Childhood Anemias

Question 1

rule of thumb for anemia

Answer 1

Hb < 11.0

Question 2

s/s of anemia

Answer 2

*fatigue/sleepiness
*pallor
*headache
*dizziness or lightheadedness
*shortness of breath
*decreased exercise tolerance/school performance
*jaundice (if a hemolytic anemia)

Question 3

MCV trends in kids

Answer 3

*high in newborns, then drops
*in children beyond infancy (up until adolescence), low normal MCV = 70 + age (ex. 2 year old, low normal MCV 72)

Question 4

general approach to anemia

Answer 4

1. look at Hb
2. look at MCV
3. if MCV normal, look at reticulocytes (elevated is GOOD because bone marrow is compensating, low is BAD)

Question 5

ddx for low Hb and low MCV (microcytic anemia)

Answer 5

*iron deficiency
*thalassemia
*Hb C, E
*anemia of chronic disease (ACD)
*sideroblastic anemia

Question 6

ddx for low Hb and high MCV (macrocytic anemia)

Answer 6

*megaloblastic (B12/folate; meds)
*bone marrow failure (congenital or acquired)
*lab error

Question 7

ddx for low Hb, normal MCV, elevated retiulocytes

Answer 7

*hemorrhage
*hemolysis (extrinsic or intrinsic)

Question 8

ddx for low Hb, normal MCV, low reticulocytes

Answer 8

*renal disease
*drugs
*inflammation
*TEC
*bone marrow infiltration

Question 9

iron deficiency vs thalassemia

Answer 9

*history
*exam
*MCV/RBC > 13.5 = iron deficiency
*MCV/RBC < 11.5 = thalassemia trait
*RDW: normal in thalassemia; increased in iron deficiency
*platelet count often increased in iron deficiency

Question 10

iron profile in iron deficiency anemia

Answer 10

*serum iron - LOW
ferritin - LOW
*TIBC - HIGH
*% saturation - LOW

Question 11

pica

Answer 11

*craving and chewing/eating substances that have no nutritional value, such as ice, clay, soil, or paper
*sign of iron deficiency

Question 12

iron deficiency anemia in kids - therapy

Answer 12

*decrease milk consumption
*ferrous sulfate supplement
*vitamin C helps absorption

Question 13

iron supplementation - side effects

Answer 13

*constipation
*abdominal pain
*irritability
*nausea
*dark stools
*staining of teeth

Question 14

clinical consequences of iron deficiency in kids

Answer 14

*impaired mental and motor development
*impairment can be seen with even mild anemia
*associated with increased all cause mortality

Question 15

hemoglobin E

Answer 15

*common in persons of southeast Asian descent
*heterozygous and homozygous states cause microcytosis with mild anemia
*clinically significant only when combined with beta thalassemia

Question 16

transient erythroblastopenia of childhood (TEC)

Answer 16

*subtype of pure red cell aplasia
*age 6 months - 5 years
*etiology unknown (transient immune reaction against erythroid progenitor cells)
*hx of viral infection common
*clinically well-appearing except for pallow
*MCV is NORMAL, reticulocytopenia

Question 17

neonatal alloimmune hemolytic anemia

Answer 17

*transplacental passage of maternal alloantibody directed against fetal antigens, leading to hemolysis of fetal RBCs
*may be due to Rh incompatibility, ABO incompatibility, or other blood antigen incompatibility

Question 18

intrinsic hemolytic anemia

Answer 18

1. RBC membranopathies
   -hereditary spherocytosis
   -hereditary elliptocytosis
2. RBC enzymopathies
   -G6PD deficiency
   -PK deficiency

Question 19

target cells are seen in what type of blood conditions?

Answer 19

*THALASSEMIAS
*hemoglobin C disorders
*hepatic disease with jaundice
*postsplenectomy state