ANEMIA

 Definition = Reduction in heamoglobin concentration of the blood below the normal range for the age and sex
o <13.5 g/dl in adult males ; <11.5 g/dl in females
o 3 months to puberty < 11 g/dl
o New born infants < 15 g/dl
 Classification based on morphology

o
ESTABLISHING THE TYPE OF ANEMIA FROM HISTORY AND EXAMINATION

 History
o Nutritional anaemia
 Detailed dietary Hx from mother
 Breast feeding
 Weaning
 24 hr dietary recall of the present diet
 Present eating practices of the child
 Fe def: Pica, dysphagia & sore tongue
 Folate def: Irritable, fail to gain weight adequately, chronic diarrhea
 May accompany kwashiorkor, marasmus, or sprue.
 B 12 de: - Non specific manifestations such as weakness, fatigue, failure to thrive, or
 irritability.pallor, glossitis, vomiting, diarrhea, and icterus.
 Neurologic symptoms- paresthesias, sensory deficits, hypotonia, seizures,developmental
 delay, developmental regression, and neuropsychiatric changes.
 Neurologic problems can occur in the absence of any hematologic
 abnormalities
 Diseases of malabsorption – chronic diarrhea, steatorrhoea, LOW, poor growth
o Chronic blood loss –
 Ask Hx of malaena
 Past Hx of worm infestation & Rx
 Menstruation in older children
 Ask for drug therapy – gastric irritant drugs
o Anaemia of chronic disease
 past Hx or symptoms of Δed diseases – eg: cardiac disease, CRF, JIA, chronic infections
o Hemolytic anaemia
 Ask for previous episodes of anaemia, yellowish discolouration of eyes & darkening of urine
 Past Hx of recurrent blood transfusions, jaundice & bld transfusions at birth
 Family Hx of recurrent bld transfusions & anaemia
o BM disorder
 Is this isolated anaemia or part of a pancytopenia?
 Hx of recurrent infections & bleeding manifestations which are associated with anaemia
o Family Hx
 AD – Hereditary spherocytosis (each generation affected)
 X linked recess – G6PD
 AR – thalasseamia.
 Investigated for anaemia/bleeding tendency
o Social Hx –
 Income and education level of parents
 Family support
 Poverty & negligence
 Effect on child’s day-to-day activities and school performance
 EXAMIINATION
o General
 Growth perimeter= weight, height
 Ill/well ,Febrile/not
 Pallor & icteric
 Nutritional deficiency Fx – specialy irondef: Fx
 Glossitis
 Angular stomatitis
 Koilonychias
 Facial Fx of Thalasseamia – bossing of frontal bone, enlarged maxilla
 Dysmorphic Fx, short stature – in DBA
 Lemon hue on face – pernicious anaemia
 Purpura & petichiae – in pancytopenia
 Lower limb ulcers – in sickle cell anaemia & thalasseamia
  Abdominal examination
o distension
o Splenectomy scar
o Epigastric tenderness
o Hepatomegaly
o Splenomegaly - haemolytic anaemia
 CVS
o systolic flow murmur
o Evidence of heart failure – in severe anaemia

INVESTIGATIONS

 FULL BLOOD COUNT

o Confirm anaemia by Hb concentration
o Exclude a pancytopenia
o Red cell indices – guide to classify anaemia based on morphology
o RDW – quantitative assessment of the various sizes of RBC in blood
 Blood picture – Establish morphology as microcytic hypochromic, normocytic normochromic& Macrocytic.
o Identify various types of cells – help for Δ
 Spherocytosis – microspherocytes
 G6PD def – Bite cells
 Blister cells / basket cells
 Helmet cells
 Sideroblastic anaemia – Microcytic hypochromic anaemia in BP (Ring sideroblasts in BM)
 Pb poisoning – Basophilic stripling (blue spots in red cells)
 DIC – fragmented red cells, thrombocytopenia
 • Retic count
o ↓In Fe def anaemia
o ↑In haemolytic anaemia