Anemia in Children, by Audace NIYIGENA


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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