Thank you for the presentation on anemia in pediatrics. I appreciate you taking the time to provide an overview of the key topics.

1. Audace NIYIGENA
Intern in pediatrics
In King Faisal Hospital in Kigali
Supervised by
Dr SABITI Stephen

2. PLAN
Overview
Etiologies
Assessment
Managment
Prognosis
Conclusion

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. 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. 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. 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. Physical Exam
 Hepato or splenomegaly
 Heart abnormalities
 tachycardia
 Gallop rhythm
 Bounding pulse
 Skin pallor
 malnutrition and neurological changes
 Jaundice
 Angina
 Trauma evidence

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. 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.  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.  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.  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.  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.

15. 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

18. 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

19. When to transfuse?
PRBC dose is 15-20 ml/kg over 3-4 hours. the rate of
transfusion 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

20. Iron Deficiency Anemia
 Dx:
 Smear: microcytic & hypochromic
 additional diagnostic tests
 serum ferritin (decreased)
 serum iron (decreased)
 Iron binding capacity (increased)
 Iron saturation (decreased)

21.  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

22. 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

23. 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

24. 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.

25. 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

26. 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