Pallor/Anaemia

Question 1

DDx for pallor

Answer 1

Anaemia
• Haemorrhage/blood loss

• Haemolysise.g. thalassaemia
• Inadequate production
  * Haematinics: Fe, B12, Folate
  * BM failure: lymphoma, leukaemia (ALL)

Cardiac
• Cyanotic heart disease
• Heart failure

Other
• Infection/sepsis
• Hypoglycaemia
• Hypovolaemia
• Intussusception
• Renal disease

Question 2

How can we classify anaemias based on MCV?

Answer 2

Microcytic:

• low serum ferritin -> iron def
• normal serum ferritin -> thalassaemia minor
• Rare causes: chronic inflammation, chronic lead poisoning (high blood lead level), sideroblastic anaemia

Normocytic:

• inc reticulocyte count -> haemolysis/blood loss
• not inc ret count/other abnormalities -> marrow hypoplasia, leukaemia, infiltration

Macrocytic: e.g. folate, B12 def

Question 3

What is the most common cause of anaemia in children?What can cause it?

Answer 3

• Fe-deficiency anaemia
• Usually nutritional:
  
  • Insufficient red meat, fish, chicken, green vegetables, pulses
  • excessive cow’s milk
    ○ Bioavailability of iron in cow’s milk is very low
    ○ CMPI - cow’s milk colitis of varying severity
• rarely due to malabsorption or GI bleeding

Question 4

Risk factors for Fe-deficiency anaemia

Answer 4

○ Prematurity
○ low birth-weight
○ multiple pregnancy
○ exclusive breast-feeding after 6 months and excessive cow’s milk
○ Aboriginals and adolescent females are also at risk.

Question 5

How is thal minor Dx? What can mix up the test, and so what must you do when testing?

Answer 5

• diagnosed on Hb electrophoresis - HbA2 > 3.5%
○ Note:HbA2 may not be elevated in the presence of concomitant iron deficiency, therefore giveiron therapy (if ferritin low) before ordering test.

Question 6

Which ethnicities are associated with thal minor?

Answer 6

• South East Asian, Mediterranean, Arabic families

Question 7

What is Hb like in thal minor?

Answer 7

normal or borderline low Hb

Question 8

Basic Ix for anaemi

Answer 8

• FBE
• Blood film
- Reticulocyte count

Question 9

Clinical features in children with anaemia

Answer 9

• Weakness
• Listlessness
• Shortness of breath
• Lethargy
• Poor growth
• Pallor
• Pale conjunctivae
• Flow murmur
• Signs of cardiac failure

Question 10

Mx for Fe-deficiency anaemia

Answer 10

• Iron supp if Hb < 100g/l, or low ferritin even if Hb normal
- Premmies need at 4-6w (not earlier - infection risk)
• F/U
• Dietary advice (increase red meat, chicken, fish, pulses, green vegetables; limit cow’s milk consumption to 500 ml/day, needs solids > 6mo)

Transfusion rarely required (eg. cardiac failure, urgent surgery required)

Question 11

What should you remember about RBC transfusions?

Answer 11

• Amount based on symptoms, not necessarily [Hb]

- Should not give over any longer than 4 hours - blood is a culture medium