Anemia in Children: DR - Muthulakshmi
Anemia in Children: DR - Muthulakshmi
Anemia in Children: DR - Muthulakshmi
Dr.Muthulakshmi
Definition
A reduction in number of RBCs, blood hemoglobin
concentration, or hematocrit per cubic millimeter,
2SDs below mean for normal population or <5th
percentile for age & sex.
Normal values
Causes of anemia
Blood loss
Decreased production of red blood cells (Marrow
failure)
Increased destruction of red blood cells
hemolysis.
Dietary History
Medications
antibiotics
anti-inflammatories
anticonvulsants
Family History
Maternal history during pregnancy
Anemialow blood, transfusions,
iron supplements
Symptoms
Depends on how rapidly the anemia
develops
Constitutional: fatigue, etc
pallor of mucous membranes
CVS: tachycardia, postural changes,
flow murmurs
Physical examination
Pallor
Petechiae, purpura
Jaundice
Cavernous hemangioma
Glossitis
Angular stomatitis
Splenomegaly
Hepatomegaly, lymphadenopathy
Iron Deficency
World Health Organization - IDA
affects up to 50% of women &
children in developing countries.
Causes of IDA
Poor dietary sources of iron
Rapid growth (infancy, adolescence,
pregnancy)
Exhaustion of gestational iron stores
Early introduction of cows milk
Occult blood loss secondary to cows milk
intolerance, parasitic infestation, chronic GI
loss.
Blood loss (esp. with menses)
Malabsorption states
Iron Studies
Gold Standard?
Bone marrow aspirate
Lab studies?
Hb,retic count, blood picture and MCV
ferritin
Serum iron
Total Iron Binding Capacity
Fe Saturation
Microcytic Anemia
Ferritin
Serum iron
Varies significantly daily
A measure of all non-heme Fe in
blood
Virtually all serum iron is bound to
transferrin
Only a trace of serum Fe is free or
complexed in ferritin
TIBC
High specificity for decreased iron,
low sensitivity
measure of total amount of
transferrin present in blood
Saturation
Serum Fe
TIBC
As a percentage or proportion
Free Erythrocyte
Protoporphyrin
Immediate precursor of Hb
Accumulates in RBC s when iron is unavailable
Detects iron deficiency prior to onset of anemia
Used as a screen for lead poisoning
Can be falsely elevated in infection and
inflammation
Serum
Fe
TIBC
Fe defic
RDW
(>15)
AOCD
N/
Sideroblastic
N/
Thalassemia
N/
N/
N/
Sources of Iron
Dietary sources of heme iron - Meat, fish, Poultryabsorption 10-20%.
Dietary sources of non-heme iron - Cereal, bread,
fruit,vegetables - absorption 2-7%.
Promote breastfeeding
Iron fortified foods at 4-6 months
Iron fortified formula through 1 year
Iron supplementation for infants at risk
Discuss cows milk volume limitations, max
400ml/day
Encourage iron rich foods at each well check up
regardless of age.
Current Screening
recommendations
Infants
Current Screening
Recommendations
Treatment
Prophylaxis 3mg/kg/day
Deficiency 6mg/kg/day
Iron containing food meat, leafy
green egetables, dates, beans, lentils
and liver.
Megaloblastic anemia
Folate or Vitamin B 12 DEFICIENCY
BP RBCs are large, oval and hyper
segmented neutrophils.
MCV >100fl.
Nuclear maturation is delayed than the
cytoplasmic maturation.
Folate deficiency
Alone, it is very rare
Deficiency occurs in exclusive goats
milk feeds, chronic diarrhoeal state,
anticonvulsants, methotrexate and
defective folic acid metabolism
Diagnosis
Typical BP
LDH elevated
BM megaloblastic maturation at all
levels
Folate level in the serum is reduced
<3ng/ml (5 -20ng/ml)
Treatment
0.5 1.0mg/day of folate for 3-4 weeks
and maintenance of 0.2mg /day after
that.
Vitamin B12
Cannot be synthesized by humans
Mainly derived from animal product
Cyanocobalamin stomach( R pr +
IF)Absorbed in the ileum in the
plasma binds to Transcobalamin II
Liver, BM and storage sites.
Causes
Inadequate intake strict
vegetarians,
Lack of IF, imapaired
absorption,absence of B12 transport
protein.
Manifestations
Irritability,weakness,failure thrive
Vomiting, diarrhoea,glossitis,pallor
and icterus
CNS paraaesthesia, sensory
deficits, hypotonis,seizures, devel
delay/ regression and
neuropsychiatric manifestations.
Diagnosis
Exactly like folate deficiency
Treatment
Vit B12 1mg IM stat
To see response within 2-4days.
CNS manifestations 1mg IM daily
for 2 weeks followed by monthly
injections.