Pediatric Anemia

Question 1

What is the effect of anemia on the oxygen dissociation curve, 2,3-DPG concentration with RBC’s, pH, and temperature?

Answer 1

• Curve shifts to the RIGHT
• Concentration of 2,3-DPG and temperature ↑↑↑
• ↓ pH

Question 2

List 5 clinical signs and symptoms often seen in patients with anemia.

Answer 2

• Pallor
• Sleepiness
• Irritability
• Decreased exercise tolerance
• Flow murmur**

Question 3

Which red cell lab value represnts the mean value of the volume of individual RBC’s in the sample?

Answer 3

MCV (mean corpuscular volume)

Question 4

Which red cell lab value represents the grams of Hgb per 100mL of RBC’s?

Answer 4

MCHC (mean corpuscular hemoglobin concentration)

Question 5

Which red cell lab value represents the average content (mass, weight) of Hgb per RBC?

Answer 5

MCH (mean corpuscular hemoglobin)

Question 6

Which red cell value is used to characterize an anemia as being hypochromic, normochromic, or hyperchromic?

Answer 6

• MCHC: ≤32 g/dL = hypochromic
• MCHC: 33-34 g/dL = normochromic
• MCHC: ≥35 g/dL = hyperchromic

Question 7

Microcytic vs. macrocytic anemias in a pediatric patient is based on an MCV of what percentile for age, race, and sex?

Answer 7

• Microcytic = ≤2.5^th percentile
• Macrocytic = ≥97.5^th percentile

Question 8

What are the 5 principle features of intravascular hemolysis?

Answer 8

• Anemia
• Hemogloniuria
• Hemoglobinemia
• Hemosiderinuria
• Jaundice

Question 9

What does a low or low-normal number of reticulocytes in pt with anemia indicate?

Answer 9

• Inadequate bone marrow response
• Either relative BM failure or ineffective erythropoiesis (not enough building blocks)

Question 10

At what age do children hit a physiologic nadir for values of hematocrit and hemoglobin?

Answer 10

2 months of life

Question 11

What type of anemia and other lab values will be seen in neonatal immune hemolytic anemia due to ABO or Rh incompatibility?

Answer 11

• Normocytic anemia
• (+) direct coombs test
• ↑ indirect bilirubin
• ↑ reticulocyte count

Question 12

What type of anemia and reticulocyte count will be seen in congenital infection with Parvovirus B19?

Answer 12

Normocytic anemia w/ ↓ reticulocyte count

Question 13

What type of anemia and reticulocyte count will be seen in Diamond-Blackfan syndrome; what is this disorder caused by?

Answer 13

• Macrocytic anemia with ↓ reticulocyte count
• Congenital PURE red cell aplasia resulting from ↑ apoptosis in erythroid precursors
• 30% have other abnormalities; average age of dx is 3-months-old

Question 14

What is the most common inherited form of aplastic anemia?

Answer 14

Fanconi anemia

Question 15

What type of anemia, reticulocyte count, and other lab values are indicative of Fanconi anemia?

Answer 15

• Macrocytic anemia and reticulocytopenia + thrombocytopenia + leukopenia
• ↑ susceptibility of progenitor cells in BM leads to ↑ apoptosis
• Progresses to pancytopenia (may not see sx’s until 10 y/o)

Question 16

How is the anemia of iron-deficiency anemia classified and what is the RDW count + peripheral smear findings?

Answer 16

• Microcytic hypochromic anemia w/ ↑ RDW
• Peripheral smear = target cells + hypochromic microcytes

Question 17

What is the Mentzer index and how can it be used to differentiate iron deficiency anemia from beta-thalassemia?

Answer 17

• Mentzer index = MCV/RBC count in millions
• If, >13 = iron deficiency anemia is more likely
• If, <13 = beta-thalassemia is more likely

Question 18

How is the anemia seen with lead poisoning classified and what is seen on peripheral smear?

Answer 18

• Microcytic, hypochromic anemia
• Peripheral smear = basophilic stippling

Question 19

What type of hemolysis is characteristic of G6PD deficiency; inheritance pattern; peripheral smear findings?

Answer 19

• Causes episodic hemolysis
• X-linked recessive
• Heinz bodies and bite cells