Pediatric Anemia Flashcards
Which hemoglobin dominates At newborn, 6months, and adult for a normal child?
For a sickle cell child?
Normal:
newborn: HbF
6 months: HbA
Adult: HbA
Sickle:
Newborn: HbS
9 months: HbA
Differentiate between the structures of HbF and HbA
HbF (alpha, gamma)
HbA (alpha, beta)
The smaller or premature the child how does it affect their hemoglobin and MCV?
Lower
When is IDA common for under 6 months?
If mother had low iron stores (ferritin)
What medications cause anemia?
Anti-folates
- phenytoin
- alcohol
Oxidant stress
- nitrofurantoin
Immune hemolysis
- penicillin
What are the 3 most important tests to order to identify anemia
- CBC - Hb, MCV, RBC, WBC, platelets
- Reticulocyte count - bone marrow response
- Peripheral blood - morphological clues
What does an increase/normal or decrease reticulocyte count indicate?
Normal or decrease:
- check MCV
Increased
- blood loss
- hemolysis
What is important based on reticulocyte count?
The ADEQUATE RETIC RESPONSE not the absolute retic count.
What are causes of IDA
- Inadequate iron stores at birth
- Inadequate diet (cow milk)
- Blood loss (GI tract)
- Malabsorption of iron (meds)
What is the dosing of elemental iron for pediatrics
Give 3-6mg/kg per day
How do you rule out malabsorption of iron
Perform an oral iron challebnge
- Give 1mg/kg/dose of oral iron
- Fast before and 2 hours after
- Take serum iron tests
- Test should increase 20+ mmol/L
What are the steps for evaluating childhood anemia? When do you refer?
- Review patient history + physical examination
- Order lab tests: CBC, reticulocyte count, peripheral blood smear
- Refer if
- Poor response to oral iron
- Anemia with additional cytopenia
- Evidence of acute/chronic hemolysis
- Unexplained normocytic anemia
Explain the conditions associated with quantitative and qualitative hemoglobin
Quantitative: reduced globin snythesis
- thalassemia
Qualititative: structural hemoglobin difference
- sickle cell
- Methaemoglobinemia
- G6PD
What is the mutation in sickle cell
B globin (HBB)
- glutamic acid replaced by valine in amino acid ^
What is the risk factor for sickle cel
Ancestry from
- africa
- south america
What are causes of sickle cell (3)
- Vaso-occlusion: RBC gets trapped in blood vessel
- Intravascular hemolysis: promotes inflammation and leads to vasculopathy
- Chronic hemolysis/anemia
- inc LDH + bilirubin
- dec Hgb
What is the presentation and treatment for sickle cell crisis?
Presentation
- chest pain
- dyspnea
- low PO2
Treatment
- analgesics: opioids, ketamine, NSAIDs
- bronchodilators O2
- Hydration
- Transfusions
What are risk factors for sickle cell crisis
- dehydration
- infections
What are treatment options for SCD. When is it safe and effective (age)?
- Hydroxyurea; over 9+ months
- Blood transfusions
What is the mechanism for hydroxyurea?
Induces production of fetal hemoglobin (primary)
What is the dosing for hydroxyurea for children/adults
Start at 20 mg/kg can go up to 25mg/kg
Adult
1000mg daily and inc as tolerated
Which lab values will increase and decrease in response to hydroxyurea
Increase
- HbF
- MCV
- Hgb
Decrease
- Platelet
- neutrophil
- Retic
What are some options for supportive care for sickle cell
Penicillin
Splenectomy
Folic acid
What can help differentiate between IDA and thalassemia
Mentzer index is divided by RBC
Thalassemia: less than 13
- High HbA2
- rest is normal
IDA: 13+
