Anaemia Flashcards
Causes of anaemia (3)
Decreased RBC production
Decreased RBC lifespan
Excessive blood loss
Causes of decreased RBC production (3)
IDA-malabsorption/nutrition
Marrow replacement-malignancy, marrow aplasia
Chronic disease-renal failure, inflammatory conditions e.g. JIA
Causes of decreased RBC lifespan (9)
Intrinsic defects:
- G6PD
- spherocytosis
- eliptocytosis
- pyruvate kinase deficiency
- haemoglobinopathies
Extrinsic:
- immune mediated: ABO/rhesus incompatibility, haemolytic anaemia
- malaria
- hypersplenism
- microangiopathy e.g. HUS
Common causes of excessive blood loss (4)
GI: hookworm, Meckel’s
Iatrogenic: excessive venesection in babies
epistaxis
menorrhagia
Causes of IDA in children (5)
Commonest at 1yr is early introduction of unmodified cow’s milk at 6mo.
Prematurity: not immediately anaemic but have poorer iron stores so more susceptible to developing IDA
Excessive bleeding
Malnutrition
Malabsorption: coeliac, CF
Presentation of IDA (6)
babies: less happy, poor psychomotor development, poor cognition
poor feeding
low energy
malabsorption
FHx of sickle cell/thalassaemia
pallor of conjunctiva/palmar creases/tongue
Ix for IDA (5)
FBC
Hb
Ferritin-lowered (acute phase protein, can be raised w. inflammation)
TIBC-raised
Transferrin-raised (iron-binding protein)
Long term problems in children w. sickle cell (8)
short stature/delayed puberty
cognitive problems due to repeated strokes
adenotonsilar enlargement>sleep apnoea
leg ulcers
renal dysfunction
pigment gallstones
retinopathy
cardiac enlargement/heart failure
Age of presentation and Dx of sickle cell (4)
presents around 6mo
Guthrie heel prick test in 1st day of life
Hb electrophoresis
Afro-Caribbeans routinely screened before GA
Blood test findings in sickle cell (4)
low Hb
raised bilirubin
raised reticulocytes
target cells
Presentation of sickle cell in children (2)
Acute dactylitis:
- painful, swollen hand which is painful to touch
- in combination w. apyrexia and good feeding
(NB advise to avoid cold, exercise, stress, hypoxia, dehydration)
When to admit a child w. sickle cell (2)
Any chest Sx
Pyrexia
Initial Mx of sickle cell crisis (4)
IV fluids
O2
oramorph
Abx-crisis can be triggered by infection
(exchange transfusion in certain scenarios)
When to give exchange transfusion to a sickle cell patient (3)
only if:
- priapism
- acute chest crisis
- stroke
Features, Dx and Mx of thalassaemia (3)
raised HbA2 in thalassaemia minor
also screened for in neonatal blood spot test
bone marrow transplant is only cure
Genetics and presentation of hereditary spherocytosis (4)
AD cytoskeletal mutation
Presentation:
- anaemia/fatigue
- jaundice
- splenomegaly
Ix for hereditary spherocytosis (5)
FBC, blood film
Raised:
- unconjugated bilirubin
- LDH
- urinary and foecal urobilinogen
Low haptoglobin
Rx of hereditary spherocytosis
splenectomy at 5yrs
Genetics, presentation and blood film of G6PD (2)
X-linked recessive
Presents w. neonatal jaundice
Film: Heinz bodies and bite cells
Acute triggers of G6PD (3)
Henna, fava beans, touching moth balls
infection
drugs:
- ciprofloxacin
- nitrofurantoin
- sulpha-drugs: sulphonylureas, sulphasalazine, sulphonamides
- anti-malarials: primaquine
Features and pathology of parvovirus (2)
transmitted via resp secretions and vertical transmission
virus infects erythroblastoid red cell precursors in BM and supresses erythropoiesis for <7d
(NB outbreaks mostly in spring)
Presentation of parvovirus infection
erythema infectiosum/slapped cheek/5th disease:
-viral Sx followed by slapped cheek rash>reticular/lacy rash on limbs
aplastic crisis in children w.:
- immunodeficiency
- chronic haemolytic anaemia
infection in utero>hydrops/death
