Paediatric anaemia

Question 1

What test will differentiate the cause of microcytic anaemia?

Answer 1

Ferritin!

> 20 = ug/L = thalassemia

<20 ug/L = iron deficiency

Electrophoresis for beta vs alpha thlassemia

Question 2

What test will differentiate normocytic anaemia?

Answer 2

Reticulocytes!

High = haemolysis OR blood loss

normal = marrow hypoplasia/leukaemia/infiltration

Question 3

What test will differentiate macrocytic anaemia?

Answer 3

Vitamin B12
+
Folate

one of these!

Question 4

List 6 red flags for admission in paediatric anaemia

Answer 4

Hb <60 g/L
Signs of high output cardia failure
Signs of jaundice e.g. scelral icterus
Nucleated red blood cells on film
Associated thrombocyto/neutropaenia
Severe B12/folate deficiency
Need for transfusion
Unclear diagnosis

Nucleated red blood cells sugest bone marrow hypoxia/ischaemia inlcuding leukaemia

Question 5

Name 5 causes of microcytic hypochromic anaemia in kids

Answer 5

Iron deficiency (most common)
Thalassemia minor (second)
Chronic inflammation
Sideroblastic anaemia
Lead poisoning

Don’t know why RCH guideline has sideroblastic and lead because lead poisoning causes anaemia through sideroblastic anaemia

Sideroblastic anaemia = unable to incorporate iron into haemagolbin so you also get

Question 6

Name some causes of normochromic normocytic anaemia in kids

Answer 6

Haemolytic anaemia: Coombs test /G6PD/spherocytosis/blood group

Sickle cell disease

Aplastic anaemia: leukaemia | drugs e.d. cyclophosphamide/sulfonamides | viral infection

Chronic disease e.g. renal disease

Blood loss

Question 7

What will be low in aplastic anaemia?

Answer 7

Reticulocytes

Normally increase in response to anaemia but can’t in this condition

Question 8

Name four causes of macrocytic anaemia in kids

Answer 8

Vit B12 deficiency
Folate deficiency
Liver disease
Hypothyroidism

E.g. vegan diet!