Anaemia Flashcards
Hb reference ranges vary with age t/f
True normal for a 2/12 old baby to have a hb=94 normal lower end of range
Low hb need a MCV and RCC
MCV helps you classify the anaemia as
Micro iron def anaemia /thalassemia
Normo acute blood loss / renal disease/ spherocytosis/G6PD def
Macro b12/folate/ Down’s syndrome /hopythyroidism/ Coeliac (folate)
Iron def anaemia is the commonest cause of. Anaemia in children t/f
True
Features of iron def anaemia
Seen 6-36/12 of age
Cows milk excess low in iron
Low oral iron
Blood film microcytic hypochromic anaemia low sr Ferritin<10
Falsely elevated sr ferritin seen in 3 things
1 liver disease
Infection
3 cancer
Management of iron def anaemia
1 iron supplementation 6mg/kg/day for 3 months
2 iron rich diet
3 limit cows mild 400mls per day
Rpt the blood test 10days -2weeks to check MCV and HB and sr ferritin rising. Compliance sand responses
Prevention of iron def anaemia
1 iron rich foods at 6/12 of age
2 iron supplementation in prem/ twins/ blood transfusion
3 delay intro of cows milk
Cows milk protein intolerance
May be seen too early intro of cows milk
Can be seen in some BF baby
See anaemia and low albumin
Treatment is boil the cows milk
Microcytosis in childhood
Impaired formation of globulins ( thalassemia) or impaired formation of haem ( eg iron def anaemia chronic diseases)
True
Thalassemia A SE Asians
B is mediteranins
C Africans
True
Features of thalassemia
Microcytic and hypochronic RBC LOW MCV
Excess changes for the degree of low hb / normal hb
Can see RBC changes eg target cells
B thalassemia
Mediterranean
Presents 3-6 months of age
Minor hypochromic microcytic anaemia mild or none
Thal B major severe transfusion dependent for life
Ix FBC and film
HbEPG diagnostic high HbA2 levels
Ferritin if anaemia can mask the HbEPG changes
DNA prenatal testing
Treatment blood transfusion for life 4/52
Iron chelation s/c < 6years oral >6years
Thalassemia Alpha
SE Asians
4 gene deletion fetal hydrops die inutero
3 gene deletion mod haemolytic anaemia ? Splenectomy
2 gene deletion micro hypo +/- low hb
1 gene deletion. Silent carrier
Diagnosis difficult MCV low Hb may or not be anaemia ferritin +/- low HbEPG usually normal occas see HbH rare Family study helpful DNA testing prenatal
Macrocytic anaemia
B12 and folate def Hypothyroidism Down’s syndrome Liver disease Reticulocytosis
Causes of b12 def in child
1 mother Pernicous anaemia IF Ab
2 vegan
3 surgical removal of Terminal Illeuim
Folate def RARE because of food fortification Coeliac disease
