1: Haematology - IDA Flashcards
What is iron deficiency anaemia
Low Hb, caused by iron deficiency
What are 5-causes of IDA in children
- Malnutrition
- Malabsorption
- Hookworm
- Blood loss
- Increase demand
What diet in infants can predispose to IDA
Prolonged consumption of breast-milk or cows-milk (which is low in iron) with late introduction of iron into diet
What diets in children can predispose to IDA
Low levels dietary iron
GI bleed
What can cause low levels of dietary iron
High milk-consumption which is low in iron
What can cause GI blood loss
Cows milk protein intolerance
What increases iron demand
Puberty
What causes malabsorption
Coeliac disease (duodenum is where iron is absorbed) IBD
What can cause blood loss
Cow’s milk protein intolerance
Meckel diverticulum
Oeseophagitis
What intestinal parasites can cause blood loss
Hookworm - more common in developing world
What are 5 RF for IDA in children
- Pre-term
- Multiple pregnancy
- Low birth-weight
- Delayed introduction of solid foods 6m after
breastfeeding - Menstruation in adolescent females
What is a stereotypical RF for IDA in children
Delayed introduction of solid-foods 6m after breast feeding in females
Explain presentation of symptoms in IDA in children
Most cases of IDA are sub-clinical. Children adapt very well with IDA and it takes very low levels of Hb to be symptomatic
What level does Hb reach before children become symptomatic
6-7g/dL
What symptoms occur in mild-moderate IDA
Neurological symptoms:
- Listlessness
- Lifelessness
- Irritable
- Mood change
How does severe anaemia present in children
Pallour Poor Feeding Breathlessness Lethargy Pica
Explain changes in Hb during infancy
Hb at birth can be as high as 22 and then drop to 11 at 3-months
Explain investigation work-up for IDA
- History
- FBC
- Iron binding studies
- Blood Film
What is important in the history and why
Weaning history: as delayed weaning onto solid foods (6m after breast feeding) is a RF for IDA
What is seen on FBC
Microcytic Hypochromic anaemia
What defines low Hb at less than 5-years
<11
What defines low Hb at less than 5-11
<11.5
What defines low Hb at less than 12-14
<12
What defines microcytic anaemia
MCV <80
What is hypochromic anaemia
low MCH, low MCHC
Explain findings of iron binding studies in IDA
Low ferritin
High TIBC
Why is ferritin low in IDA
Due to low iron stores
What should always be checked with ferritin and why
CRP. As ferritin is an acute phase reactant and can be falsely elevated in inflammation
How will TIBC present in IDA and why
High. As there is low iron, there will be more available sites on Hb for iron to bind
What are 3 findings on blood film in IDA
- Pencil cells
- Target cells
- Anisopolikocytes
What are anisopoikilocytes
RBC of different sizes and shapes
How is IDA managed
5mg/Kg elemental iron per-day (Ferrous sulphate)
How long should elemental iron be continued for
Give 3-months after Hb returns to normal, in order to replenish stores
Give 3 methods to prevent IDA in children
- Encourage oral iron intake: cereal, dark vegetables
- Iron-supplementation in pre-term infants
- Avoid prolonged milk
