Haematology - Anaemia in Children Flashcards
What are the causes of anaemia in infancy?
Physiologic anaemia of infancy
- Anaemia of prematurity
- Blood loss
- Haemolysis
- Twin-twin transfusion
What is twin-twin transfusion?
Blood unequally distributed between twins that share a placenta
What are some causes of haemolysis in a neonate?
Haemolytic disease of the new-born
Hereditary spherocytosis
G6PDH deficiency
What is physiologic anaemia of infancy?
Normal dip around 6-9 weeks in babies
High oxygen delivery by high hb levels at birth cause negative feedback
EPO production by kidneys suppressed, causes reduction haemoglobin production by bone marrow
High oxygen causes low Hb production
What is anaemia of prematurity?
Premature neonates much more likely to become significantly anaemic in first weeks of life
More premature, more likely to need transfusions
Even more likely if unwell at birth e.g. neonatal sepsis
Why do neonates become anaemic?
Less time in utero getting iron from mother
RBC cannot keep up with rapid growth in first few weeks
Reuced EPO
Blood tests remove significant portion of their circulating volume
What is haemolytic disease of the new-born?
Rhesus D positive baby and rhesus D negative mother
Causes immune response leading to haemolysis
How does haemolytic disease of the new-born occur?
Rhesus D negative mother becomes pregnant, rhesus D positive baby blood enters the maternal blood stream during birth and immune system becomes sensitised to rhesus D positive antigens
In following pregnancies mother’s anti-D antibodies can cross the placenta into foetus
If the foetus is RhD+ this can cause antibodies to attack rbcs leading to haemolysis
When can haemolytic disease of new-born occur in first pregnancy?
If sensitisation happens early on from foetal blood entering maternal blood stream
What does haemolytic disease of the new-born lead to?
Haemolysis
Anaemia
High bilirubin
How can haemolytic disease of the new-born be treated?
Rhogam within 72 hours of birth if mother is RhD-
What can be used to check for immune haemolytic anaemia?
Direct Coombs test
What are the key causes of anaemia in older children?
Iron deficiency anaemia due to dietary insufficiency
Most common
Blood loss, menstruation in older girls
What are some rare causes of anaemia in older children?
Sickle cell anaemia
Thalassaemia
Leukaemia
Hereditary spherocytosis
Hereditary elliptocytosis
Sideroblastic anaemia
What is the most common cause of chronic anaemia and iron deficiency in developing countries?
Helminth infection with
- Roundworms
- Hookworms
- Whipworms
Treat with single dose of albendazole or mebendazole
What are the causes of microcytic anaemia?
TAILS
Thalassaemia
Anaemia of chronic disease
Iron deficiency anaemia
Lead poisoning
Sideroblastic anaemia
What are the causes of normocytic anaemia?
Acute blood loss
Anaemia of chronic disease
Aplastic anaemia
Haemolytic anaemia
Hypothyroidism
What are the causes of macrocytic anaemia?
Megaloblastic anaemia
Impaired DNA synthesis, prevents cell dividing normally
Grows into large, abnormal cell
- B12 deficiency
- Folate deficiency
Normoblatic macrocytic anaemia
- Alcohol
- Reticulocytosis (from haemolytic anaemia or blood loss)
- Hypothyroidism
- Liver disease
- Azathioprine
What are the symptoms of anaemia?
Tiredness
Shortness of breath
Headaches
Dizziness
Palpitations
Worsening of other conditions
What symptoms are specific to iron deficiency anaemia?
Pica
Hair loss
What are the signs of anaemia?
Pale skin
Conjunctival pallor
Tachycardia
Tachypnoea
What are signs are specific to iron deficiency?
Koilonychia
Angular cheilitis
Atrophic glossitis
Brittle hair and nails
When do bone deformities occur in anaemia?
Thalassaemias
What initial investigations should you do for anaemia?
FBC for Hb and MCV
Blood film
Reticulocyte count
Ferritin
B12 and folate
Bilirubin
Direct Coombs test
Haemoglobin electrophoresis
What do you do a direct coombs test for?
Autoimmune haemolytic anaemia
What is haemoglobin electrophoresis done for?
Haemoglobinopathies
What does high reticulocyte count indicate?
Anaemia due to haemolysis or blood loss
How is anaemia managed?
Depends on underlying cause e.g. iron is direct replacement of iron
Severe anaemia may need blood transfusions
