36. Anaemia in children Flashcards
Anaemia pathogenesis:
- Reduced RBC production
- Increased RBC destruction (haemolysis)
- Blood loss
Reduced production of RBC (common causes):
- Nutritional: B12, iron, folate deficiency
- Reduced intake
- Malabsorption
- Increased requirements (growth)
Reduced production of RBC (rare causes):
- Bone marrow failure
- Malignancy and chemo
- Diamond blackfan anaemia
- Aplastic anaemia
Increased destruction/ Haemolysis:
- Immune haemolysis
- Intracellular red cell defects (abnormal Hb, Membrane defects, enzymopathies)
- Infections
Increased destruction - immune haemolysis
- Anti-Rb antibodies
- Anti-ABO antibodies
- 2ndary jaundice required photography in the 24h of life
- Maybe IVIG, blood transfusion
Increased destruction - Intracellular red cell defects
- Abnormal Hb (sickle cell disease, thalassemia)
- Membrane defects (hereditary spherocytosis, hereditary elliptocytosis)
- Enzymopathies
Intracellular red cell defects – abnormal haemoglobin:
- Sickle cell disease (reduced beta globin production, haemolytic anaemia, inflammation, vaso-occlusion – tissue ischaemia or infarction, splenic infarction and hyposlenism)
- Thalassemias (reduced production of globin chains, huge heterogeneity in severity, severe haemolytic anaemia with abnormal hypochromic and microcytic cells)
Intracellular red cell defects – membrane defects:
- Hereditary spherocytosis (anaemia, spherocytes on blood film, splenomegaly, risk of aplastic/haemolytic/megaloblastic crisis)
- Hereditary elliptocytosis
Intracellular red cell defects – enzymopathies:
- G6DP
- Pyruvate kinase deficiency
Increased destruction/ Haemolysis:
- Immune haemolysis
- Intracellular red cell defects (abnormal Hb, Membrane defects, enzymopathies)
- Infections
Increased destruction (haemolysis) – infection:
- Parvovirus
- Malaria
- Haemolytic Uraemic Syndrome
Anaemia pathogenesis:
- Reduced RBC production
- Increased RBC destruction (haemolysis)
- Blood loss
Blood loss causes:
- Gastric ulcers
- Milk intolerance
- Hereditary haemorrhagic telangiectasia
- Meckel’s diverticulum
- IBD
- Epistaxis
Iron deficiency causes in infants:
- Maternal iron deficiency
- Prematurity and low birth weight
- Multiple pregnancy
- Exclusive breast feeding after 6 months
- Late/insufficient introduction of iron rich solids
- Excess cow’s milk consumption
Iron deficiency causes in children/adolescents:
- Vegetarian/vegan
- GI disorders (coeliac disease, IBD, GI infection)
- Extreme athletes
- Heavy menstrual bleeding
- Chronic blood loss
Red flags in anaemia:
- Hb <60g/L
- Tachycardia, murmurs, cardiac failure
- Haemolysis (dark urine, jaundice)
- Nucleated RBCs on blood film
- Associated thrombocytopenia or neutropenia
- Severe vitamins B12 or folate deficiency
Microcytic anaemia (decreased MCV)
- Iron deficiency (low ferritin)
- Thalassemia minor (normal ferritin): beta or alpha thalassemia minor
Normocytic anaemia (normal MCV)
- Haemolysis/blood loss (increased reticulocyte count)
Macrocytic (increased MCV)
- Folate or B12 deficiency
Hb in Neonates:
<140 g/dl
Hb in infants:
<110 g/dl
Hb in child:
<115 g/dl
Hb in teenager:
<120 g/dl
