Haematology: Anaemia in children; Bruising Flashcards
What are anaemia thresholds for:
* Neonates
* Infants
* Child
* Teenagers
Neonates:
- < 140
Infants:
- < 110
Child:
< 115
Teenagers:
< 120
Describe what is meant by physiological anaemia of infancy [1]
Foetus naturally has high fetal Hb (causes O2 dissociation curve to go to left) so can maximise O2 from mother
Fetal Hb is gradually lost throughout first 6 months of life
Which is why settles at 110 g/dl at 6-9months of age
When / why might a baby be suffering from IDA? [1]
If they are exclusively milk feeding (bottle / breastfeeding) at ~ 1 year age
What are common causes of reduced red cell production causing anaemia in children [4]
Common:
- Nutritional causes - iron,
B12, folate deficiency
- Reduced intake
- Malabsorption - e.g. coeliac
- Increased requirement (growth)
What are more rare causes of reduced rbc production in children [4]
Rare:
- Bone marrow failure
- Malignancy & chemo
- Diamond Blackfan anaemia (genetic syndrome w reduced bone morrow production of rbc)
- Aplastic anaemia
What are the causes of infant IDA [6]
Maternal IDA
Premature / LBW
Multiple pregnancy
Exclusively breast-fed after 6 months
Late or insufficient introduction of iron rich solid
XS cow’s milk consumption
What causes IDA in children / adolescents? [5]
Vegan / vegetarian diet
GI disorders (Mecke’s diverticulum, coeliac, IBD, gastric surgery)
Extreme athletes
Heavy menstruation
Other chronic blood loss
What are the three overall causes of haemolysis causing anaemia (in children) [3]
3 Is:
Immune
Intracellular red cell defects
Infections
What are causes for immune haemolysis anaemia (in children) [2]
Anti-Rh antibodies
Anti ABO antibodies
A baby has rhesus incompatibility. How would they present [4] due to which condition? [1]
How might you treat? [4]
Hydrops fetalis
- Skin oedema, pericardial effusions, ascites, secondary jaundice
Treatment:
- Phototherapy, IV IG, Blood transfusion, exchange transfusion
What are the most common causes of intracellular red defects [6]
Describe their presentations [+]
Sickle cell disease
Thalassemias
Hereditary spherocytosis
- splenomegaly
- risk of aplastic, haemolytic or megaloblastic crisis (causing acute exacerbation of anaemia)
Hereditary eliptocytosis
G6PD deficiency
- bite cells and heinz bodies
- avoid triggers
Pyruvate kinase defiency
Which infections would most likely cause haemolysis [3]
Parvovirus
Malaria
HUS
Describe the presentation of parvovirus b19 infection [+]
- causes transient aplastic anaemia, temporary suspension of erythropoeisis - risk in SCA or hereditary spherocytosis
- mild feverish illness which can be hardly noticeable
- cheeks appear bright red, hence the name ‘slapped cheek syndrome’
- child begins to feel better as the rash appears and the rash usually peaks after a week and then fades
- the rash is unusual in that for some months afterwards, a warm bath, sunlight, heat or fever will trigger a recurrence of the bright red cheeks and the rash itself
- causes aplastic crisis in SCA ptx
Why does malaria cause anaemia? [3]
Increased splenic activity
Bone marrow suppression
Increased haemolysis of rbc
Which causes of anaemia in children would be due to blood loss? [5]
Blood loss
* Gastric ulcers
* Milk intolerance
* Hereditary
haemorrhagic telangiectasia
* Meckels diverticulum
* IBD
* Epistaxis
How would you determine if a microcytic anaemia is due to IDA or thalassemia minor on initial investigation? [1]
How would you then determine if a patient has Beta thalassaemia minor / alpha thalassaemia minir? [2]
Look at ferritin level
- if low = IDA
- if normal = thal. minor
Then do Hb electrophoresis
- Elevated HbA2 = beta thal. minor
- Normal HbA2 = alpha thal. minor
Normocytic MCV:
- How would you determine if a child is suffering from haemolytic cause / blood loss? [1]
- How would you determine if is from marrow hypoplasia / leukaemia
Reticulocytes increased
What are red flags for anaemia in children? [5]
Red flags in anaemia
* Hb < 60g/L
* Tachycardia, cardiac murmur or signs of cardiac failure
* Features of haemolysis (dark urine, jaundice, scleral icterus)
* Associated reticulocytopenia (low reticulocyctes)
* Presence of nucleated red blood cells on blood film
* Associated thrombocytopenia or neutropenia
* Severe vitamin B12 or folate deficiency - associated w failure to thrive / neurodevelopment problems
Where possible defer transfusion until a definitive diagnosis is made
Why is associated reticulocytopenia (low reticulocyctes) in anaemia a red flag? [1]
Should have increased reticulocytes to correct for anaemia
Which drugs should children with ITP avoid? [1]
NSAIDs / Ibuprofen - can disrupt platelet count
add haemophilia notes
add scd notes
add leukaemia notes
Which conditions have increased platelet destruction? [4]
ITP
DIC
HUS (microangipathic)
Hypersplenism
What is the basic pathophysiology of ITP? [1]
Production of antibodies to platelets which are then destryed in liver and spleen
What advice would you give ITP patients when platelet count is low? [3]
Avoid antiplatelets, anticoagulants and IM Injections
Describe the treatment ladder for ITP [3]
Cutaneous symptoms only:
* Watchful waiting
Mucosal bleeding:
- Steroids/ IVIG/ topical or oral TXA
Chronic ITP:
- TPO agonists, MMF, rituximab, splenectomy
What is the most serious complication of ITP that should be worried about? [1]
Intraventricular haemorrhage
Large platelets but low count = [] syndrome
Bernard-Soulier syndrome
Eczema x immunodeficiency x small platelets and low count = [] syndrome
Wiskott-Aldrich syndrome
What are red flags for features in bleeding or brusing? [5]
- Unexplained bruising or inconsistent history
- Unprovoked or severe bleeding
- Fever & unwell appearance
- Associated pallor, lymphadenopathy, hepatosplenomegaly
- Family history of unusual bleeding
