Anemia in Childhood

Question 1

Factors to consider in anaemia evaluation?

Answer 1

• Hb
• MCV
• Reticulocyte count
• Red cell morphology (film)

Question 2

Microcytic anaemia causes?

Answer 2

TAILS
- Thalassemia
- Anaemia of chronic disease
- Iron deficiency
-

Question 3

Normocytic anaemia in childhood?

Answer 3

• Chronic inflamm
• Blood loss
• Transient erythroblastis of childhood
• bone marrow disorders

Question 4

Macrocytic anaemia of childhood?

Answer 4

• B12
• Folate
• Liver disease
• Diamond-Blackfan
• Hypothyroidism
• Bone marrow failure

Question 5

How do foetal RBCs compare to adult wrt size?

Answer 5

Foetal RBCs are macrocytic compared to adults

Question 6

Which form of anaemia may bone marrow disorders present with?

Answer 6

Can be:

• Normochromic
• Normocytic
• Macrocytic

Question 7

What are the types of bone marrow disorder?

Answer 7

• Infiltration: (malignant i.e. leukemia or non-malignant i.e. storage disorder)
• Myelodysplasia (not making more)
• Fanconi anaemia
• Rarer: aplastic, Pearson syndrome, CDE

Question 8

What are the causes of haemolysis causing anaemia?

Answer 8

INTRINSIC
-Enzymopathy (G6PD)
- Membranopathy (HS, HE)
- Haemoglobinopathy
- Immune HA (autoimmune, isoimmune)
EXTRINSIC
- DIC
- HUS
-Burns

Question 9

Ix for haemolysis causing anaemia

Answer 9

• Blood film (spherocytes, elliptocytes etc)
• Reticulocytosis
• Unconjugated hyperbilirubinemia
• +/- haptoglobin, LDH
• DAT

Question 10

Hx features anaemia?

Answer 10

• Perinatal Hx
• Blood loss (GI, GU)
• Naematode infestation
• Chronic infective / inflammatory conditions
• Drug / toxin exposure
• Dietary Hx (vegan, iron etc)
• Race and ethnicity (G6PD, sickle cell, thalassemia)
• Previous anaemia, exchange transfusion, FHx etc

Question 11

What does RDW indicate?

Answer 11

RBC distribution width
Indicates spread of size of RBCs. Increased in virtually all cases of iron deficiency anaemia (if 20+ likely iron deficiency).

Question 12

What must be done prior to Hb electrophoresis? Why?

Answer 12

Ferritin. Falsely negative Hb electrophoresis result if ferritin low. Always do ferritin first.

Question 13

What should be ordered in setting of reasonable clinical suspicion of iron deficiency anaemia?

Answer 13

Ferritin; not necessarily “iron studies”. Iron deficiency is diagnosed on serum ferritin: low serum iron does not necessarily indicate low total iron body stores.

Question 14

How does thalassemia differ from iron deficiency on blood results?

Answer 14

• MCV usually lower
• RBC higher
  than thalassemia than iron deficiency

Question 15

Why are premis at risk of iron deficiency?

Answer 15

Incomplete iron replacement (missed X weeks of iron supplementation via placenta). Need to supplement iron (i.e. fortifier etc)

Question 16

What are non-dietary causes of iron deficiency?

Answer 16

• Rapid growth in childhood + RFx (prem, LBW)
• Malabsorption (i.e. Coeliac)
• Meorrhagia
• GI bleeding / epistaxis
• Intestinal naematodes

Question 17

Recommendations for increasing dietary iron intake in children?

Answer 17

• Don’t introduce cow’s milk until 12m+ (as BM or formula replacement)
• Limit cow’s milk to 500mL per day
• Solid food 4-6m
• Cut down milk to increase solids
• Change infant from bottles to cup
• Encourage high iron containing foods
• iron supplement (i.e. Ferro Liquid)
• Vitamin C (aid absorption i.e. dilute fruit / veggie juice)
• Dilute milk
• Offer solids first

Question 18

When throughout lifespan is RBC production lowest?

Answer 18

Reaches nadir at 2w of life (UTD says 6-9w).

= physiological nadir.

Question 19

Ix for girl suggestive of bone marrow disorder causing anaemia?

Answer 19

• FBE
• Blood film
• LDH + haptoglobin
• Reticulocyte count
• LFTs (inc bilirubin)
• Coags

Question 20

DDx pancytopenia?

Answer 20

• Acute leukaemia
• Metastatic marrow infiltration (i.e. lymphomas going to bone)
• Aplastic anaemia
• Hypersplenism
• Myelosuppressive medications

Question 21

RFx for leukemia development

Answer 21

• Prenatal XR expsure
• High dose therapeutic irradiation
• Down syndrome
• other genetic

Question 22

What is the commonest childhood malignancy 1-7y?

Answer 22

ALL

Question 23

What are the leukemia sanctuary sites?

Answer 23

• CNS
• Testes
  Often need regular LPs / testicular exam to monitor

Question 24

Which ALL has best prognosis?

Answer 24

B cell ALL CD10

Question 25

What is the most common cause of anaemia in young infants?

Answer 25

Physiologic anaemia : erythropoiesis decreases after birth due to increased tissue oxygenation and decreased EPO

Question 26

How may pathologic anaemia be differentiated from physiologic anaemia of infancy?

Answer 26

• Anaemia under 135 in first month
• Less than 90
• Signs of haemolysis (jaundice, scleral icterus, dark urine) or symptoms of anaemia (irritability, poor feeding).

Question 27

What are the common causes of pathologic anaemia in newborns?

Answer 27

• blood loss
• immune haemolytic disease (Rh or ABO)
• Congenital infection
• Twin-twin transfusion
• Congenital haemolytic anaemia (e.g. hereditary spherocytosis, G6PD)

Question 28

Preterm vs term wrt anaemia?

Answer 28

• Low HCT and Hb
• Shorter RBC lifespan
• impaired EPO production due to immature liver
  Therefore decline earlier after birth and more severe.

Question 29

What is suggested by anaemia detected at 3-6m of age?

Answer 29

Haemoglobinopathy

Question 30

What is Diamond Blackfan anaemia?

Answer 30

Disorder of bone marrow: congenital erythroid aplasia.