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Flashcards in Pallor/Anaemia Deck (11):
1

DDx for pallor

Anaemia
• Haemorrhage/blood loss 

• Haemolysis e.g. thalassaemia 
• Inadequate production 
• Haematinics: Fe, B12, Folate 
• BM failure: lymphoma, leukaemia (ALL) 

Cardiac
• Cyanotic heart disease 
• Heart failure 

Other
• Infection/sepsis 
• Hypoglycaemia 
• Hypovolaemia 
• Intussusception 
• Renal disease 

2

How can we classify anaemias based on MCV?

Microcytic:
- low serum ferritin -> iron def
- normal serum ferritin -> thalassaemia minor
- Rare causes: chronic inflammation, chronic lead poisoning (high blood lead level), sideroblastic anaemia

Normocytic:
- inc reticulocyte count -> haemolysis/blood loss
- not inc ret count/other abnormalities -> marrow hypoplasia, leukaemia, infiltration

Macrocytic: e.g. folate, B12 def

3

What is the most common cause of anaemia in children?What can cause it?

- Fe-deficiency anaemia
- Usually nutritional:
- Insufficient red meat, fish, chicken, green vegetables, pulses
- excessive cow's milk
○ Bioavailability of iron in cow's milk is very low 
○ CMPI - cow's milk colitis of varying severity 

- rarely due to malabsorption or GI bleeding

4

Risk factors for Fe-deficiency anaemia

○ Prematurity
○ low birth-weight
○ multiple pregnancy
○ exclusive breast-feeding after 6 months and excessive cow's milk
○ Aboriginals and adolescent females are also at risk.

5

How is thal minor Dx? What can mix up the test, and so what must you do when testing?

• diagnosed on Hb electrophoresis - HbA2 > 3.5%
○ Note: HbA2 may not be elevated in the presence of concomitant iron deficiency, therefore give iron therapy (if ferritin low) before ordering test.

6

Which ethnicities are associated with thal minor?

• South East Asian, Mediterranean, Arabic families

7

What is Hb like in thal minor?

normal or borderline low Hb

8

Basic Ix for anaemi

• FBE
• Blood film
- Reticulocyte count

9

Clinical features in children with anaemia

• Weakness
• Listlessness
• Shortness of breath
• Lethargy
• Poor growth

• Pallor
• Pale conjunctivae
• Flow murmur
• Signs of cardiac failure

10

Mx for Fe-deficiency anaemia

• Iron supp if Hb < 100g/l, or low ferritin even if Hb normal
- Premmies need at 4-6w (not earlier - infection risk)
• F/U
• Dietary advice (increase red meat, chicken, fish, pulses, green vegetables; limit cow's milk consumption to 500 ml/day, needs solids > 6mo)

Transfusion rarely required (eg. cardiac failure, urgent surgery required)

11

What should you remember about RBC transfusions?

- Amount based on symptoms, not necessarily [Hb] 
- Should not give over any longer than 4 hours - blood is a culture medium