Anaemia, AIHA in child

Question 1

Normal Hb according to age

Answer 1

birth: 14
2mo: 9
2-6mo:9.5
6-24mo:10.5
2-11yrs: 11.5
>12yrs: 12F, 13M

Question 2

Physiological anaemia of infancy/physiologic nadir

Answer 2

Birth.. (Hb=14%)

Inc oxygenation of tissues
Dec erythropoietin production…

6-9wks: Hb=10-11%

Question 3

Pathological anaemia in infancy

Answer 3

1. Hb<13.5 in 1 month (14@birth)
2. Hb<9%
3. Symptoms of hemolysis (jaundice, icterus)
4. Symptoms of anaemia (irritability, dec in feeding)

Question 4

Screening for iron deficiency anaemia in children

Answer 4

In All 9-12month olds

R/F:
1. Females with menarche
2. Transition to cow milk
3. 1yr breast feed without iron rich foods
4. On fluoroquinolones, dapsone, nitrofurantoin, and sulfonylureas

Question 5

AIHA

Answer 5

Autoimmune hemolytic anaemia
1. Warm (WAHA) or cold (CAD-cold agglutinin disease

Question 6

WAHA

Answer 6

1. Hemolysis at body temp
2. IgG involved
3. Jaundice, dizzy, palpitations, confusion etc
4. Spleenomegaly
5. DVT - PE
6. Rx:
   1st - Steroids
   Rituximab (immunosupp)
   Spleenectomy
   IVIG - temporary measure before spleenectomy, etc (see below)

Question 7

CAD

Answer 7

1. Hemolysis at 3-4deg centigrade
2. IgM
3. Jaundice, Dizzy, palpitations, confusion etc
4. Raynauds
5. Rx:
   Steroids
   Chemotherapy drugs
   Blood transfusion

Question 8

Investigations in AIHA

Answer 8

1. Inc in LDH
2. Dec haptoglobin
3. Antiglobulin antibodies +
4. Coombs test +
5. Blood smear - spherocytes with polychromasia

Question 9

IVIG in AIHA

Answer 9

Used when
1. HB <6
2. Not responding to steroids > 2wks
3. Before spleenectomy
4. If Immunosupp AND spleenectomy are C/I, steroids not effective

Dose: 0.8-2g/Kg single dose
Can repeat in 3 days