Anemia AHD Flashcards

1
Q

What children should be screened for anemia?

A

AAP says–> ALL kids in their first year of life

CPS says–> screen only high risk infants (premature, low birth weight, first nations, immigrants, if cows milk before 1 year)

can be fatal

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2
Q

what is the risk in chronic anemia in infants?

A

can cause significant long term cognitive effects

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3
Q

what Hg number is considered anemia in kids?

A

varies by age, sex and even ethnicity

african canadians have lower Hg

need to look at normal ranges

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4
Q

what is a general good approach to anemia in a child?

A

ABCs

History

Physical

CBC

Additional labs

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5
Q

how would you approach history in a child with anemia?

A

pallor

fatigue

jaundice

duration of symptoms

menstrual hx

meds

blood loss

hx of infection (PARVO)

colour of urine

stool (melena, blood, sx of IBD)

travel hx

diet hx (especially milk)

birth hx (if infant)

family history–ethnicity, anemia, splenectomy/cholecystectomy

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6
Q

what infection is commonly associated with anemia in kids

A

parvo

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7
Q

what dietary question might you ask on hx for anemia

A

cows milk before age 1

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8
Q

what two etiologies should you think of in a child with tea coloured urine?

A
  1. G6PD deficiency

2. AIHA (intravascular hemolysis)

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9
Q

what should you look for on physical in a kid with anemia

A

vitals–temp, HR, BP, sats

pallor or jaundice (be careful, often missed clinically)

CV–murmur, gallop

resp–increased WOB

hepato or splenomegaly

thumb or arm abnormalities

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10
Q

what lab tests do you order in a kid with suspected anemia

A

CBC and diff

peripheral smear

retics

bili, LDH, uric acid

hemoglobin electrophoresis

group and screen/crossmatch

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11
Q

what causes the “physiologic anemia of infancy”?

A

erythropoiesis decreases dramatically after birth–> more tissue oxygenation, less erythropoietin

10 fold decrease in RBC production in the week after birth

lowest at 6-9 weeks of life

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12
Q

when is Hg/red cell mass lowest in infancy

A

6-9 weeks of life

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13
Q

what do you do in a kid with anemia and simultaneous pancytopenia?

A

investigate further–> heme referral

likely bone marrow biopsy needed urgently

worry about MALIGNANCY or MARROW FAILURE SYNDROME

may still be benign

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14
Q

what do you worry about in the pancytopenic kid

A

malignancy or marrow failure syndrome

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15
Q

what are the 6 things on the differential for a microcytic anemia in kids

A
  1. iron deficiency
  2. thalassemia
  3. lead poisoning
  4. anemia of chronic disease
  5. sideroblastic anemic
  6. copper deficiency
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16
Q

what is the most common cause of anemia in kids

A

iron deficiency

17
Q

what kids are most at risk of iron deficiency anemia

A

toddlers who drink too much milk, GI blood loss, heavy menses

18
Q

how do you treat iron deficiency anemia in kids

A

with iron and get rapid resolution

transfusions very rarely required

19
Q

is thalassemia a common cause of childhood anemia

20
Q

what populations are most likely to have a thalassemia

A

asians
mediterraneans
arabic
african

21
Q

what do you see on smear in a kid with lead poisoning?

A

coarse basophilic stippling

22
Q

what is on the differential for macrocytic anemia in kids

A
  1. B12 deficiency
  2. folate deficiency
  3. reticulocytosis
  4. meds
  5. other–thyroid, burns, liver disease, MDS
23
Q

what meds cause macrocytic anemia

A

methotrexate

anti seizure meds

septra

24
Q

why is RDW useful in diagnosing anemia?

A

tells you variability of RBC sizes in a sample

helpful in distinguishing thalassemia from iron deficiency

thal–> small RDW

iron def–> large RDW

25
what cells on a smear are diagnostic for leukemia?
blasts
26
what cells on a smear are suggestive of iron deficiency
microcytic and hypochromic cells
27
what cells on a smear are diagnostic for sickle cell anemia
sickle cells
28
what cells on a smear are suggestive of HS or AIHA
spherocytes
29
what cells on a smear are suggestive of HUS, TTP or MAHAs
schistocytes
30
what cells on a smear are suggestive of G6PD
blister cells
31
what are the 4 general causes of normocytic anemias
decreased production increased destruction blood loss sequestration
32
what does a normocytic anemia plus low retic count suggest
decreased production--> bone marrow problem
33
what does a normocytic anemic plus high reticulocyte count suggest
increased destruction, blood loss or sequestration
34
what if all 3 cells lines are low in a normocytic anemia
aplastic anemia ***infection*** leukemia
35
what if low retics and only anemia
transient erythroblastopenia of childhood diamond blackfan renal disease acute blood loww ***infection***
36
what are the AIHAs
autoimmune hemolytic anemias autoantibodies to RBCs warm/cold or both triggered by infections, meds, tumours, autoimmune states often difficult to crossmatch blood steroids are first line "least incompatible blood" often needed
37
what is hereditary spherocytosis
hemolytic anemia often family hx northern europeans RBCs live 10-30 days rather than 120 aplastic crisis splenic sequestrations **think of this if you see gallstones at early age**
38
what is G6PD deficiency
x linked disease asians, mediterraneans, africans (malaria belt) triggered by meds, moth balls, fava beans occasionally transfusion acquired **normal G6PD during acute crisis does NOT rule out disease
39
what causes HUS and what are you concerned about
E coli H7:O157 renal failure concerns