Anemia in paediatrics

8/7/2019 Anemia in paediatrics

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Hb pattern

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term 1-3d 2w 1m 6m-2y 2-6y 6-12y 12-18y


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criteria

AGE Hb in g/dL

CHILDREN 6 MONTHS - 6 YEAR


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PCV (Hematocrit)

Volume of RBCs

Volume of whole blood

NORMAL ranges between 36-56


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MCV

Mean volume of an RBC

NORMAL 80-100 Fl


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MCH

Mean amount of Hb in an RBC

NORMAL 27-31 pg


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MCHC

Amount of Hb per unit volume of RBCs

NORMAL 32-36 g/dL


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Reticulocyte count

Differentiate anemia due to increaseddestruction from anemia due to decreasedproduction

Assess response to therapy

NORMAL newborn 2-6%

children 0.5-2%


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Corrected reticulocyte

count

Corrected Retic Count = Retic % X (Patient's

HCT/Normal HCT)

The normal corrected reticulocytepercentage is 1 - 2%.


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TC, DC, platelet count

Other cell lines also affected

Megaloblastic anemia

Aplastic anemia AML, ALL

Myeloproliferative diseases

Metastatic disease


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PERIPHERAL SMEAR

RBC

Size

Color Shape

Inclusion bodies

Immature cells

WBC & PLATELETS


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Microcytic hypochromic

Reduced iron availability/ utilization

Iron deficiency, anemia of c/c diseases

Reduced heme synthesis

lead poisoning, sideroblastic anemia

Reduced globin synthesis

thalassemia & other hemoglobinopathies


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Macrocytic anemia

Abnormal nucleic acid maturation

cobalamine & Folate deficiency, drugszidovudin, hydroxyurea

Any condition causing reticulocytosishemolytic disease, c/c hemorrhage

Alcohol, hypothyroidism, CLD

Abnormal RBC maturation

MDS, a/c Leukemia, LGL


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NORMOCYTIC NORMOCHROMIC

A/C blood loss

Anemia of c/c diseases

CKD


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others


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iron deficiency parameters

Depletion of stainable iron in bone marrow

Dec serum ferritin levels (14.5) Low serum iron (470MCG/DL)

low transferrin saturation (


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Peripheral smear

hyper segmented neutrophils &macro ovalocytes

Yes no

likely Megaloblastic likely non Megaloblastic

B i ti t fi M l bl ti i


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Bone marrow examination to confirm Megaloblastic anemia

Response to vit B12 / folic acid therapy

Megaloblastic marrow &

Anemia improves

Continue vit B12 / Folate

non Megaloblastic marrow or

no improvement

investigate for : intrinsic factor

drug induced


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If no hyper segmented

neutrophils & macro ovalocytes

reticulocyte count

Decreased increased

Hypothyroidism Hemolysis

Liver disease hemorrhage


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When peripheral smear points towards an

hemolytic etiology

Osmotic fragility testing

Coombs test

Sickling testHb electrophoresis

Serum bilirubin & urine urobilinogen

LDHHaptoglobin


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When nutritonal anemia is suspected

- Iron status

- B12 level

- Folate level


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If other cell lines also affected


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Initial management may depend on the

severity of anemia & general condition of

the patient

Definitive treatment of anemia dependson the etiology , so correct diagnosis of

the cause is important


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Dietary counseling

If nutritional anemia correct Fe , vitB12 & folicacid

Parasitic infestations

Fe deficiency anemia oral iron

preparations, par enteral iron & blood

transfusion in severe cases


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During an acute attack of hemolysis

maintain fluidbalance & renal output

Thalassemia blood transfusion & iron chelation therapy

Hereditary spherocytosis

splenectomy performed after6 yrs of age with pre- surgical immunizations for Hib, strep. Pneumoniae & neisseria meningitidis


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Documents

Anemia in paediatrics