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    Add as FriendAnemia in children

    by: Mofazzol

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    1 : Anemia in Children
    2 : Anemia is defined as a decreased concentration of hemoglobin and RBC mass compared with that in age – matched controls or 2 SD below the mean for the age and sex. Anemia is a frequent laboratory abnormality in children. As 20 percent of children in the united States and 80 percent of children in developing countries will be anemic at some point by the age of 18 years.
    3 : Iron deficiency anemia is rarely found in full-term infants younger than six months and in premature infants before they have doubled their birth weight.
    4 : Classification: 1. Hypoproductive anemia. 2. Red cell maturation defect. 3. Blood loss/hemolytic anemia.
    5 : Fig-12.1 The Physiologic classification of anemia. Anemia CBC, RETICULOCYTE Index <2.5 Index ? 2.5 Red cell Morphology Hemolysis/ hemorrhage
    6 : - Blood loss - Intravascular hemolysis - Metabolic defect - Membrane abnormality - He moglobinopathy - Autoimmune defect -Fragmentation hemolysis - Marrow danage - Cytoplasmic ? Infiltration ? Iron deficiency ( severe) ? Aplasis ? Thalassemia - Iron deficiency (early) ? Sideroblastic anemia Stimulation Nuclear defects ? Inflammation ? Folate deficiency ? Metabolic defect ? Vitamin B12 deficiency ? Renal disease ? Drug toxicity ? Refractory anemia Nomocytic normochromic Micro or Macrocytic Hypo- Proliferative Maturation disorder
    7 : Table 12.6 Causes of anemia in infancy and childhood 1. Nutritional 3. Hemolysis Prematurity Intrinsic defects of RBC Prolonged breast feeding Congenital spherocytosis Poor diet Thalassaemia Deficiency of- G-6 PD deficiency Iron, folic acid, B12 Extrinsic defects of RBC vit-C, pyridoxine Infections Malabsorption Red cell antibodies Chemical and physical agents 2. Blood loss 4. Defective RBC production Bleeding from umbilical cord Infection Hemorrhagic disease of Aplastic anemia newborn ( HDN) Marrow infiltration Hiatus hernia Leukemia Peptic ulcer disease Lymphoma Hook worm Metastatic carcinoma Hematuria Chronic hepatic disease Hemophilia Chronic renal disease Hypothyoidism Drugs
    8 : Diagnostic approach to anemia in children. Most children with anemia are asymptomatic and have an abnormal hemoglobin or hematocrit level on routine screening. Symptoms: There may not be any signs and or symptoms in mild anemia. A dietary history may give clues to iron and folic deficiency, and malnutrition.
    9 : In moderate to severe anemia, there may be weakness, lethargy, fatigue, palpitation, shortness of breath 9 particularly on exercise), and symptoms of cardiac failure. Signs: The signs of anemia may be divided into general and specific. The general signs are pallor of the conjunctiva mucosa, nail bed, plams and soles. A hyperdynamic circulation may be present with tachycardia, bounding pulse, cardiomegaly, and a systolic murmur (particularly apical).
    10 : Features of congestive heart failure may be present in more severe anemia. Specific signs are associated with particular type of anemia, e.g. koilonychia in iron deficiency anemia, jaundice in hemolytic anemia, hepatosplenomegaly in thalassaemia or leukemia, bone deformity in thalassaemia and other congenital anemia. Anemia with excess bruising or hemarthrosis indicates bleeding or coagulation disorder.
    11 : * Glucose-6- phosphate dehydronase deficiency. * Pyruvate kinape deficiency – AR, Ch hemolytic anaemia. * Iron deficiency * Red cell aplasia- recent viral illness. * Malabsorption occult blood loss- celiac spree.
    12 : Investigations: The following tests are done for the initial workup of anemia. 1. Complete blood count ( CBC) A. Red blood cell count 1. Hemoglobin 2. Hemoglobin 3. Reticulocyte count B. Red blood cell indices 1. MCV 2. MCH 3. MCHC 4. RDW (red cell distribution width)
    13 : C. White blood cell count 1. Cell differential 2. Nuclear segmentation of neutrophil D. Platelet count E. Cell morphology 1. Iron supply studies 2. Serum iron 3. TIBC 4. Serum ferritin, marrrow iron stain
    14 : II. Marrow examination A. Aspirine 1. M/E (mycloid to erythropoid prccursor) ratio 2. Cell morphoilogy 3. Iron stain B. Biopsy 1. Cellularity 2. Morphology The component of CBC help in the classification of anemia.
    15 : Iron- deficiency anemia Definitation: Iron deficiency anemia is a condition in which there is confirmed evidence of iron deficiency in blood and bone marrow study. Iron requirements The newborn infant contains about 0.5 g of iron , whereas the adult content is estimated at about 5 g. Accordingly, to maintain a positive iron balance in childhood, about 1 mg iron must be absorbed each day.
    16 : Table-12.9 Causes of iron-deficiency anemia
    17 : Clinical manifestations A. Symptoms and signs pertaining to anemia. B. Symptoms and signs specific to iron deficiency. 1. Atrophic changes in the epithelium. A. Oral lesion: b. Dysphagia: c. Nail lesions: 2. Pica: 3. Neurologic and intellectual function: 4. Reduced immune response: 5. Widening of diploe of skull: 6. Breath holding attacks: 7. Therapeutic trials:
    18 : Investigations: 1. Blood * Hemoglobin: * RBC count: * Reticulocyte count: * TC and DC: * Platelet count. * ESR: * MCV, MCH: * RDW:
    19 : * Blood film: * Serum iron studies: * Serum iron (Sl): * Serum ferritin: * TIBC: * Transferrin satuation: * Protoporphyrin levels (of red cell).
    20 : Treatment: I. Determine and treat the cause of iron deficiency II. The patient should be encouraged to maintain a well balanced diet. III. Give anthelminthic to the child. IV. Therapy. Oral iron therapy a. Iron chelates. B. Iron salts. 2. Dose and administration. 3. Duration of therapy. 4. The response to iron therapy varies.
    21 : Parenteral therapy Transfusion of blood Follow up
    22 : THANK YOU

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