Anemia in childhood Flashcards
anemia
decreased oxygen carrying potential to support metabolic needs as a result of
reduction in RBC number
reduction in Hb
reduction in RBC volume
how is Hb assayed?
direct spectrophotometry
how is Hct assayed?
determined by RBC count and MCV
MCHC greater than 35 indicates what condition?
spherocytosis
what are the two ways anemia is classified?
- size of RBC
2. increased destruction vs. decreased production
microcytic hypochromic anemia could be due to what causes?
- iron deficiency
- lead toxicity
- thalassemia
macrocytic hyperchromic anemia could be due to what causes?
- B12 deficiency
2. folate deficiency
goat milk is low in what nutrient?
folate
what are differentials for normocytic anemia with decreased reticulocytes?
- diamond blackfan
- transient erythroblastopenia of childhood
- parvovirus
what are the differentials for normocytic anemia with increased reticulocytes?
- blood loss
- ABO / Rh incompatibility (positive Coomb’s - immune)
- membrane defect, hemoglobinopathy, G6PD, pyruvate kinase defect (negative Coomb’s - non immune)
what are the common causes of iron deficiency anemia in childhood?
- excessive milk intake
- early milk intake prior to 1 year
- blood loss
what are the lab values for iron deficiency anemia in childhood?
- MCV decreased
- RDW increased
- ferritin decreased
- transferrin decreased
- serum iron decreased
- TIBC increased
- reticulocytes normal to increased
cow milk should be avoided in children until what age?
12 months
how does transient erythroblastopenia of childhood present?
- decreased production of RBCs in bone marrow
- moderate to severe anemia
- MCV normal
- reticulocyte count usually decreased
- may follow a viral illness
how does diamond blackfan anemia present?
- almost always under 1 year of age
- moderate to severe anemia
- MCV normal or sometimes increased
- reticulocytes decreased
- Hb F increased
- 25% physical findings - snub nose, wide eyes, hand/finger defects, short stature
what is the cause for congenital pure red cell dysplasia (diamond blackfan)?
ribosomal protein synthesis is abnormal - causes lack of progenitor cells
what is the treatment for TEC?
supportive only unless there is CV instability, in which case transfuse
what is the treatment for DBA?
prednisone, transfusions
what is the treatment for iron deficiency anemia?
6mg/kg/day of oral elemental iron until Hb is normal, then additional two months to replete iron stores
what are the three sickle cell crises?
- vaso-occlusive
- aplastic
- hemolytic / splenic sequestration
vaso-occlusive sickle cell crisis is often precipitated by what conditions?
- infection
- acidosis
- dehydration
- hypoxia
what is the pathology associated with vaso-occlusive sickle cell crisis?
sickled RBCs block small vessels causing bone and tissue infarctions, splenic RBC trapping, stroke, and PAIN
what are the treatments for vaso-occlusive sickle cell crisis?
- supportive
- pain management
- hydroxyurea
why does hydroxyurea help treat vaso-occlusive sickle cell crisis?
increases Hb F
what is often the causative agent for aplastic sickle cell crisis?
parvovirus B19
what is the pathology associated with aplastic sickle cell crisis?
- slow down in RBC production
- acute drop in Hct and Hb
- fall in reticulocytes
what are the features of sickle cell hemolytic crisis?
- acute drop in Hct and Hb
2. large rise in reticulocytes - increased destruction state
what is the treatment for sickle cell hemolytic crisis?
prophylactic antibiotics
