Anemia in Children, by Audace NIYIGENA

6,055 views
5,656 views

Published on

Published in: Health & Medicine
0 Comments
16 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
6,055
On SlideShare
0
From Embeds
0
Number of Embeds
16
Actions
Shares
0
Downloads
499
Comments
0
Likes
16
Embeds 0
No embeds

No notes for slide

Anemia in Children, by Audace NIYIGENA

  1. 1. Audace NIYIGENA Intern in pediatricsIn King Faisal Hospital in Kigali Supervised by Dr SABITI Stephen
  2. 2. PLANOverviewEtiologiesAssessmentManagmentPrognosisConclusion
  3. 3. ANEMIA is a decrease in number of red blood cells(RBCs) or less than the normal quantity of hemoglobin in the blood. The normal range varies with age, so anaemia can be defined as:  Neonate: Hb <14g/dl  1-12 months: Hb <10g/dl  1-12 years: Hb <11g/dl.  ˃12years: <12g/dl Hb Anemia is not a disease, but an expression of an underlying disorder or disease.
  4. 4. ETIOLOGIES Production defects:  Nutritional deficiencies - Vitamin B12, folate or iron deficiency.  Inflammation/chronic disease.  bone marrow disorders- pure red cell aplasia,myelodysplasia. Blood loss  Hemorrhage  Chronic GI blood loss Blood destruction.  haemolysis  Sequestration (hypersplenism)-usually associated with mild pancytopenia
  5. 5. ASSESSMENT diagnosis is made by:  Patient history  Patient physical exam  Hematologic lab findings Identification of the cause of anemia is important so that appropriate therapy is used to treat the anemia.
  6. 6. Patient History Dietary habits Medication Possible exposure to chemicals and/or toxins Description and duration of symptoms Tiredness Headache and vertigo (dizziness) Dyspnia from exertion G I problems Overt signs of blood loss such as hematuria (blood in urine) or black stools
  7. 7. Physical Exam Hepato or splenomegaly Heart abnormalities  tachycardia  Gallop rhythm  Bounding pulse Skin pallor malnutrition and neurological changes Jaundice Angina Trauma evidence
  8. 8.  Patients with acute and severe anemia appear in distress, with tachycardia, tachypnea, and hypovolemia. Patients with chronic anemia are typically well compensated and usually asymptomatic
  9. 9. Hematologic Lab Findings Hematocrit (Hct) or packed cell volume in %  The normal range is 42-60% Hemoglobin (Hgb) concentration in grams/deciliter  The normal range is 13.5-20 g/dl An RBC count:  The normal range is 13.5-20 g/dl Reticulocyts :  The normal range is 0.5% to 1.5%
  10. 10.  Mean corpuscular volume (MCV)  Hct (in %)/RBC (x 1012/L) x 10  At birth the normal range is 98-123  In old child and adults the normal range is 80-100  The MCV is used to classify RBCs as:  Normocytic (80-100)  Microcytic (<80)  Macrocytic (>100)
  11. 11.  Mean corpuscular hemoglobin concentration (MCHC) – is the average concentration of hemoglobin in g/dl (or %)  Hgb (in g/dl)/Hct (in %) x 100  The normal range is 30-36  The MCHC is used to classify RBCs as:  Normochromic (30-36)  Hypochromic (<31)  hyperchromic, not (>37), they just have decreased amount of membrane.
  12. 12.  Mean corpuscular hemoglobin (MCH) – is the average weight of hemoglobin/cell in picograms (pg= 10-12 g)  Hgb (in g/dl)/RBC(x 1012/L) x 10  At birth the normal range is 31-37  In adults the normal range is 26-34  This is not used much anymore because it does not take into account the size of the cell.
  13. 13.  Red cell distribution width (RDW) – is a measurement of the variation in RBC cell size  Standard deviation/mean MCV x 100  The range for normal values is 11.5-14.5%  A value > 14.5 means that there is increased variation in cell size above the normal amount  A value < 11.5 means that the RBC population is more uniform in size than normal.
  14. 14. Using MCV to Characterize Anemia Microcytic  Normocytic  Macrocytic  Iron deficiency  Acute blood loss  Normal newborn anemia  Infection  Increased  Thalassemia erythropoiesis  Renal failure  Post-splenectomy  Sideroblastic anemia  Liver disease  Liver disease  Chronic infection  Early iron  Obstructive  Severe Malnutrition deficiency jaundice  Hypothyroidism
  15. 15. Managment Acute anemia usually warrants immediate medical attention. Treatment depends on the severity and underlying cause of the anemia Supportive measures, such as supplemental oxygen for decreased oxygen-carrying capacity, fluid resuscitation for hypovolemia, and bed rest or activity restriction for fatigue, may be required
  16. 16. When to transfuse? PRBC dose is 15-20 ml/kg over 3-4 hours. the rate oftransfusion can be modified according to the clinical situation. Give PRBCs if: Hb˂5g/dl Hb ≤7 g/dl with regardless of clinical signs of clinical signs of anemia anemia
  17. 17. Iron Deficiency Anemia Dx:  Smear: microcytic & hypochromic  additional diagnostic tests  serum ferritin (decreased)  serum iron (decreased)  Iron binding capacity (increased)  Iron saturation (decreased)
  18. 18.  Tx:  oral iron supplementation: 6mg/kg/day of elemental iron  for at least 3 months  check retic count after 2 weeks  Iron Dextran  provides 50mg/ml elemental iron  Dose(ml) =0.0442 (desired Hgb - Observed Hgb) x Wt + (0.26 x W)  Ferrlecit (sodium ferrous gluconate)  each 10cc provides 125mg elemental iron  dilute 10ml in 100ml 0.9NS and administer IV over 1 hour  repeat for up to 8 sessions
  19. 19. B12/Folate Deficiency Dx:  Smear: Macrocytic (High MCV) RBCs,  B12  Low serum B12,  Anti-IF Abs,  Folate  Serum folate level-- can normalize with a single good meal Tx:  B12 deficiency: B12 1 mg/month IM, or 1-2 mg/day PO  Folate deficiency: Improved diet, folate 1 mg/day
  20. 20. Thalassemias Genetic defect in hemoglobin synthesis  synthesis of one of the 2 globin chains ( or )  “Ineffective erythropoiesis” Dx:  Smear: microcytic/hypochromic, RBCs  Fe stores are usually elevated Tx:  Mild: None  Severe: RBC transfusions + Fe chelation, Stem cell transplants
  21. 21. Prognosis The prognosis depends on the severity and acuteness with which the anemia develops and the underlying cause of the anemia. Mortality and morbidity rates vary according to the underlying pathologic process causing the anemia, the degree of severity, and the acuteness of the process.
  22. 22. CONCLUSION Anemia is not a desease but, a condition caused by various underlying pathologic processes A proper history and physical examination is more important in an easy way of approaching a child with anemia Lab exams leads to definitive cause of anemia All cases of anemia are not necessary to be transfused
  23. 23. REFERENCES Illustrated textbook of paediatrics 3rd edition, Tom Lissauer and Graham Clayden, 2010 First aid for Pediatric clerkship, LATHA G. STEAD et al Pocket medicine 4th edition, Mare S. Sabatine, 2011 Emedicine.medscape.com/article/954506 Pedinreview.com

×