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Pediatrics 2 > Anemia AHD > Flashcards

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

A

yes

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
Q

what cells on a smear are diagnostic for leukemia?

A

blasts

26
Q

what cells on a smear are suggestive of iron deficiency

A

microcytic and hypochromic cells

27
Q

what cells on a smear are diagnostic for sickle cell anemia

A

sickle cells

28
Q

what cells on a smear are suggestive of HS or AIHA

A

spherocytes

29
Q

what cells on a smear are suggestive of HUS, TTP or MAHAs

A

schistocytes

30
Q

what cells on a smear are suggestive of G6PD

A

blister cells

31
Q

what are the 4 general causes of normocytic anemias

A

decreased production

increased destruction

blood loss

sequestration

32
Q

what does a normocytic anemia plus low retic count suggest

A

decreased production–> bone marrow problem

33
Q

what does a normocytic anemic plus high reticulocyte count suggest

A

increased destruction, blood loss or sequestration

34
Q

what if all 3 cells lines are low in a normocytic anemia

A

aplastic anemia

infection

leukemia

35
Q

what if low retics and only anemia

A

transient erythroblastopenia of childhood

diamond blackfan

renal disease

acute blood loww

infection

36
Q

what are the AIHAs

A

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
Q

what is hereditary spherocytosis

A

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
Q

what is G6PD deficiency

A

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
Q

what causes HUS and what are you concerned about

A

E coli H7:O157

renal failure concerns

Pediatrics 2 (19 decks)

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