Anaemia in children

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Anaemia

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Anaemia in children

  1. 1. Anaemia(IDA) in children Dr.K.V.Giridhar Associate Prof. of Pediatrics GMC. Ananthapuramu, A.P., India.
  2. 2. • It is greek word • “Ana” = absent/ decresed • „emia‟ = blood
  3. 3. Definition • Reduction of Hb con. Or Hematocrit below the level of normal for that Age & Sex. • Aprox. normal level of Hb in child hood – 11gm/dl • Physiological anaemia of infancy.
  4. 4. WHO's Hb thresholds used to define anemia Age or gender group Hb threshold (g/dl) Hb threshold (mmol/l) Children (0.5–5.0 yrs) 11.0 6.8 Children (5–12 yrs) 11.5 7.1 Teens (12–15 yrs) 12.0 7.4 Women, non- pregnant (>15yrs) 12.0 7.4 Women, pregnant 11.0 6.8 Men (>15yrs) 13.0 8.1
  5. 5. classification of Anaemia Anemia Etiological Morphologi cal Patho physiological severity
  6. 6. Etiological classification of Anaemia Anaemia Decreased production IDA Bone marrow suppression Increased loss Haemorrhage Increased destruction 17 March 2014 6 Clinical importance
  7. 7. A) Aetiological classification: (Classification according to cause) 1. Anemia due to blood loss: a. Acute post hemorrhagic: It occurs due to any accident, which cause large amount of blood loss. Anemia is normocytic normochromic anemia b. Chronic post hemorrhagic: When small amount of blood is lost continuously from our body.E.g. in Hookworm infestation, chronic duodenal ulcer, bleed piles Anemia is initially normochromic normocytic but later changes to Hypochromic microcytic anemia. 7 17 March 2014 7
  8. 8. 2.Anemia due to impaired red cell formation: a. due to disturbance of bone marrow function due to deficiency of factors necessary for erythropoiesis I.Iron deficiency anemia II.Megaloblastic anemia b.due to disturbance of bone marrow function not due to deficiency of factor required for erythropoiesis 1.Anemia associated with chronic infection like renal failure, liver disease, disseminated malignancy 2. Bone marrow infiltration 3. Aplastic anemia 4. Anemia associated with myxedema,Hypopituitarism 8 17 March 2014 8
  9. 9. 3.Anemia caused by excessive red cell destruction: (Hemolytic anemias) i.Intracorpuscular causes - production of Hb (Thalassemia) - abnormal production of Hb (hemoglobinopathies) – sickle cell anemia. ii. extracorpuscular causes mechanical, antibodies X RBCs etc.
  10. 10. Morphological classification Size&color of RBCs Normocytic normochromic Microcytic hypochromic Macrocytic anemia Laboratory importance
  11. 11. B Morphological classification: Based on characteristics of red cell as determined by blood examination (MCV, MCH, MCHC) 1. Normocytic normochromic anemia: Here MCV, MCH, MCHC are normal. E.g. aplastic anemia, acute post hemorrhagic anemia. 2. Microcytic hypochromic anemia: MCV: Decreased MCHC: Decreased MCH: Decreased E.g. iron deficiency anemia 3. Macrocytic anemia: MCV: Raised. E.g. megaloblastic anemia 11 17 March 2014 11
  12. 12. Patho-Physiological Increased demand Decreased production Increased loss
  13. 13. • C. Patho physiological classification(how anaemia occurs) • i. Increased demand. eg. infancy and childhood. Reproductive age and pregnacy in female. • iii. Decrease production. • iii. Increased loss
  14. 14. Severity WHO Moderate 7-10.9 g/dl Severe 4-6.9 g/dl Very severe <4 g/dl
  15. 15. -The primary function is oxygen transport. -Average total body iron content 3.5-4 g. -Approximately 2/3 found in hemoglobin, -Iron is also stored in RE cells (BM, Spleen and liver) as hemosiderin and ferratin. -Also iron found in myglobin and myeloperoxidase and in certain electron transfer. -Iron is more stable in ferric state (Fe+++) than in ferrous state (Fe++). Normal iron metabolism:
