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Anaemia in children
Refers to a decrease in haemoglobin levels below the age and sex specific normal ranges
Causes of anaemia in infants
- Physiologic anaemia of infancy - Blood loss - Haemolysis - Twintwin transfusion - Anaemia of prematurity
Causes of haemolysis in neonates
- Haemolytic disease of the newborn - ABO or rhesus incompatibility - Hereditary spherocytosis - G6PD deficiency
Causes of reduced red cell production
- Iron deficiency - Folic acid deficiency - B12 deficiency - Red cell aplasia - Chronic renal failure - Chronic inflammation
Causes of increased erythrocyte destruction
- Glucose 6 phosphate dehydrogenase deficiency (G6PD) - Hereditary spherocytosis (red cell membrane defect) - Sickle cell disease - Thalassemia - Haemolytic disease of the newborn
Causes of anaemia of prematurity in premature babies
- Less time in utero receiving iron from the mother - Red blood cell creation cannot keep up with rapid growth in the first few weeks - Reduced erythropoietin levels - Blood tests remove a significant portion of their circulating volume
Causes of microcytic anaemia
- Thalassaemia - Anaemia of chronic disease - Iron deficiency anaemia - Lead poisoning - Sideroblastic anaemia
Causes of normocytic anaemia
- Acute blood loss - Anaemia of chronic disease - Aplastic Anaemia - Haemolytic Anaemia - Hypothyroidism
Causes of macrocytic megaloblastic anaemia
- B12 deficiency - Folate deficiency
Causes of normoblastic macrocytic anaemia
- Alcohol - Reticulocytosis (usually from haemolytic anaemia or blood loss) - Hypothyroidism - Liver disease - Drugs such as azathioprine
Signs and symptoms of anaemia
- Fatigue - Pallor (pale skin, mucous membranes, and nail beds) - Tachycardia (increased heart rate) - Shortness of breath - Pica (craving for nonfood substances like soil) - Hair loss
Investigations for anaemia
- Full Blood Count (FBC) - Reticulocyte Count - Iron studies - Vitamin B12 and Folate levels - Genetic testing
Normal haemoglobin ranges
- Birth: 150-235 grams/litre - 2-4 weeks: 135-190 grams/litre - 4-8 weeks: 95-130 grams/litre - 2 months-6 years: 110-140 grams/litre - 6-12 years: 115-155 grams/litre - Female (age 12-18): 120-160 grams/litre - Male (age 12-18): 130-160 grams/litre
Investigations for iron deficiency anaemia
- Serum Ferritin: decreased - Serum Iron: decreased - Total iron-binding capacity: high - Transferrin levels: normal/high - Transferrin saturation: low
Management of anaemia
- Iron supplementation - Vitamin B12 or Folate supplementation - Transfusion - Treatment of underlying diseases
Acute management of sickle cell disease
- Pain relief - Oxygen supplementation - Intravenous fluids - Top-up transfusions
Long-term management of sickle cell disease
- Regular transfusions, folic acid supplementation, and iron chelation therapy - Prophylactic antibiotics - Immunizations - Genetic counselling - Hydroxycarbamide - Crizanlizumab
Complications of sickle cell disease
- Anemia - Increased risk of infection - Chronic kidney disease - Sickle cell crises - Acute chest syndrome - Stroke - Avascular necrosis - Pulmonary hypertension - Gallstones - Priapism
Signs and symptoms of sickle cell crisis
- Vasoocclusive crises characterized by severe pain - Anemia - Jaundice - Episodes of acute chest syndrome
Diagnosis of sickle cell disease
- Newborn blood spot screening test - Complete blood count - Peripheral blood smear - Haemoglobin electrophoresis
Long-term Management of Crisis
Regular transfusions, folic acid supplementation, iron chelation therapy
Managing Chronic Hemolytic Anemia
Prophylactic antibiotics, immunizations (influenza and pneumococcal vaccines), genetic counseling
Hydroxycarbamide
Stimulates production of fetal hemoglobin (HbF), reduces vasoocclusive crises, improves anemia
Crizanlizumab
Monoclonal antibody that targets P-selectin, reduces frequency of vasoocclusive crises
Sickle Cell Trait and Malaria
Having sickle cell trait reduces severity of malaria
Complications of Sickle Cell Anemia
Anemia, increased risk of infection, chronic kidney disease, sickle cell crises, acute chest syndrome, stroke, avascular necrosis, pulmonary hypertension, gallstones, priapism
Sickle Cell Crisis
Acute exacerbations caused by sickle cell disease, can range from mild to life-threatening, managed supportively
Vasoocclusive Crisis
Most common type of sickle cell crisis, caused by clogging of capillaries by sickle-shaped red blood cells, presents with pain and swelling primarily in hands or feet
Splenic Sequestration Crisis
Caused by blood pooling in spleen, leads to acute enlargement and pain, can cause severe anemia and hypovolemic shock, managed with blood transfusions and fluid resuscitation
Aplastic Crisis
Temporary absence of new red blood cell production, triggered by infection with parvovirus B19, managed supportively
Acute Chest Syndrome
Vessels supplying lungs become clogged with red blood cells, can be triggered by vasoocclusive crisis, fat embolism, or infection, presents with fever, shortness of breath, chest pain, cough, and hypoxia, requires prompt management and treatment
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Anaemia in children refers to a decrease in haemoglobin levels below the age and sex specific normal ranges
Anaemia in children is defined as a decrease in haemoglobin levels below the age and sex specific normal ranges.
