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ANEMIA IN CHILDREN

Sumadiono

Dept. of Pediatric

Fac. Of Medicine GMU

Yogyakarta

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video.flow bgs.flv

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Plasma consists

of:

90% water

10%solutes:albumin, globulin,clotting factors,

antibodies,electrolytes

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RBCs

RBCs

delivering oxygen

Life cycle 120 days

video.blood floow cardio.flv

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ANEMIA

Definition

Reduction in blood Hb concentration

WHO:- 6 month 6 year: > 11 g%

- > 6 year: > 12 g%

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Production

Bone Marrow:

- Aplastic Anemia

- Leukemia

Nutrition:- IDA (Iron Def. Anemia)

-Folate def.

- B12def.

Bloodloss

CLASSIFICATION

CausesofANEMIA

Twobroadcategories

Bleeding:

- Acute

- Chronic

Hemolytic:

- Thallasemia- AIHA (Autoimmune

Hemolyticanemia)

- G6PD Def.

- Sicklecell, Spherocytocis

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Symptomsand SignsofAnemia

Paloor

Fatique Low concentration

Tahycardia

Respiratory rate >> Apetite

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(IDA):

Mostcommonanemia

In1-3yearolds

50% of children indeveloping countries

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Causesof IDA

1. Ironintake

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Symptoms

Associated with low oxygenation of tissue:

Pallor

Fatigue

Shortness or breath

Irritability

Intolerance of physical work / exercise

PICA

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Signs

Conjunctiva: Pallor

Koilonychia

Angular Stomatitis

Glossitis

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Haemoglobin: low

Serum iron (low)

Serum ferritin (low)

TIBC: Increase

Laboratory

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Bloodsmear

MicrocyticLow MCV

Hypochromic

Low MCH,

Low MCHC

Normal

FeisneededforproductionIfdecreased: smallcell

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Management

Treat the etiology Ironsupplementation:

re-check retic & Hgb: in 1 week

until Hgb normal + 1-2 months

Nutritional:

Infants 12 months />

intake of milk

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Megaloblastic

Folicacid & B12isneededforMitosis

ifdecreased: largecell

Hypersegmentation

Teatment

Folic Acidfisrt

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Acquired orinherited

Production of blood cells:absentordecreased.

Decrease in:- RBCs, WBCs,Platelets.

Causes

Exposure to:- drugs

- chemicals

- toxins

Infection

Idiopathic

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Pancytopenia Anemia

Leucopenia

Thrombhocytopenia

Pallor

Fever

Bleeding/

PetechieWithout

Organomegaly

Reticulocyte low

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Bonemarrow:

HypoplasiaFatcell >>

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Management

Immunosuppressive therapy

Antithymocyte globulin

Bone Marrow Transplant

An aplastic.flv

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ProvidingInherited

Defects in the red cellmembrane

- Spherocytosis- Elliptocytosis- Sickle cell

Defects of red cellmetabolism

- G6PD def.

- Pyruvate kinaseDef.

Hb Disorders- Thalassemias

Acquired

Immune-mediatedAuto-immune

hemolytic anemia

Non-ImmuneInfection

Drug-induced

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2000-2001 24

Signs-Symptoms & Lab.

ofHemolytic Anemia

Pallor/ Anemia

Icterus

SPLENOMEGALY

LABORATORY

ANEMIA,

NORMOCYTIC

RETICULO-

CYTOSIS

ERYTHROBLAST

BILIRUBIN >

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Spherocytosis The RBCs: trapped in the splenic sinuses and

cords destroyed & removed

Diagnosis

- Anemia,splenomegaly,icterus- Spherocytecell,bilirubin

- Osmoticfragilitytest +

Treatment:

Splenectomy

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Spherocytosis

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SICKLE CELLS

Disease

- Cellsbecomesickleshapedandrigid

-Loseabilitytoadaptshapetosurroundings

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SICKLE CELLS Disease

Leg Ulcers

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Hereditary Elliptocytosis

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Glucose-6-Phosphate Dehydrogenase Deficiency

>> inmales

Hemolysis:episodic

following todrugs,infectionoringestionoffavabeans

Theimportantdrugs:

- anti-malarials

- sulfonamides

- some antipyretics/analgesics

- vitamin K, nalidixic acid

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G6PD Deficiency Contd.

Diagnosis

Hemolysis with a triggering agent

Qualitative and quantitative measurement of G6PD

Management

Supportive care

Blood transfusion

Education to prevent further episodes.

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MALARIA

PHAGOSISTOSIS by Plasmodium:

HIPERSPLENISME

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Antibodies to the RBC antigens(autoantibodies).

- Warm autoimmune hemolytic anemia:IgG: optimal at 370 C

- Cold autoimmune hemolytic anemia:IgM: optimally below 370 C

Auto-immune Hemolytic Anemia (AIHA)

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Glucocorticoids

Splenectomy

Immunosuppressive drugs.

The direct & Indirect Coombs test

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Thalassemias

Autosomal recessive

Mediterranean, Middle East, India, SouthEast Asia and Africa

Decreased or absent synthesis ofglobin chains

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2000-2001 36

Haemoglobin Production

HbA (Adult): 2F2

HbF (Fetal): 2Gamma2

HbA2 (Adult): 2Delta2

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2000-2001 37

Haemoglobinopaty

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Beta Thalassemia Major

The first signs & symptoms: first year of life

pallor

poor feeding

failure to thrive

hepatosplenomegaly

skull bossing in the older child

Icterus

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2000-2001 39

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Laboratory

AnemiaHypochromia & microcytosis

Aniso-poikilocytosis

Nucleated RBCs

Bilirubin >>

Hb electrophoresis

Hb F >>

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RBCCharacteristics

Microcytosis =

small in size

Hypochromia =

decrease hemoglobin

Poikilocytosis =

abnormal shape

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2000-2001 42

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Management

Transfusion: PRC

Splenectomy

for hypersplenism , increased blood transfusion

Iron chelation therapy

with desferrioxamine: SC, IV

Stem cell transplantation

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COMMON:

Acutebloodloss

Hemolytic Anemia

(Jaundice)

- ABO

- Rhesus

- Infection

- Celldefect

- Enzym defect

Rare

Decrease

Production

Hypoplasia/

Aplasia

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Bone Marrow Aspiration

CHild BMP.flvBMP adult. flv.bmp

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