Anemia AHD Flashcards
What children should be screened for anemia?
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
what is the risk in chronic anemia in infants?
can cause significant long term cognitive effects
what Hg number is considered anemia in kids?
varies by age, sex and even ethnicity
african canadians have lower Hg
need to look at normal ranges
what is a general good approach to anemia in a child?
ABCs
History
Physical
CBC
Additional labs
how would you approach history in a child with anemia?
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
what infection is commonly associated with anemia in kids
parvo
what dietary question might you ask on hx for anemia
cows milk before age 1
what two etiologies should you think of in a child with tea coloured urine?
- G6PD deficiency
2. AIHA (intravascular hemolysis)
what should you look for on physical in a kid with anemia
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
what lab tests do you order in a kid with suspected anemia
CBC and diff
peripheral smear
retics
bili, LDH, uric acid
hemoglobin electrophoresis
group and screen/crossmatch
what causes the “physiologic anemia of infancy”?
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
when is Hg/red cell mass lowest in infancy
6-9 weeks of life
what do you do in a kid with anemia and simultaneous pancytopenia?
investigate further–> heme referral
likely bone marrow biopsy needed urgently
worry about MALIGNANCY or MARROW FAILURE SYNDROME
may still be benign
what do you worry about in the pancytopenic kid
malignancy or marrow failure syndrome
what are the 6 things on the differential for a microcytic anemia in kids
- iron deficiency
- thalassemia
- lead poisoning
- anemia of chronic disease
- sideroblastic anemic
- copper deficiency
what is the most common cause of anemia in kids
iron deficiency
what kids are most at risk of iron deficiency anemia
toddlers who drink too much milk, GI blood loss, heavy menses
how do you treat iron deficiency anemia in kids
with iron and get rapid resolution
transfusions very rarely required
is thalassemia a common cause of childhood anemia
yes
what populations are most likely to have a thalassemia
asians
mediterraneans
arabic
african
what do you see on smear in a kid with lead poisoning?
coarse basophilic stippling
what is on the differential for macrocytic anemia in kids
- B12 deficiency
- folate deficiency
- reticulocytosis
- meds
- other–thyroid, burns, liver disease, MDS
what meds cause macrocytic anemia
methotrexate
anti seizure meds
septra
why is RDW useful in diagnosing anemia?
tells you variability of RBC sizes in a sample
helpful in distinguishing thalassemia from iron deficiency
thal–> small RDW
iron def–> large RDW
what cells on a smear are diagnostic for leukemia?
blasts
what cells on a smear are suggestive of iron deficiency
microcytic and hypochromic cells
what cells on a smear are diagnostic for sickle cell anemia
sickle cells
what cells on a smear are suggestive of HS or AIHA
spherocytes
what cells on a smear are suggestive of HUS, TTP or MAHAs
schistocytes
what cells on a smear are suggestive of G6PD
blister cells
what are the 4 general causes of normocytic anemias
decreased production
increased destruction
blood loss
sequestration
what does a normocytic anemia plus low retic count suggest
decreased production–> bone marrow problem
what does a normocytic anemic plus high reticulocyte count suggest
increased destruction, blood loss or sequestration
what if all 3 cells lines are low in a normocytic anemia
aplastic anemia
infection
leukemia
what if low retics and only anemia
transient erythroblastopenia of childhood
diamond blackfan
renal disease
acute blood loww
infection
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
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
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
what causes HUS and what are you concerned about
E coli H7:O157
renal failure concerns