Physiologic anaemia of infancy causes most cases of anaemia in infancy
Physiologic anaemia of infancy is the most common cause of anaemia in infancy.
There is a normal dip in haemoglobin around six to nine weeks of age in healthy term babies
Healthy term babies experience a normal dip in haemoglobin levels around six to nine weeks of age.
The other causes of anaemia in infants are:
Other causes of anaemia in infants include: anaemia of prematurity, blood loss, haemolysis, twintwin transfusion, and haemolytic disease of the newborn.
Causes of haemolysis in a neonate include:
Causes of haemolysis in a neonate include: haemolytic disease of the newborn, ABO or rhesus incompatibility, hereditary spherocytosis, and G6PD deficiency.
Causes of reduced red cell production include:
Causes of reduced red cell production include: iron deficiency, folic acid deficiency, B12 deficiency, and chronic renal failure.
Causes of increased erythrocyte destruction include:
Causes of increased erythrocyte destruction include: glucose 6 phosphate dehydrogenase deficiency (G6PD), hereditary spherocytosis, sickle cell disease, thalassemia, and haemolytic disease of the newborn.
Anaemia may also arise as a consequence of blood loss or unique circumstances in premature babies, a condition known as anaemia of prematurity
Anaemia may also occur in premature babies due to blood loss or unique circumstances, which is known as anaemia of prematurity.
Microcytic anaemia can be caused by:
Microcytic anaemia can be caused by: thalassaemia, iron deficiency anaemia, chronic disease, and lead poisoning.
Normocytic anaemia can be caused by:
Normocytic anaemia can be caused by: acute blood loss, anaemia of chronic disease, aplastic anaemia, hypothyroidism, and sideroblastic anaemia.
Megaloblastic anaemia is caused by:
Megaloblastic anaemia is caused by: B12 deficiency and folate deficiency.
Signs and symptoms of anaemia include:
Common signs and symptoms of anaemia include: fatigue, pallor of the skin, mucous membranes, and nail beds, tachycardia, and shortness of breath.
Symptoms specific to iron deficiency anaemia may include:
Symptoms specific to iron deficiency anaemia may include: pica (craving for nonfood substances like soil) and hair loss.
Blood tests used to investigate anaemia include:
Blood tests used to investigate anaemia include: full blood count (FBC), reticulocyte count, iron studies, vitamin B12 and folate levels, and genetic testing.
Normal haemoglobin ranges in different age groups:
Normal haemoglobin ranges in different age groups: - Birth: 150-235 grams/litre - 2-4 weeks: 135-190 grams/litre - 4-8 weeks: 95-130 grams/litre - 2 months-6 years: 110-140 grams/litre - 6-12 years: 115-155 grams/litre - Females (age 12-18): 120-160 grams/litre - Males (age 12-18): 130-160 grams/litre
Diagnostic criteria for iron deficiency anaemia include:
Diagnostic criteria for iron deficiency anaemia include: decreased serum ferritin, decreased serum iron, high total iron-binding capacity, normal/high transferrin levels, and low transferrin saturation.
Management options for anaemia include:
Management options for anaemia include: iron supplementation, vitamin B12 or folate supplementation, and blood transfusion in severe cases.
Sickle cell anaemia is an autosomal recessive condition that results in the synthesis of an abnormal haemoglobin chain, termed HbS
Sickle cell anaemia is an autosomal recessive condition that results in the synthesis of an abnormal haemoglobin chain, termed HbS, which causes sickle-shaped red blood cells.
Symptoms of sickle cell anaemia include:
Symptoms of sickle cell anaemia include: vasoocclusive crises, anaemia, jaundice, and episodes of acute chest syndrome.
Diagnostic tests for sickle cell anaemia include:
Diagnostic tests for sickle cell anaemia include: complete blood count, peripheral blood smear, and haemoglobin electrophoresis.
Acute management of sickle cell anaemia includes:
Acute management of sickle cell anaemia includes: pain relief, oxygen supplementation, intravenous fluids, and top-up transfusions if necessary.
