Pallor Flashcards
Ddx of anaemia and Pallor
Normal variant - deep lying venous system or opaque skin. Hypo chromic microcytic anaemias Iron deficiency anaemia Thalassaemia trait Normochromic normocytic anaeia Lead poisoning Haemolytic anaemia Hereditary spherocytosis Autoimmune haemolysis Red cell enzymes disorder e.g. G6PD deficiency Haemoglobinopathies Other anaemia Leukaemia Anaemia of marrow infiltration Leukaemia Lymphoma Histiocytosis Neuroblastoma Metabolic storage disorders Bone marrow failure Leukaemia Aplastic anaemia Congenital Falcon anaemia Acquired aplastic anaemia Post infection Sickle cell Anaemia Other cause Chronic infection Chronic renal failure Malignancies
DDX for microcytic anaemia
Iron deficiency
Thalassaemias
Sideroblastic anaemias
Anaemia of chronic disease
DDX for macrocytic anaemia
Bone marrow failure syndromes ef aplastic anaemia
Myelodysplastic syndroms
Megaloblastic anaemia eg B12/folate deficiency
Drugs
DDX for normalocytic anaemia
Haemolysis Sequestration Anaemia of chronic disease recent significant bleeding Combined iron and B12/folate deficiency
Ddx for high reticulocyte count
Haemolytic anaemia
G6PD - linked
Autoimmune - coombs test
Ddx for low reticulocyte count
Hypo chromic Microcytic - iron deficiency, lead poisoning, thallasaemia trait
Leukemia and other malignancies
Anaemia of chronic disease
Renal failure
History questions for a child with pallor
Symptoms of anaemia - Fatigue, lethargy, pallor, poor feeding, anorexia, poor growth, dyspnoea on exertion, Rarely stomatitis or koilnychia
Diet - Drinking Cow milk too early. excessive intake of milk, not enough solids for age,
Ask about pica (lead poisoning). Home condition? any exposure to fumes or old lead paint?
Hx of bleeding
Ethnic origin or consanguinity
FmHx - Haemoglobinopathies
Medication history
Examination of a child with pallor
Signs of anaemia - Pallor of conjunctivae and nail beds, Hepatosplenomegaly
Height and weight 0 FTT, malabsorption
Dysmorphic features e.g. Micrognathia, cleft palate, abnormal/absent thugs - fantom;s anaemia, diamond-blackman anaemia
Jaundice - Haemolysis
Adenopathy/organomegaly - underlying malignancy,
Ix for a child with pallor
FBC - Severity and types of anaemia, Presence of bizarre cells or blast cells
Ferritin - low in iron deficiency
Zn-protoporphyrin - Raised in iron deficiency and lead poisoning
Lead level - high in lead toxicity
Haemoglobin electrophoresis - abnormal haemoglobinopathies
U & E - abnormal in renal failure
Blood and urine culture - Chronic infection
Bone marrow aspirate - only needed if blast cells seen on peripheral film
Tx of iron deficiency anaemia
Give 5mg/kg elemental iron/day for 2-3months
Optimise dietary iron content
Causes of iron deficiency anaemia in pre school age children
Inadequate dietary iron
Inadequate complementary foods e.g. excess milk ingestion
Cow milk allergy
Rapid/rebound growth, former low birth weight
Coeliac disease
Parasitic infection
GI blood loss.
Causes of iron deficiency anaemia in older children
Inadequate dietary iron Rapid/rebound growth Coeliac disease Parasitic infection GI blood loss
Causes of iron deficiency anaemia in adolescent and premenopausal women
Inadequate iron intake
Blood loss e.g. menorrhagia, GI, haemostat defect.
Coeliac disease
Parasitic infection
Causes of iron deficiency anaemia in adult men and postmenopausal women
Exclude GI blood loss and coeliac disease
Ix with gastroscopy/colonscopy, coeliac screening
Tx of iron deficiency anaemia for adults
100-200mg for elemental iron per day for >3 months after normalisation of Hb.
Iv if needed
Optimise dietary iron and address underlying cause
