Anaemia

Question 1

What’s the formula for oxygen delivery to tissues?

Answer 1

DO2 = Cardiac output * Hb * SpO2 * 1.31 (amount of oxygen carried by 1g of Hb)

Question 2

Name 5 symptoms/signs of anaemia

Answer 2

Pallor, pale conjunctiva, flow murmur, lethargy, poor growth, weakness, SOB, heart failure

Question 3

Name the 3 initial Ix to do with a child with anaemia

Answer 3

FBE, blood film and reticulocyte count

Question 4

How do you initially stratify the causes of anaemia? Name subsequent tests to do after that to better characterise the cause

Answer 4

Based on the MCV

Microcytic = Fe deficiency (ferritin low) or thalassaemia (normal ferritin)

Normocytic = haemolysis/blood loss (increased reticulocytes) or marrow failure/infiltration (normal reticulocytes)

Macrocytic = folate or B12 deficiency (folate/B12 tests)

Question 5

Name 4 reasons for iron deficiency in a child

Answer 5

Increased iron requirements (rapid growth, low birth weight, in utero anaemia)
Inadequate intake (poor diet)
Malabsorption (coeliac, chronic diarrhoea)
Blood loss (hookworm, cows’ milk allergy, menstruation)

Question 6

What’s the characteristic shape of an Fe deficient RBC on blood film?

Answer 6

Target cells

Question 7

Name 2 interventions for Fe deficiency

Answer 7

Change diet
Iron supplements (ferrous gluconate) - take with OJ, warn of black stools, brush teeth to avoid staining

Question 8

What type of anaemia does haemolysis cause?

Answer 8

Normocytic anaemia with increased reticulocytes

Question 9

Name 3 causes of haemolysis of a newborn

Answer 9

Immune-mediated (ABO, Rh)
Metabolic (G6PD deficiency)
Intrinsic RBC defects (hereditary spherocytosis, sickle cell anaemia)
Infection (sepsis)

Question 10

Name 3 causes of non-traumatic blood loss in a child

Answer 10

ITP (low platelets, give steroids)
Coagulopathies (Haemophilia, VWD)
Haemolytic disease of newborn (Give Vit K)

Question 11

Name the 3 most important things to determine if presented with a pale child

Answer 11

Are they sick or well?

Are they anaemic?

Is it acute or chronic?

Question 12

Name 4 reasons to admit a child with anaemia

Answer 12

Possible infiltrative/malignant disorder
Hb under 60 g/L
Active haemolysis
Needs transfusion

Question 13

Name 3 important things in starting/monitoring a blood transfusion

Answer 13

1. Check that ID, blood type, blood product is right
2. Take frequent vital observations (before, during, and after - 4 hourly up to 24 hours after transfusion)
3. Patient has been consented, knows risks of procedure