Child with Palor Flashcards
What’s the normal Hb of a newborn?
10-12
What is the equation for O2 delivery?
CO x Hb x SpO2 x 1.31
Where does the 1.31 come from in the O2 delivery equation?
Amount of oxygen carried by 1g of Hb
For how long is breast milk a good source of iron?
Six months
What are some symptoms of anaemia
Lethargy SOB Fatigue Chest pain Poor school performance
What is the most common cause of iron deficiency in kids?
Poor nutrition
Why does a cow milk diet course iron deficiency anaemia?
Reduces appetite for other foods
The iron it contains isn’t as bioavailable
Cow’s milk allergy causing occult loss
Why do premature babies get iron deficient?
Maternal iron is transferred in the third trimester
Iatrogenic loss
Why don’t you replace iron in preterm babies immediately?
It increases the risk of certain bacterial infections
Start at around 4 weeks
What must you consider when interpreting iron studies in children?
Ferritin may be falsely normal or elevated due to infection/inflammation
How can you clarify the results of iron studies?
Reticulocyte count
How do you investigation Fe def.
FBE and film
Iron studies
Reticulocyte count
How do you differentiate Fe def and thalassaemia?
RDW - Fe def is higher
Hb electrophoresis
How do you replace Fe?
Oral supplementation
Infusion (caution anaphylaxis), not used as much in kids
What do you advise parents about iron supplementation
Can course constipation and abdo pain Take with vitamin C, not on an empty stomach Don't overdose Dark stools Brush teeth after taking it
What happens in iron ingestion overdose?
Inflammation of GIT
- mucosal inflammation
- Strictures
How long do you take oral iron for?
At least a month - usually 2 months
How do you tell if someone is responding to iron in anaemia?
Increases reticulocyte count
How does thalassaemia major present?
Hypertrophy of maxillary bones
Hepatomegaly
How do you decide whether to transfuse?
Symptomatic or not
Comorbidities
Progressive or not
How do you decide how much blood to give?
Weight (kg) x DeltaHb (g/dL) x 3-4 = ml of blood
How many ml of blood in a unit?
250ml
What is the maximum length of time over which a transfusion should be given?
6hr
Practically 4 hours
What do you accompany the administration of blood with (in most cases)?
Accompany with diuretic so as not to overfill
What must you do when administering blood?
Check that everything matches
Monitor - every 5 minutes for first half hour
