APPROACH TO A CHILD
WITH ANEMIA
Presenter – Dr. Seetaram Gurjar
Moderator – Dr. Vinod Kumari Ma’am
ANEMIA
• It is defined as a reduction of the total circulating red cell mass with
decrease in hemoglobin when compared with normal for that age
group and sex.
• There is reduction in the oxygen-carrying capacity of the blood,
leading to tissue hypoxia.
EVALUATION OF ANEMIC CHILD
PATIENT -
• Following steps are required:
• 1. History and clinical examination
• 2. Hematologic investigations
• 3. Other investigations
Investigations required for evaluation of anemia are
-
• Hemoglobin
• Hematocrit
• Red cell count
• Red cell indices— MCV, MCH, MCHC, RDW
• Reticulocyte count, Immature reticulocyte fraction
• Red cell morphology on a stained peripheral smear
• Leucocyte count
• Differential leucocyte count
Investigations required for evaluation of anemia are …
• Platelet number and morphology
• ESR
• Bone marrow evaluation, bone marrow iron store
assessment
• Other investigations for hemolytic anaemia
• Serum iron, ferritin and transferrin saturation
CASE 1
• A female present to OPD with her 6 year old girl
• Presenting with easy fatiguability, and restlessness since last 3 month which is
slowly rising with time.
• On examination:-
Pallor present
Angular stomatitis present
BP - 114/78mmHg
PULSE – 112/min
RR – 30/min
Sex: Female
Age: 06 year
PBF Examination -
PBF -
RBC-
Density reduced
Microcytic hypochromic cells predominantly with moderate
anisopoikilocytosis.
Few elliptocytes, pencile cells,and tear drop cells seen.
No nRBC / parasite seen
PBF-
WBC-
Leucocytopenia
No atypical cell seen.
PLATELET –
Adequate in number on smear.
ADVISE - Serum Iron Profile Analysis.
SERUM IRON PROFILE
• Serum iron - 40ug/dL (65.00 - 175.00 µg/dL )
• Serum ferritin – 14ng/l (22-322ng/l)
• Transferrin saturation - 12% (20-50%)
• Total iron-binding capacity - 621 µg/dL (250.00 - 425.00
µg/dL)
• Following findings are suggestive of Iron deficiency anemia.
• Iron deficiency anemia is commonest anemia of pediatric age
group.
Iron deficiency anemia
• It is characterized by microcytic hypochromic red cells with
reduced MCV and MCH according to age and sex of patient.
• Morphologic changes of red cells appear as the iron stores
get depleted and iron is not available in adequate amounts
for heme synthesis In IDA.
Etiology of Iron Deficiency Anemia
1. Dietary deficiency
2. Malabsorption
3. Increased blood loss
4. Increased physiological demands
Iron deficiency clinical findings…
Gastrointestinal system - Loss of appetite
- Angular stomatitis
- Atrophic glossitis
- Dysphagia
- Pica
Iron deficiency clinical findings…
Skin – Pallor
Nails – Koilonychia
Musculoskeletal system - Decreased effort capacity
- Exercise limitation
Cardiovascular system - Increased cardiac output
- Tachycardia
- Cardiomegaly
- Heart failure
Iron deficiency clinical findings…
Central nervous system - Irritability
- Fainting
- Restless leg syndrome
- Sleep disturbance
- Attention deficit
- Learning difficulty
- Retardation in motor and mental .
. . developmental tests
Approach to diagnosis of Microcytic Hypochromic Anemia
Differential Diagnosis of microcytic hypochromic anemia
Thalassemia major:
inherited abnormality of globin production
result from defects in the rate of synthesis of Alpha or Beta chains
Iron stores are increased with hepatosplenomegaly and other
parameters of hemolytic anemia and raised HbF.
Anemia of chronic disorders (AOCD):
Iron stores are normal to increased and clinical features of chronic
disorder are present.
There is S. ferritin, Hepcidin and normal S. TfR levels in contrast to IDA.
Sideroblastic anemia: Bone marrow demonstrates
increased iron stores with ring sideroblasts.
Thalassemia minor: Red cell count is > 5 milion/cu mm
with a microcytic hypochromic blood picture and Hb A2
≥3.5%, RDW is not increased in comparison to IDA.
THANKS…
