Flashcards in Pallor/Anaemia Deck (11):
DDx for pallor
• Haemorrhage/blood loss
• Haemolysis e.g. thalassaemia
• Inadequate production
• Haematinics: Fe, B12, Folate
• BM failure: lymphoma, leukaemia (ALL)
• Cyanotic heart disease
• Heart failure
• Renal disease
How can we classify anaemias based on MCV?
- low serum ferritin -> iron def
- normal serum ferritin -> thalassaemia minor
- Rare causes: chronic inflammation, chronic lead poisoning (high blood lead level), sideroblastic anaemia
- inc reticulocyte count -> haemolysis/blood loss
- not inc ret count/other abnormalities -> marrow hypoplasia, leukaemia, infiltration
Macrocytic: e.g. folate, B12 def
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
Risk factors for Fe-deficiency anaemia
○ low birth-weight
○ multiple pregnancy
○ exclusive breast-feeding after 6 months and excessive cow's milk
○ Aboriginals and adolescent females are also at risk.
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.
Which ethnicities are associated with thal minor?
• South East Asian, Mediterranean, Arabic families
What is Hb like in thal minor?
normal or borderline low Hb
Basic Ix for anaemi
• Blood film
- Reticulocyte count
Clinical features in children with anaemia
• Shortness of breath
• Poor growth
• Pale conjunctivae
• Flow murmur
• Signs of cardiac failure
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)
• 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)