alterations, and thrombocytopenia. The high prevalence of normochromic normocytic anemia and iron deficiency anemia underscores the profound impact of malnutrition on hematopoiesis. These findings emphasize the need for early identification, targeted nutritional interventions, and routine hematological monitoring to improve health outcomes in malnourished children.