Pediatric Anemia

Question 1

List some common reasons for childhood anemia

Answer 1

Malignancy
Bloody diarrhea (IBD,celiac)
Breastfeeding (need supplemented iron until 6 months)
Malabsorption
inadequate intake during periods of rapid growth (infancy and adolescence)
Vegetarians at risk, especially if heavy/frequent menses.
Infants who digest large amounts of whole milk also at risk.

Question 2

List some signs of hemolytic anemia in children

Answer 2

Signs of anemia (headache, weakness, tachycardia) + jaundice

Question 3

Explain hemolytic andemia in children according to the classification of Intravascular and Extravascular types.

Answer 3

A) Intravascular:
■ Low Haptoglobin and precence of schistocytes on blood smear.
■ Symptoms: Hemoglobinuria, Hemosiderinuria, Urobillinogen in urine +/- precesnce of high uncongugated billirubin.
■ Causes: paroxysmal nocturnal hemoglobinuria, microangiopathic
hemolytic anemias (e.g. TTP/HUS).

B) Extravascular:
■ Macrophages in spleen clear RBCs. Spherocytes seen in peripheral smear. No hemoglobinuria/hemosiderinuria. +/- urobilinogen in urine.
■ Most common: Hereditary spherocytosis and autoimmune hemolytic anemia (warm IgG or cold IgM antibodies)
■ Hemolytic disease of newborn (maternal IgG against fetal Rh, Kell,
Duffy, etc)