EXAM #2: ANEMIA IN CHILDHOOD

Question 1

What is the definition of anemia as it relates to childhood?

Answer 1

Decreased RBC mass

Question 2

What is the consequence of anemia?

Answer 2

Decreased oxygen carrying capacity

Question 3

What labs help to make the diagnosis of anemia in children?

Answer 3

• CBC and PBS
• Hb
• Hct
• Red cell indices
• Reticulocyte count

Question 4

What symptoms are characteristic of anemia in children?

Answer 4

• Fatigue
• Irritability
• Inappropriate behavior

*****Other sx of anemia i.e. decreased exercise tolerance, dyspnea, palpitations…etc. are seen in severe anemia in children.

Question 5

What is the dietary history that is important when evaluating anemia in children?

Answer 5

Milk intake– children often over consume cow’s milk

* 16-20 ounces is recommended in the toddler*

Question 6

When is screening for anemia recommended in children?

Answer 6

1) 12 months
2) Kindergarten entrance
3) Adolescents

Question 7

How is the lower limit of MCV calculated in children less than 10?

Answer 7

Age in years + 70

Question 8

How is the upper limit of MCV calculated in children?

Answer 8

84 + 0.6x age in years

Question 9

What is a MCHC greater than 35 g/dL characteristic of?

Answer 9

Spherocytosis

Mean Corpuscular Hemoglobin Concentration*

Question 10

When is a low MCHC found?

Answer 10

Iron deficiency anemia

Question 11

What is increased WBC/ low platelets and anemia a sign of?

Answer 11

HUS

Hemolytic Uremic Syndrome

Question 12

What can a normal WBC/ low platelet count and mild anemia be a sign of?

Answer 12

ITP

Idiopathic Thrombocytopenic Purpura

Question 13

What are the causes of microcytic/ hypochromic anemia in children?

Answer 13

1) Iron deficiency
2) Pb toxicity
3) Thalassemia

Question 14

What are the causes of macrocytic/ hyperchromic anemia?

Answer 14

1) B12 deficiency
2) Folate deficiency

Note that a PE exam finding with B12 deficiency that is commonly overlooked is a positive Rhomberg.*

Question 15

What is a common cause of Folate Deficiency in infants?

Answer 15

Infants that are fed goat milk

Question 16

What are the characteristics of Diamond Blackfan anemia?

Answer 16

Normocytic anemia with decreased RC

Question 17

If you see a normocytic anemia and decreased RC count, what should your differential include?

Answer 17

• Diamond Blackfan anemia
• Transient Erythroblastopenia of Childhood
• Parvovirus B19

Question 18

What is a normocytic anemia with increased reticulocytes a sign of?

Answer 18

Blood loss

Question 19

What is a normocytic anemia/ increased RC count with a positive coombs’ test indicate of?

Answer 19

Autoimmunity:

1) ABO incompatibility
2) Rh incompatibility

Question 20

What is a normocytic anemia/ increased RC count with a negative coombs’ test indicate of?

Answer 20

• Non-immune mediated destruction
• Membrane defect
• Hemoglobinopathy
• G6PD
• Pyruvate Kinase Deficiency

Question 21

When is iron deficiency anemia common in children?

Answer 21

9-24 months

Question 22

What is the common cause of iron deficiency anemia in children?

Answer 22

• Excessive milk intake
• Early milk intake
• Blood loss

Question 23

What are the labs that are indicative of iron deficiency anemia?

Answer 23

• Mild to moderate anemia i.e. Hb (7-10)
• Decreased MCV i.e microcytic
• RDW increased
• Ferretin low
• Transferrin low
• Serum iron low
• TIBC HIGH
• RC normal to increased

Question 24

How is iron deficiency anemia prevented?

Answer 24

• Encourage breast-feeding for more than 6 months
• Iron fortified cereal
• Avoid cow milk under 12 months
• High Fe diet

Question 25

What are the characteristics of TEC?

Answer 25

- Unknown etiology causing transient decrease in RBC production - Age is greater than 1 year - Moderate to severe anemia - MCV is normal i.e. normocytic - Reticulocyte count is decreased

Question 26

What are the characteristics of Diamond Blackfan anemia?

Answer 26

- Under 1 year of age - Moderate to severe anemia - RC decreased - HgB F increased - 25% have physical abnormalities

Question 27

What causes of Diamond Blackfan anemia?

Answer 27

Abnormal ribosomal protein synthesis ****Don't make precursor cells*****

Question 28

What is the treatment of TEC?

Answer 28

- Supportive - Transfuse if unstable Spontaneous recovery usually happens within a year

Question 29

What is the treatment for DBA?

Answer 29

- Prednisone - Transfusion - Bone marrow transplant IF resistant to steroids

Question 30

How is iron deficiency treated?

Answer 30

6mg/kg/day of oral elemental iron until Hb is normal + 2 more months

Question 31

How is iron overload treated?

Answer 31

Chelation therapy The drug used for this procedure is "Deferoxamine"

Question 32

What are the three types of crises that are seen in Sickle Cell Disease?

Answer 32

1) Vaso-occlusive crisis/ pain 2) Aplastic crisis 3) Hemolytic/ Splenic Sequestration

Question 33

What is the role of hydroxyurea in Sickle Cell Disease?

Answer 33

Increase in Hb-F

Question 34

What is a common cause of aplastic crisis in Sickle Cell Disease?

Answer 34

Parvovirus B19 This viral infection leads to an acute drop in Hb/Hct and RCs

Question 35

How do you tell the difference between aplastic crisis and hemolytic crisis?

Answer 35

Both will cause an acute drop in Hb and Hct. The difference: - Aplastic= drop RC - Hemolysis= increase in RC and +DAT

Question 36

What infections are children at risk with that are functionally asplenic because of Sickle Cell Disease?

Answer 36

Encapsulated bacteria - S. pneumonia - H. influenza - N. meningitidis

Question 37

What is a common cause of osteomyelitis in children with Sickle Cell Disease?

Answer 37

Salmonella

Question 38

What should you be concerned about if a child's house is over 60 years old?

Answer 38

Pb toxicity

Question 39

When should infants be Fe supplemented?

Answer 39

After 4 months

Question 40

How is aplastic crisis treated in children with Sickle Cell Disease?

Answer 40

Blood transfusion This can be a truly lifesaving procedure in these children.