Pediatric Anemia

Question 1

Define anemia

Answer 1

A reduction of the Hb concentration or RBC volume below the range of values occurring in healthy persons (<5th percentile for age)

Question 2

T/F: normal values for Hb and Hct vary with age in pediatric population

Answer 2

True

Question 3

What effect does anemia have on 2,3-DPG levels and the Hb oxygen dissociation curve?

Answer 3

Concentration of 2,3-DPG increases within RBC

Oxygen dissociation curve shifts to the right (affinity of Hb for O2 is reduced in tissues needing to be oxygenated)

Question 4

Pertinent history components in pediatric pt with suspected anemia

Answer 4

Age
Race and ethnicity
Sex
Diet
Meds
Chronic diseases
Infections
Travel
Exposures

FH of anemia, splenomegaly, jaundice, early-age onset of gallstones

Question 5

PE findings to look for in pediatric pts with suspected anemia

Answer 5

Pallor — tongue, nail beds, palms, conjunctiva, mucosal surfaces

Sleepiness

Irritability

Decreased exercise tolerance

Flow murmur

[note: not usually seen until Hb is below 7-8 g/dL; as anemia becomes more severe may see weakness, tachypnea, DOE, tachycardia, cardiomyopathy, high output heart failure]

Question 6

What information do you get when you order an H/H?

Answer 6

Hemoglobin (g/dL) — actual amount of Hb in the blood

Hematocrit (%) — volume percentage of RBCs in blood

Question 7

RBC indices MCV, MCHC, RDW

Answer 7

MCV = mean corpuscular volume; represents mean value of volume of individual RBCs in the sample

MCHC = mean corpuscular Hb concentration; represents Hb/Hct

RDW = red cell distribution width; represents variability of RBC size

Question 8

What does a peripheral smear tell you?

Answer 8

Provides info about RBC and WBC morphology, platelet “clumping” and hemolysis

Question 9

What RBC indices are used most often to classify anemia?

Answer 9

MCV — microcytic/normocytic/macrocytic

MCHC — hypochromic (<32), normochromic (33-34), Hyperchromic (>35)

Peripheral smear may reveal changes in morphology that help narrow down Ddx

Question 10

Once anemia is divided into micro-, normo-, or macrocytic, further division is based on underlying physiology. What are 3 general physiologic causes of anemia?

Answer 10

Decreased RBC production (bone marrow problem)

Increased destruction of RBCs

Bleeding

Question 11

Why is it useful to know the reticulocyte count in a pt with anemia?

Answer 11

Low or low-normal number of reticulocytes in a pt with anemia is indicative of an inadequate bone marrow response

Increased number of reticulocytes is a normal bone marrow response to anemia (it’s trying to keep up)

Question 12

When referring to normal values for Hct and Hb during the first year of life in healthy term infants, it is important to remember that at the age of about ________, kids hit a physiologic nadir for their Hb (normal)

Answer 12

2 months

Question 13

Describe lab results in a pt with neonatal immune hemolytic anemia d/t ABO or Rh incompatibility

Answer 13

Positive direct Coombs test

Elevated indirect bilirubin

Normocytic anemia

Elevated reticulocyte count

Question 14

Macrocytic anemia with low reticulocyte count d/t congenital pure red cell aplasia

Answer 14

Diamond-Blackfan syndrome

Question 15

Most common form of inherited aplastic anemia; characterized as macrocytic anemia and reticulocytopenia, thrombocytopenia, and leukopenia that progresses to pancytopenia

Answer 15

Fanconi anemia

Question 16

Classify iron deficiency anemia by MCV, MCHC, and RDW

Answer 16

Microcytic
Hypochromic
High RDW

[+target cells]

Question 17

What is the Mentzer index?

Answer 17

Used to differentiate iron deficiency anemia from beta thalassemia in cases of microcytic hypochromic anemia with low RDW

Mentzer index = MCV/RBC count in millions

> 13 = iron deficiency more likely

<13 = beta thalassemia more likely

Question 18

Cause of microcytic hypochromic anemia associated with basophilic stippling on peripheral smear

Answer 18

Lead poisoning

Question 19

Episodic hemolysis
Fava beans
X-linked recessive
Heinz bodies and bite cells

Answer 19

G6PD deficiency

Question 20

75% of cases are autosomal dominant

Howell Jolly bodies

Answer 20

Hereditary spherocytosis

Question 21

Thalassemias inheritance

Answer 21

Autosomal co-dominant disorders

Question 22

Inheritance of sickle cell disease

Answer 22

Autosomal recessive

Question 23

Pathophys of anemia of chronic disease

Answer 23

Inflammatory mediators increase hepatic hepcidin production

Hepcidin inhibits iron transfer from enterocyte to plasma, iron can’t be utilized