  16. 16. Distribution of iron in body 1. 65% in the form of Hb 2. 4% in the form of myoglobin in muscle 3. 1% in various heme compounds that promote intracellular oxidation (cytochrome, catalase, and peroxidase) 4. 0.1% in combination form with protein transferrin in blood plasma 5. 30% is stored mainly in R.E. system and liver cell as ferritin 16 17 March 2014 16
  17. 17. Forms of iron A) Hemoglobin iron B) Plasma (transport) iron: Those bound with transferrin C) Tissue iron: a. Available iron: In the form of ferritin and hemosiderin b. Non-available iron:In the form ofmyoglobin. In enzymes of cellular respiration Iron present as a constituent of cell 17 17 March 2014 17
  18. 18. Sources of iron: Meat, liver, egg yolk, peas, beans, lentils & green leafy vegetables. Daily requirement(RDA): Male: 0.5-1 mg Female during reproductive life : 1.5-2 mg Pregnant women: 1.5-2.5 mg Children : 0.5 mg/day Daily dietary requirement: Male: 5-10 mg Female: 15-20 mg Children : 5-10 mg Pregnant women = 20-30 mg Only 10% of dietary iron is absorbed from gut, so dietary requirement is greater than body requirement18 17 March 2014 18
  19. 19. Daily loss Male: 0.5-1 mg Menstruating female: 1.5-2 mg Absorption of iron: Iron absorption occurs mainly in duodenum and proximal jejunum. Form of absorption: Ferrous (Fe++) (Iron found in food is in ferric form, so all ferric iron must be converted to ferrous iron for absorption in GIT) Mechanism of absorption: Active transport (pinocytosis) 19 17 March 2014 19
  20. 20. clinical features of IDA Symptoms • Easy fatigability • SOB • Lethargy • Drowsy • Dizziness • Head ache • De. Alertness • Palpitation • Pica Signs • Pallor • Angular cheilosis • Beefy tongue • Koilonychia • Tachycardia • RD • CCF • Pharyngeal webs
  21. 21. Pallor
  22. 22. Koilonychia
  23. 23. Angular chelosis& tongue changes
  24. 24. Laboratory diagnosis: •Red cell indices: Low Hb conc. MCV, MCH, MCHC* •Blood film: Hypochromic microcytic Picture. Occasional Target cells. Pencil shaped poikilocytes. Normal reticulocyte count. •Bone marrow iron: Normal to hypercellular. RBC precursors are increased in number. Iron stain negative. •Chemical testing on serum: Serum iron : Decreased Transferrin/TIBC : Normal to High Serum ferritin : Decreased (Very low)
  25. 25. Hypochromic Microcytic picture (IDA) -ve BM Iron Stain +ve
  26. 26. Labo. Approach (work-up) M: Hb <13.5 Hct <41 F:Hb <12 Hct <36 : Child ; Hb <11 [check MCV] MCV <80 = microcytic • Fe deficiency • thalassemia • anemia of chronic disease • sideroblastic anemia www.freelivedoctor.com
  27. 27. MCV >100 = macrocytic • megaloblastic anemia • VitB12 deficiency • folate deficiency • alcoholic liver disease MCV 80-100 = normocytic [chech reticulocyte count] www.freelivedoctor.com
  28. 28. low reticulocyte: - marrow failure - leukemia/metastasis - aplastic anemia - renal failure - Myelofibrosis - anemia of chronic disease high reticulocyte: - sickle cell anemia - autoimmune hemolytic anemia - G6PD deficiency - hereditary spherocytosis - paroxysmal nocturnal hemoglobiuria www.freelivedoctor.com
  29. 29. Treatment Rx of ID anaemia Supportive Nutritional O2, rest Vit.c, Folate Therapeutic Elemental Iron oral parenteral Blood transfusion PCV Whole blood
  30. 30. Complications of IDA • Feeding problems • Delay in growth & Developement • Low IQ • Decreased scholastic performance • Rarely CCF *(if untreated death)
  31. 31. Prevention of IDA • Promotion of exclusive breast feeding • Provision of iron rich foods (green leafy veg. Red meat) • Nutritional anaemia Control programme in children • Iron def. Anamia Control programme for adolescent girls • Hook worm control programme (Albendazole)
  32. 32. Thank you

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