EXAM #2: ANEMIA IN CHILDHOOD Flashcards
What is the definition of anemia as it relates to childhood?
Decreased RBC mass
What is the consequence of anemia?
Decreased oxygen carrying capacity
What labs help to make the diagnosis of anemia in children?
- CBC and PBS
- Hb
- Hct
- Red cell indices
- Reticulocyte count
What symptoms are characteristic of anemia in children?
- Fatigue
- Irritability
- Inappropriate behavior
*****Other sx of anemia i.e. decreased exercise tolerance, dyspnea, palpitations…etc. are seen in severe anemia in children.
What is the dietary history that is important when evaluating anemia in children?
Milk intake– children often over consume cow’s milk
* 16-20 ounces is recommended in the toddler*
When is screening for anemia recommended in children?
1) 12 months
2) Kindergarten entrance
3) Adolescents
How is the lower limit of MCV calculated in children less than 10?
Age in years + 70
How is the upper limit of MCV calculated in children?
84 + 0.6x age in years
What is a MCHC greater than 35 g/dL characteristic of?
Spherocytosis
Mean Corpuscular Hemoglobin Concentration*
When is a low MCHC found?
Iron deficiency anemia
What is increased WBC/ low platelets and anemia a sign of?
HUS
Hemolytic Uremic Syndrome
What can a normal WBC/ low platelet count and mild anemia be a sign of?
ITP
Idiopathic Thrombocytopenic Purpura
What are the causes of microcytic/ hypochromic anemia in children?
1) Iron deficiency
2) Pb toxicity
3) Thalassemia
What are the causes of macrocytic/ hyperchromic anemia?
1) B12 deficiency
2) Folate deficiency
Note that a PE exam finding with B12 deficiency that is commonly overlooked is a positive Rhomberg.*
What is a common cause of Folate Deficiency in infants?
Infants that are fed goat milk
What are the characteristics of Diamond Blackfan anemia?
Normocytic anemia with decreased RC
If you see a normocytic anemia and decreased RC count, what should your differential include?
- Diamond Blackfan anemia
- Transient Erythroblastopenia of Childhood
- Parvovirus B19
What is a normocytic anemia with increased reticulocytes a sign of?
Blood loss
What is a normocytic anemia/ increased RC count with a positive coombs’ test indicate of?
Autoimmunity:
1) ABO incompatibility
2) Rh incompatibility
What is a normocytic anemia/ increased RC count with a negative coombs’ test indicate of?
- Non-immune mediated destruction
- Membrane defect
- Hemoglobinopathy
- G6PD
- Pyruvate Kinase Deficiency
When is iron deficiency anemia common in children?
9-24 months
What is the common cause of iron deficiency anemia in children?
- Excessive milk intake
- Early milk intake
- Blood loss
What are the labs that are indicative of iron deficiency anemia?
- Mild to moderate anemia i.e. Hb (7-10)
- Decreased MCV i.e microcytic
- RDW increased
- Ferretin low
- Transferrin low
- Serum iron low
- TIBC HIGH
- RC normal to increased
How is iron deficiency anemia prevented?
- Encourage breast-feeding for more than 6 months
- Iron fortified cereal
- Avoid cow milk under 12 months
- High Fe diet
What are the characteristics of TEC?
- Unknown etiology causing transient decrease in RBC production
- Age is greater than 1 year
- Moderate to severe anemia
- MCV is normal i.e. normocytic
- Reticulocyte count is decreased
What are the characteristics of Diamond Blackfan anemia?
- Under 1 year of age
- Moderate to severe anemia
- RC decreased
- HgB F increased
- 25% have physical abnormalities
What causes of Diamond Blackfan anemia?
Abnormal ribosomal protein synthesis
Don’t make precursor cells*
What is the treatment of TEC?
- Supportive
- Transfuse if unstable
Spontaneous recovery usually happens within a year
What is the treatment for DBA?
- Prednisone
- Transfusion
- Bone marrow transplant IF resistant to steroids
How is iron deficiency treated?
6mg/kg/day of oral elemental iron until Hb is normal + 2 more months
How is iron overload treated?
Chelation therapy
The drug used for this procedure is “Deferoxamine”
What are the three types of crises that are seen in Sickle Cell Disease?
1) Vaso-occlusive crisis/ pain
2) Aplastic crisis
3) Hemolytic/ Splenic Sequestration
What is the role of hydroxyurea in Sickle Cell Disease?
Increase in Hb-F
What is a common cause of aplastic crisis in Sickle Cell Disease?
Parvovirus B19
This viral infection leads to an acute drop in Hb/Hct and RCs
How do you tell the difference between aplastic crisis and hemolytic crisis?
Both will cause an acute drop in Hb and Hct. The difference:
- Aplastic= drop RC
- Hemolysis= increase in RC and +DAT
What infections are children at risk with that are functionally asplenic because of Sickle Cell Disease?
Encapsulated bacteria
- S. pneumonia
- H. influenza
- N. meningitidis
What is a common cause of osteomyelitis in children with Sickle Cell Disease?
Salmonella
What should you be concerned about if a child’s house is over 60 years old?
Pb toxicity
When should infants be Fe supplemented?
After 4 months
How is aplastic crisis treated in children with Sickle Cell Disease?
Blood transfusion
This can be a truly lifesaving procedure in these children.
