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Childhood Anemia

Childhood Anemia. Ghada Saad Abdelmotaleb Assistant Professor of Pediatric. Objectives :. 1-To know what is anemia. 2-To know different types of anemia. 3-How to diagnose and treat anemia?. Anemia.

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Childhood Anemia

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  1. Childhood Anemia Ghada Saad Abdelmotaleb Assistant Professor of Pediatric

  2. Objectives : • 1-To know what is anemia. • 2-To know different types of anemia. • 3-How to diagnose and treat anemia?

  3. Anemia Definition :reduction of the red cell volume or HB concentration below the normal range for age. • 1- Hemorrhagic Anemia. • 2- Decrease RBCs production. • 3-Hemolytic Anemia.

  4. Classification of anemia

  5. Symptoms of anemia in children Non-specific symptoms --Pallor. –Irritability . –Poor sleep quality. –Anorexia. –Poor concentration and school work. –Failure to thrive. •Dizziness / syncope. •Malaise, easy fatigue, impaired exercise . tolerance -Palpitation. - Systolic murmur at base. -Cardiomegaly. - Congestive HF in (sever cases).

  6. Anemia manifesting in neonatalperiod is usually result of recent blood loss, iso-immunization, congenital hemolytic anemia or congenital infection. • Significant jaundice suggest congenital hemolytic anemia (e.g. Hereditary spherocytosis, G6PD, Pyruvate kinase deficiency). • Nutritional iron deficiency is seldom responsible for anemia before 6 months of age in term infants (earlier in preterm infants).

  7. Thalassemia syndrome more common in South East Asians and Mediterranean. • Sickle cell disease more common in Africans. Diet • Assess for dietary sources of iron, folic acid and vitamin B12. Pica suggest iron deficiency.

  8. Laboratory investigations

  9. CBC • Haemoglobin: 8.8 g/dl • Haemotocrite: 32% • Red cell count:3.100000/cmm • Red cell indices: MCV:68.0 fl MCH:26.3 pg MCHC: 28.7% • Leucocytic count: 6100 Basophils: 0% Esinophils: 2% Staff : 2% Segmented:53% Lymphocytes:41% Monocytes:2% • Platelet count :210000 /cmm

  10. The red cell indices in CBC MCV (mean corpuscular volume) –The only red cell index directly measured by the electronic counter. –Reflects a quantitative defect in the production of Hb due to ↓hemoglobin synthesis. – Classifyanemia into microcytic, normocytic and macrocytic types –Value must be interpreted with age.

  11. •MCHC & MCH are calculate values & therefore less accurate. • RDW (Red cell volume distribution width): –Reflects the variability in cell size and measures the degree of anisocytosis. –Normal < 14.5% –↑ ↑ in Fe deficiency anemia –Normal in thalassemia trait

  12. Physiological changes in red cell indices (Hb, Hct, RBC) with age Very high level at birth –Relative hypoxemia in fetal life • Physiological anemia at 2 –3 month of age –Dramatic reduction in erythropoiesis after birth –Rapid growth in early infancy • Gradual rise from childhood to adolescent • Higher level in male vs female in adulthood [Effect of androgens vs estrogen, menstruation].

  13. Reticulocyte count (RC) • Reflects the rate at which new RBC are produced; Normally < 2% after 3 months; at birth up to 10%. • Reticulocytosis :in hemolysis and occur as response to treatment with iron after 48-72h from start == active BM

  14. Causes of iron deficiency anaemia 1-Low birth weight and perinatal hemorrhage. 2-Inadequate dietary iron intake (cow milk , ↓supplementation). 3-Impaired absorption :chronic diarrhea, malabsorption, excessive tea, high phytate intake, antacids, low gastric acidity. 4-Chronic blood loss e.g. ankylostoma, cow milk allergy, peptic ulcer.

  15. Microcytic anemia (DD)Get Iron panel: serum iron , TIBC, ferritin

  16. Treatment • Prophylactic : 1-adequate iron to pregnant mother. 2- Breast feeding (exclusive). 3- Iron supplementation after 3rd month, earlier in premature. • Curative : 1-ttt cause 2-Oral iron 6mg elemental/kg /day for 3-6m. 3-Parental iron therapy. 4-Packed RBCs in sever cases ---??HF.

  17. Folic acid deficiency anemia • Asynchrony between nuclear and cytoplasm maturation→ ↓DNA ,↑RNA → ↑ RBCs size. • ↓ Serum folate , thrombocytopenia, hemorrahage • Vit. B12 deficiency (juvenile pernicious anemia) . {AR} - tongue smooth ,red, painful. • Neurological [sensory ataxia, parathesias , hyporeflexia, +ve Babiniski, clonus, coma]

  18. Hemolytic anemias (general features) • Pallor (acute, chronic) + previous general features of anemia. • Tinge of jaundice {indirect hyper-bilirubinaemia} • Hepato-splenomegaly. • Stool may be dark. • Urine (acute crisis →hemoglobinuria)

  19. How to diagnosis? • Reticulocytosis >2% + nucleated RBCs in peripheral blood. • Hyper- bilirubinamia (indirect). • High serum iron +low iron binding capacity. • Low RBCs life span. • low serum Haptoglobin. • High urobilinogin. • X-ray : skull, long and short bones, chest and heart

  20. Diagnosis of the cause • Shape of RBCs in blood smear. • Enzymatic assay. • Fragility test sickling preparation (Na metabisulfite) . • Hemoglobin electrophoresis. • Coombs test. • Alkaline denaturation test.

  21. Hereditary Spherocytosis • AD, abnormal cell membrane. • Due to abnormal in sub-membrane protein skeleton (Spectrin) → ↑ permeability to Na →spherical RBCs + ↑ ATP use in Cation pump → premature aging, especially in spleen → destruction and chronic hemolysis. C/P: • Early onset (jaundice, neonatal anemia). • Aplastic crisis (Human Parvo-virus). • Gall bladder stone (pigment stone).

  22. Splenomegaly??splenectomy Investigations : • All as previous + • Blood smear • Osmotic fragility test. Treatment: 1- Splenectomy ??overwhelming sepsis [capsulated org.] 2- Blood transfusion

  23. G.6.PD deficiency • XL- recessive (Glutathione) • Oxidizing agents or infection. • Acute hemolysis (abdominal pain, nausea, vomiting, hemoglobinuria) . • Anemia ,jaundice. • Early neonatal presentation. Diagnosis: Low Hb, high retic. Blood smear [Heinz inclusion bodies+ tear drop RBCs]. Enzymatic activity assay(3m).

  24. Treatment • Prophylactic : avoid???????? • Curative : 1-Mild : observation. 2-Sever: packed RBCS (10-20ml/kg)

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