Long-term management of sickle cell anaemia includes:
Long-term management of sickle cell anaemia includes: regular transfusions, folic acid supplementation, iron chelation therapy, prophylactic antibiotics, immunizations, genetic counseling, and hydroxycarbamide or crizanlizumab therapy.
Complications of sickle cell anaemia include:
Complications of sickle cell anaemia include: increased risk of infection, chronic kidney disease, sickle cell crises, acute chest syndrome, stroke, avascular necrosis, pulmonary hypertension, gallstones, and priapism.
Sickle cell crises are acute exacerbations caused by sickle cell disease, and they can range from mild to life-threatening
Sickle cell crises are acute exacerbations caused by sickle cell disease and can range from mild to life-threatening. They can occur spontaneously or be triggered by dehydration, infection, stress, or cold weather.
Sickle cell disease is tested for on the newborn blood spot screening test at around five days of age
Sickle cell disease is tested for on the newborn blood spot screening test at around five days of age.
Hydroxycarbamide works by stimulating the production of fetal haemoglobin (HbF)
Hydroxycarbamide works by stimulating the production of fetal haemoglobin (HbF), which does not lead to the sickling of red blood cells, unlike HbS.
Crizanlizumab is a monoclonal antibody that targets P-selectin
Crizanlizumab is a monoclonal antibody that targets P-selectin, an adhesion molecule found on endothelial cells and platelets. It reduces the frequency of vasoocclusive crises in sickle cell disease.
Sickle cell trait reduces the severity of malaria
Having sickle cell trait reduces the severity of malaria.
Long-term Management of Sickle Cell Disease
Regular transfusions, folic acid supplementation, and iron chelation therapy to manage chronic hemolytic anemia; prophylactic antibiotics in asplenic patients to prevent infections; regular immunizations (influenza and pneumococcal vaccines); genetic counseling for affected individuals and their families
Hydroxycarbamide in Sickle Cell Disease
Stimulates the production of fetal hemoglobin (HbF), which does not lead to the sickling of red blood cells like HbS. Reduces the frequency of vaso-occlusive crises, improves anemia, and may extend lifespan
Crizanlizumab in Sickle Cell Disease
Monoclonal antibody that targets P-selectin, an adhesion molecule found on endothelial cells and platelets. Prevents red blood cells from sticking to blood vessel walls, reducing the frequency of vaso-occlusive crises
Complications of Sickle Cell Anemia
Anemia, increased risk of infection, chronic kidney disease, sickle cell crises, acute chest syndrome, stroke, avascular necrosis in large joints (e.g., hip), pulmonary hypertension, gallstones, priapism (painful and persistent penile erections)
Sickle Cell Crisis
Acute exacerbations caused by sickle cell disease. Can range from mild to life-threatening. Can be spontaneous or triggered by dehydration, infection, stress, or cold weather. Managed supportively with low threshold for hospital admission, treating underlying infections, keeping warm, maintaining good hydration, and providing analgesia
Vaso-occlusive Crisis
Also known as painful crisis. Most common type of sickle cell crisis. Caused by sickle-shaped red blood cells clogging capillaries and causing distal ischemia. Presents with pain and swelling in the hands or feet, but can affect other body areas. Can be associated with fever and priapism in men. Managed with analgesia, hydration, and supportive care
Splenic Sequestration Crisis
Caused by red blood cells blocking blood flow within the spleen, leading to an enlarged and painful spleen. Can cause severe anemia and hypovolemic shock. Managed with blood transfusions and fluid resuscitation. Splenic infarction can lead to hyposplenism and susceptibility to infections. Splenectomy may be used in recurrent cases
Aplastic Crisis
Temporary absence of the creation of new red blood cells, usually triggered by infection with parvovirus B19. Leads to significant anemia (aplastic anemia). Managed supportively with blood transfusions if necessary. Resolves spontaneously within around a week
Acute Chest Syndrome
Occurs when the vessels supplying the lungs become clogged with red blood cells. Can be triggered by vaso-occlusive crisis, fat embolism, or infection. Presents with fever, shortness of breath, chest pain, cough, and hypoxia. Managed as a medical emergency with supportive care, treatment of underlying cause, analgesia, hydration, antibiotics or antivirals, and respiratory support
Rhesus Incompatibility
An immunological condition that arises when a rhesus-negative mother becomes pregnant with a rhesus-positive fetus. Can cause hemolytic disease of the newborn if there is sensitization of the mother's immune system. Managed with Rh immunoglobulin administration
Scholarly Assistant's Insights
A comprehensive flashcard deck covering various pediatric conditions and management strategies.
Anaemia
Haemolysis
Red Cell Production
Erythrocyte Destruction
Microcytic Anaemia
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