Anaemia

• What is anaemia?

  Low level of haemoglobin in blood

  Due to underlying disease, not a disease itself
• Normal ranges for Hb depends on age of the child.
• What are the causes of anaemia in infancy?


  Physiologic anaemia of infancy

  Anaemia of prematurity

  Blood loss

  Haemolysis

  Twin-twin transfusion -> where blood is unequally distributed between twins that share a placenta

  Haemolytic disease of the newborn

  Hereditary spherocytosis

  G6PD deficiency
• What is physiologic anaemia of infancy?

  Normal dip in Hb around 6-9 weeks in healthy term babies

  High Hb at birth -> negative feedback -> less erythropoietin by kidneys -> reduced Hb production in bone marrow
• What is anaemia of prematurity?

  Premature neonates are more likely to become significantly anaemic during first few weeks of life

  Due to...

  • less time in utero receiving iron from mother
  • RBC production cannot keep up with rapid growth in first few weeks
  • reduced erythropoietin levels
  • blood tests remove signif portion of their circulating volume
• What are the potential causes of anaemia in older children?


  Iron deficiency anaemia

  Blood loss (common in menstruating girls)

  Sickle cell anaemia

  Thalassaemia

  Leukaemia

  Hereditary spherocytosis

  Hereditary eliptocytosis

  Sideroblastic anaemia
• What are the symptoms of anaemia?


  Fatigue

  SOB

  Headaches

  Dizziness

  Palpitations

  Worsening of other conditions

  Specific to iron deficiency anaemia

  • Pica -> dietary cravings for abnormal things
  • Hair loss
• What are the signs of anaemia?


  General signs

  • pale skin
  • conjunctival pallor
  • tachycardia
  • tachypnoea

  Specific signs

  • koilonychia -> iron deficiency anaemia
  • angular cheilitis -> iron deficiency anaemia
  • atrophic glossitis -> iron deficiency anaemia
  • brittle hair/nails -> iron deficiency anaemia
  • jaundice -> haemolytic anaemia
  • bone deformities -> thalassaemia
• What are the Inx for anaemia?


  FBC

  Blood film

  Reticulocyte count (high levels indicate anaemia due to haemolysis or blood loss)

  Ferritin

  B12

  Folate

  BIlirubin

  Direct Coombs test (autoimmune haemolytic anaemia)

  Haemoglobin electrophoresis (haemoglobinopathies)
• What is the management of anaemia?

  Depends on underlying cause

  Iron deficiency -> iron supplementation

  Severe anaemia -> blood transfusions
• What are the DDx of anaemia?

  Leukaemia

  Lead poisoning

  Hypothyroidism