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Flashcards in Pallor Deck (18):
1

Ddx of anaemia and Pallor

Normal variant - deep lying venous system or opaque skin.
Hypo chromic microcytic anaemias
Iron deficiency anaemia
Thalassaemia trait
Normochromic normocytic anaeia
Lead poisoning
Haemolytic anaemia
Hereditary spherocytosis
Autoimmune haemolysis
Red cell enzymes disorder e.g. G6PD deficiency
Haemoglobinopathies
Other anaemia
Leukaemia
Anaemia of marrow infiltration
Leukaemia
Lymphoma
Histiocytosis
Neuroblastoma
Metabolic storage disorders
Bone marrow failure
Leukaemia
Aplastic anaemia
Congenital Falcon anaemia
Acquired aplastic anaemia
Post infection
Sickle cell Anaemia
Other cause
Chronic infection
Chronic renal failure
Malignancies

2

DDX for microcytic anaemia

Iron deficiency
Thalassaemias
Sideroblastic anaemias
Anaemia of chronic disease

3

DDX for macrocytic anaemia

Bone marrow failure syndromes ef aplastic anaemia
Myelodysplastic syndroms
Megaloblastic anaemia eg B12/folate deficiency
Drugs

4

DDX for normalocytic anaemia

Haemolysis
Sequestration
Anaemia of chronic disease
recent significant bleeding
Combined iron and B12/folate deficiency

5

Ddx for high reticulocyte count

Haemolytic anaemia
G6PD - linked
Autoimmune - coombs test

6

Ddx for low reticulocyte count

Hypo chromic Microcytic - iron deficiency, lead poisoning, thallasaemia trait
Leukemia and other malignancies
Anaemia of chronic disease
Renal failure

7

History questions for a child with pallor

Symptoms of anaemia - Fatigue, lethargy, pallor, poor feeding, anorexia, poor growth, dyspnoea on exertion, Rarely stomatitis or koilnychia
Diet - Drinking Cow milk too early. excessive intake of milk, not enough solids for age,
Ask about pica (lead poisoning). Home condition? any exposure to fumes or old lead paint?
Hx of bleeding
Ethnic origin or consanguinity
FmHx - Haemoglobinopathies
Medication history

8

Examination of a child with pallor

Signs of anaemia - Pallor of conjunctivae and nail beds, Hepatosplenomegaly
Height and weight 0 FTT, malabsorption
Dysmorphic features e.g. Micrognathia, cleft palate, abnormal/absent thugs - fantom;s anaemia, diamond-blackman anaemia
Jaundice - Haemolysis
Adenopathy/organomegaly - underlying malignancy,

9

Ix for a child with pallor

FBC - Severity and types of anaemia, Presence of bizarre cells or blast cells
Ferritin - low in iron deficiency
Zn-protoporphyrin - Raised in iron deficiency and lead poisoning
Lead level - high in lead toxicity
Haemoglobin electrophoresis - abnormal haemoglobinopathies
U & E - abnormal in renal failure
Blood and urine culture - Chronic infection
Bone marrow aspirate - only needed if blast cells seen on peripheral film

10

Tx of iron deficiency anaemia

Give 5mg/kg elemental iron/day for 2-3months
Optimise dietary iron content

11

Causes of iron deficiency anaemia in pre school age children

Inadequate dietary iron
Inadequate complementary foods e.g. excess milk ingestion
Cow milk allergy
Rapid/rebound growth, former low birth weight
Coeliac disease
Parasitic infection
GI blood loss.

12

Causes of iron deficiency anaemia in older children

Inadequate dietary iron
Rapid/rebound growth
Coeliac disease
Parasitic infection
GI blood loss

13

Causes of iron deficiency anaemia in adolescent and premenopausal women

Inadequate iron intake
Blood loss e.g. menorrhagia, GI, haemostat defect.
Coeliac disease
Parasitic infection

14

Causes of iron deficiency anaemia in adult men and postmenopausal women

Exclude GI blood loss and coeliac disease
Ix with gastroscopy/colonscopy, coeliac screening

15

Tx of iron deficiency anaemia for adults

100-200mg for elemental iron per day for >3 months after normalisation of Hb.
Iv if needed
Optimise dietary iron and address underlying cause

16

Presentation of Thalassemai

Beta - major
after the first 4-6 months of life they develop profound hypo chromic anaemia
compensatory bone marrow hyperplasia - bossing of facial and skull bones and leads to dental abnormalities. Makes hepatosplenomegaly
minor
mild anaemia
little or no clinical disability
Commonly detected due to mild anaemia needing iron therapy

17

Ix of Thalassemia

Dx - Beta = electrophoresis with elevated levels of hemoglobin A2 and F
Alpha = requires genetic studies
Microscopy blood smear - hypo chromic, microcytosis, target cells
Ix - all in one test for Beta/Alpha/Sickle cell.

18

Presentation of sickle cell

At 5-6months old when fetal Hb falls
Anaemia, fever (medical emergency), Jaundice, Splenomegaly
Crisis (dactylitis present first)
Trait -asymptomatic
autosplenotomy by 5 yr