Childhood anaemia

Question 1

What diagnoses should be considered in children with anaemia with an MCV <70?

Answer 1

IDA

Thalassaemia

Question 2

How might IDA present in a child?

Answer 2

Poor diet
Poverty
Stomatitis
Bleeding
Koilonychia

Question 3

How might thalassaemia present in a child?

Answer 3

Short stature
Muddy complexion
Icteric sclera
Distended abdomen
Hepatosplenomegaly
Bossed skill
Prominent maxillae

Question 4

What 3 mechanisms can cause anaemia in a child?

Answer 4

Destruction
Lack of production
Loss of blood

Question 5

What diagnoses should be considered in children with anaemia with an MCV >100?

Answer 5

Low folate
Low B12
Haemolysis

Question 6

What diagnoses should be considered in children with anaemia with an MCV 81-97?

Answer 6

Haemolysis

Marrow failure

Question 7

What are the potential causes for low folate in a child?

Answer 7

Malabsorption

Phenytoin

Question 8

What are the potential causes for low B12 in a child?

Answer 8

Breast milk from a vegetarian
Decreased intrinsic factor
Malabsorption
Poor feeding

Question 9

What are the potential symptoms of low B12 in a child?

Answer 9

Late milestones
Odd movements
Microcephaly
Failure to thrive

Question 10

What can cause marrow failure in a child to cause anaemia?

Answer 10

Transient
After infection
Thyroid, kidney or liver failure
Malignancy

Question 11

What are some severe tropical anaemias that may be found in children?

Answer 11

malaria
bacteraemia
worms
HIV
sickle cell

Question 12

If a child has anaemia with a raised CRP and ESR what may this indicate?

Answer 12

Chronic disease

Question 13

On a blood film in a child with anaemia, what do hypochromic microcytic RBCs indicate?

Answer 13

IDA

Question 14

On a blood film in a child with anaemia, what do target cells indicate?

Answer 14

liver disease

Thalassaemia

Question 15

What percentage of infants worldwide are affected by IDA?

Answer 15

26%

Question 16

What is the peak age for a child to develop IDA?

Answer 16

~18 months

Question 17

In recurrent IDA what diagnoses should be suspected in a child?

Answer 17

Meckel’s diverticulum

Oesophagitis

Question 18

How is IDA treated in children?

Answer 18

Ferrous fumarate syrup at 0.25ml/kg/12h

Question 19

In a child with anaemia, when should a diagnosis of malaria or sickle cell disease be considered?

Answer 19

Evidence of increased RBC production
Decreased RBC survival
Intravascular haemolysis
Inborn error of metabolism, spherocytosis

Question 20

What is hereditary spherocytosis?

Answer 20

Autosomal dminant abnormality of erythrocytes causing them to be spherical rather than biconcave in shape

Question 21

What happens to a person with hereditary spherocytosis if they develop a parovirus B19 infection?

Answer 21

transient severe anaemia

Question 22

How is hereditary spherocytosis investigated?

Answer 22

Flow cytometric analysis of eosin-5-malemide

Question 23

What treatment may be considered for hereditary spherocytosis to increase RBC survival?

Answer 23

Splenectomy

Question 24

What is a complication of hereditary spherocytosis?

Answer 24

Gallstones in the 1st decade of life

Question 25

What is the management for a patient with sickle-cell disease?

Answer 25

Hydrate
Give O2
Pain relief
- warmth
- hydration
- ibuprofen
- pt-controlled analgesia