Anaemia In Children

Question 1

Normal Haematological Values
Varies with age
RBC Neonates – Relative ____________ and ___________
-PCV :____-_____%
-Retics: 2-8%
- PCV decrease within _____________ of life and reach nadir of _____% (Physiological anaemia) while Premature infants reach nadir at _______ of PCV _______%

Answer 1

Polycythemia and reticulocytocis

45–65

2-3 months; 30

8-10 wks; 21-24

Question 2

Normal Haematological Values

PCV gradually increase to adult level of _______% after ________

Newborns have (smaller or larger?) red cells; MCV of 94fl (Normal is 90fl)

Newborn MCV reaches nadir of 70 – 84fl at 6 months and gradually increases to adult level after puberty

Answer 2

45; puberty; larger

Question 3

Normal Haematological Values

WHITE BLOOD CELLS:

WBC count is (lower or higher?) in infancy and early childhood then falls to adult level of ___________ /cm3

Also in neonates __________ predominate but by 1 – 6 years of age ____________ predominate and may be up to 80%

Platelets normal range is ________________/cm3

Answer 3

Higher ; 3000 - 8000

neutrophils; lymphocytes

150,000 – 400,000

Question 4

Anemia In Children

Definition :

Reduction of the ————- or ____________ below the range of values occurring in healthy children.

It is Haematocrit (PCV) or Hb value that is lower than the reference value for the individual’s age.

Answer 4

RBC volume or hemoglobin concentration

Question 5

Etiologic classification
I. Impaired RBC production:

A. Deficiency:
- decreased ___________________
- Increased _____________________
- Decreased _____________________
- Increased _———————-
- Protein Energy malnutrition

Answer 5

dietary intake (iron, Vit. B12, folate)

demands (growth, haemolysis)

absorption ( lack of intrinsic factor, malabsorption)

loss ( hemorrhage)

Question 6

Etiologic classification (contd)
B. Bone marrow failure
i. Failure of single line:
- Platelets: _______ syndrome

• RBC:
  •Congenital pure red cell aplasia
  (_____________ asyndrome)
  •Acquired RBC aplasia
  (Transient _______________________)
• WBC: Congenital neutropenia (__________ syndrome)

Answer 6

TAR

Diamond –Blackfan

Erythrobastopenia of childhood

Kostmann

Question 7

Etiologic classification (contd)
B. Bone marrow failure

ii Failure of all lines (_______/____________ anemia)
- Constitutional : ______ anemia, Dyskeratosis congenita
- Acquired : Primary/ secondary eg ______________ infection

iii Infiltration
- leukemia, neuroblastoma, storage disease

Answer 7

Pancytopenia/ Aplastic

Fanconi; Parvovirus B19

Question 8

Etiologic classification
C. Ineffective hematopoietic anemia:
- decreased erythropoiesis
1. Severe ____________________
2. Reduced ______________________

• decreased iron utilization
  1. Infections including ________
  2. ____________ failure, ________ failure
  3. Disseminated malignancy
  4. Connective tissue disease

Answer 8

protein energy malnutrition

erythropoietin production

Malaria; Chronic renal ; hepatic

Question 9

Etiologic classification
II Blood loss
- Trauma
- Burns
-____________ disease of new-born

Answer 9

Haemorrhagic

Question 10

III Increased destruction ( Hemolytic anemia)
A. Corpuscular:
1. Membrane defects:
_________,___________
2. Enzymatic defects:
________ deficiency
___________ deficiency.

3. Hemoglobin defects:
   (Haemoglobinopathies)
   - Heme : Porphyrias
   - Globin: Qualitative – Sickle
   cell disease
   Quantitative -
   Thalassemia

Answer 10

Spherocytes, elliptocytes

G6PD
Pyruvate kinase

Question 11

Etiologic classification (contd)
B. Extra corpuscular:
- Immune : Isoimmune, Autoimmune
- Non- immune: HUS, Mechanical valves
- Drugs, Toxins

Answer 11

Etiologic classification (contd)
B. Extra corpuscular:
- Immune : Isoimmune, Autoimmune
- Non- immune: HUS, Mechanical valves
- Drugs, Toxins

Question 12

Microcytic Hypochromic:

List 8

Answer 12

Thalassemia
Anaemia of chronic disease
- Iron deficiency
- Lead poisining
Sideroblastic anemia -
Copper deficiency
- Vitamin B6 deficiency

Question 13

Diagnosis
MCV ( Mean Corpuscular Volume):

Macrocytic:
- _________ anemia
-______ disease
- Increased _______________

Answer 13

Megaloblastic

Liver; erythropoiesis

Question 14

Diagnosis
MCV ( Mean Corpuscular Volume): Normocytic:
- ___________
- ___________, ___________
-_______ failure, _________ failure
- _______ anemia, bone
marrow infiltration
- Dyserythropoietic anemia

Answer 14

Acute blood loss

Infection; inflammation

Renal; hepatic

Aplastic

Question 15

RDW in relation to MCV

Normal RDW :

Decreased MCV: - __________ traits
- Anemia of _________

Increased RDW:
Decreased MCV:
-_________
-__________ diseases

Increased MCV:
- ____________
-_____________
- Immune hemolysis

Answer 15

Thalassemia
chronic disease

Iron def; Thalassemic

Folate deficiency; Vitamin B 12 deficiency

Question 16

Serum Ferritin / Iron
- low Ferritin, low Iron: ____________
- Normal Ferritin & Iron: ___________
-high Ferritin, N ,low iron: ________________
-high Ferritin, high Iron: ____________,____________

Answer 16

Iron Deficiency; Thalassemia traits

Anemia of chronic disease

Sideroblastic anemia Thalassemia disease

Question 17

Treatment
Iron deficiency anaemia
- Elemental iron ___-___mg/kg/day in 3 ÷ doses
In 3-5 days the retics count would increase and the Hb would increase thereafter.
Resolution occurs in ________

Answer 17

4-6

4-6 weeks

Question 18

Suspected Vitamin B 12 / Folate deficiency:
___________, ___________
Serum _________, Schilling test

Answer 18

Serum folate , RBC folate

Vitamin B 12