Haematology: Anaemia in children; Bruising Flashcards
(29 cards)
What are anaemia thresholds for:
* Neonates
* Infants
* Child
* Teenagers
Neonates:
- < 140
Infants:
- < 110
Child:
< 115
Teenagers:
< 120
Describe what is meant by physiological anaemia of infancy [1]
Foetus naturally has high fetal Hb (causes O2 dissociation curve to go to left) so can maximise O2 from mother
Fetal Hb is gradually lost throughout first 6 months of life
Which is why settles at 110 g/dl at 6-9months of age
When / why might a baby be suffering from IDA? [1]
If they are exclusively milk feeding (bottle / breastfeeding) at ~ 1 year age
What are common causes of reduced red cell production causing anaemia in children [4]
Common:
- Nutritional causes - iron,
B12, folate deficiency
- Reduced intake
- Malabsorption - e.g. coeliac
- Increased requirement (growth)
What are more rare causes of reduced rbc production in children [4]
Rare:
- Bone marrow failure
- Malignancy & chemo
- Diamond Blackfan anaemia (genetic syndrome w reduced bone morrow production of rbc)
- Aplastic anaemia
What are the causes of infant IDA [6]
Maternal IDA
Premature / LBW
Multiple pregnancy
Exclusively breast-fed after 6 months
Late or insufficient introduction of iron rich solid
XS cow’s milk consumption
What causes IDA in children / adolescents? [5]
Vegan / vegetarian diet
GI disorders (Mecke’s diverticulum, coeliac, IBD, gastric surgery)
Extreme athletes
Heavy menstruation
Other chronic blood loss
What are the three overall causes of haemolysis causing anaemia (in children) [3]
3 Is:
Immune
Intracellular red cell defects
Infections
What are causes for immune haemolysis anaemia (in children) [2]
Anti-Rh antibodies
Anti ABO antibodies
A baby has rhesus incompatibility. How would they present [4] due to which condition? [1]
How might you treat? [4]
Hydrops fetalis
- Skin oedema, pericardial effusions, ascites, secondary jaundice
Treatment:
- Phototherapy, IV IG, Blood transfusion, exchange transfusion
What are the most common causes of intracellular red defects [6]
Describe their presentations [+]
Sickle cell disease
Thalassemias
Hereditary spherocytosis
- Hereditary spherocytosis is a condition where the red blood cells are sphere shaped, making them fragile and easily destroyed when passing through the spleen. It is the most common inherited haemolytic anaemia in northern Europeans. It is an autosomal dominant condition.
- splenomegaly
- risk of aplastic, haemolytic or megaloblastic crisis (causing acute exacerbation of anaemia)
Hereditary eliptocytosis
G6PD deficiency
- bite cells and heinz bodies
- avoid triggers
Pyruvate kinase defiency
Which infections would most likely cause haemolysis [3]
Parvovirus
Malaria
HUS
Describe the presentation of parvovirus b19 infection [+]
- causes transient aplastic anaemia, temporary suspension of erythropoeisis - risk in SCA or hereditary spherocytosis
- mild feverish illness which can be hardly noticeable
- cheeks appear bright red, hence the name ‘slapped cheek syndrome’
- child begins to feel better as the rash appears and the rash usually peaks after a week and then fades
- the rash is unusual in that for some months afterwards, a warm bath, sunlight, heat or fever will trigger a recurrence of the bright red cheeks and the rash itself
- causes aplastic crisis in SCA ptx
Why does malaria cause anaemia? [3]
Increased splenic activity
Bone marrow suppression
Increased haemolysis of rbc
Which causes of anaemia in children would be due to blood loss? [5]
Blood loss
* Gastric ulcers
* Milk intolerance
* Hereditary
haemorrhagic telangiectasia
* Meckels diverticulum
* IBD
* Epistaxis
How would you determine if a microcytic anaemia is due to IDA or thalassemia minor on initial investigation? [1]
How would you then determine if a patient has Beta thalassaemia minor / alpha thalassaemia minir? [2]
Look at ferritin level
- if low = IDA
- if normal = thal. minor
Then do Hb electrophoresis
- Elevated HbA2 = beta thal. minor
- Normal HbA2 = alpha thal. minor
Normocytic MCV:
- How would you determine if a child is suffering from haemolytic cause / blood loss? [1]
- How would you determine if is from marrow hypoplasia / leukaemia
Reticulocytes increased
What are red flags for anaemia in children? [5]
Red flags in anaemia
* Hb < 60g/L
* Tachycardia, cardiac murmur or signs of cardiac failure
* Features of haemolysis (dark urine, jaundice, scleral icterus)
* Associated reticulocytopenia (low reticulocyctes)
* Presence of nucleated red blood cells on blood film
* Associated thrombocytopenia or neutropenia
* Severe vitamin B12 or folate deficiency - associated w failure to thrive / neurodevelopment problems
Where possible defer transfusion until a definitive diagnosis is made
Why is associated reticulocytopenia (low reticulocyctes) in anaemia a red flag? [1]
Should have increased reticulocytes to correct for anaemia
Which drugs should children with ITP avoid? [1]
NSAIDs / Ibuprofen - can disrupt platelet count
add haemophilia notes
add scd notes
add leukaemia notes
Which conditions have increased platelet destruction? [4]
ITP
DIC
HUS (microangipathic)
Hypersplenism
What is the basic pathophysiology of ITP? [1]
Production of antibodies to platelets which are then destryed in liver and spleen
What advice would you give ITP patients when platelet count is low? [3]
Avoid antiplatelets, anticoagulants and IM Injections
