1 anemia rev
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ANEMIA IN CHILDREN
Sumadiono
Dept. of Pediatric
Fac. Of Medicine GMU
Yogyakarta
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video.flow bgs.flv
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Plasma consists
of:
90% water
10%solutes:albumin, globulin,clotting factors,
antibodies,electrolytes
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RBCs
RBCs
delivering oxygen
Life cycle 120 days
video.blood floow cardio.flv
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ANEMIA
Definition
Reduction in blood Hb concentration
WHO:- 6 month 6 year: > 11 g%
- > 6 year: > 12 g%
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Production
Bone Marrow:
- Aplastic Anemia
- Leukemia
Nutrition:- IDA (Iron Def. Anemia)
-Folate def.
- B12def.
Bloodloss
CLASSIFICATION
CausesofANEMIA
Twobroadcategories
Bleeding:
- Acute
- Chronic
Hemolytic:
- Thallasemia- AIHA (Autoimmune
Hemolyticanemia)
- G6PD Def.
- Sicklecell, Spherocytocis
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Symptomsand SignsofAnemia
Paloor
Fatique Low concentration
Tahycardia
Respiratory rate >> Apetite
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(IDA):
Mostcommonanemia
In1-3yearolds
50% of children indeveloping countries
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Causesof IDA
1. Ironintake
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Symptoms
Associated with low oxygenation of tissue:
Pallor
Fatigue
Shortness or breath
Irritability
Intolerance of physical work / exercise
PICA
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Signs
Conjunctiva: Pallor
Koilonychia
Angular Stomatitis
Glossitis
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Haemoglobin: low
Serum iron (low)
Serum ferritin (low)
TIBC: Increase
Laboratory
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Bloodsmear
MicrocyticLow MCV
Hypochromic
Low MCH,
Low MCHC
Normal
FeisneededforproductionIfdecreased: smallcell
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Management
Treat the etiology Ironsupplementation:
re-check retic & Hgb: in 1 week
until Hgb normal + 1-2 months
Nutritional:
Infants 12 months />
intake of milk
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Megaloblastic
Folicacid & B12isneededforMitosis
ifdecreased: largecell
Hypersegmentation
Teatment
Folic Acidfisrt
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Acquired orinherited
Production of blood cells:absentordecreased.
Decrease in:- RBCs, WBCs,Platelets.
Causes
Exposure to:- drugs
- chemicals
- toxins
Infection
Idiopathic
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Pancytopenia Anemia
Leucopenia
Thrombhocytopenia
Pallor
Fever
Bleeding/
PetechieWithout
Organomegaly
Reticulocyte low
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Bonemarrow:
HypoplasiaFatcell >>
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Management
Immunosuppressive therapy
Antithymocyte globulin
Bone Marrow Transplant
An aplastic.flv
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ProvidingInherited
Defects in the red cellmembrane
- Spherocytosis- Elliptocytosis- Sickle cell
Defects of red cellmetabolism
- G6PD def.
- Pyruvate kinaseDef.
Hb Disorders- Thalassemias
Acquired
Immune-mediatedAuto-immune
hemolytic anemia
Non-ImmuneInfection
Drug-induced
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2000-2001 24
Signs-Symptoms & Lab.
ofHemolytic Anemia
Pallor/ Anemia
Icterus
SPLENOMEGALY
LABORATORY
ANEMIA,
NORMOCYTIC
RETICULO-
CYTOSIS
ERYTHROBLAST
BILIRUBIN >
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Spherocytosis The RBCs: trapped in the splenic sinuses and
cords destroyed & removed
Diagnosis
- Anemia,splenomegaly,icterus- Spherocytecell,bilirubin
- Osmoticfragilitytest +
Treatment:
Splenectomy
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Spherocytosis
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SICKLE CELLS
Disease
- Cellsbecomesickleshapedandrigid
-Loseabilitytoadaptshapetosurroundings
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SICKLE CELLS Disease
Leg Ulcers
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Hereditary Elliptocytosis
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Glucose-6-Phosphate Dehydrogenase Deficiency
>> inmales
Hemolysis:episodic
following todrugs,infectionoringestionoffavabeans
Theimportantdrugs:
- anti-malarials
- sulfonamides
- some antipyretics/analgesics
- vitamin K, nalidixic acid
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G6PD Deficiency Contd.
Diagnosis
Hemolysis with a triggering agent
Qualitative and quantitative measurement of G6PD
Management
Supportive care
Blood transfusion
Education to prevent further episodes.
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MALARIA
PHAGOSISTOSIS by Plasmodium:
HIPERSPLENISME
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Antibodies to the RBC antigens(autoantibodies).
- Warm autoimmune hemolytic anemia:IgG: optimal at 370 C
- Cold autoimmune hemolytic anemia:IgM: optimally below 370 C
Auto-immune Hemolytic Anemia (AIHA)
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Glucocorticoids
Splenectomy
Immunosuppressive drugs.
The direct & Indirect Coombs test
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Thalassemias
Autosomal recessive
Mediterranean, Middle East, India, SouthEast Asia and Africa
Decreased or absent synthesis ofglobin chains
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2000-2001 36
Haemoglobin Production
HbA (Adult): 2F2
HbF (Fetal): 2Gamma2
HbA2 (Adult): 2Delta2
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2000-2001 37
Haemoglobinopaty
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Beta Thalassemia Major
The first signs & symptoms: first year of life
pallor
poor feeding
failure to thrive
hepatosplenomegaly
skull bossing in the older child
Icterus
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2000-2001 39
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Laboratory
AnemiaHypochromia & microcytosis
Aniso-poikilocytosis
Nucleated RBCs
Bilirubin >>
Hb electrophoresis
Hb F >>
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RBCCharacteristics
Microcytosis =
small in size
Hypochromia =
decrease hemoglobin
Poikilocytosis =
abnormal shape
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2000-2001 42
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Management
Transfusion: PRC
Splenectomy
for hypersplenism , increased blood transfusion
Iron chelation therapy
with desferrioxamine: SC, IV
Stem cell transplantation
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COMMON:
Acutebloodloss
Hemolytic Anemia
(Jaundice)
- ABO
- Rhesus
- Infection
- Celldefect
- Enzym defect
Rare
Decrease
Production
Hypoplasia/
Aplasia
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Bone Marrow Aspiration
CHild BMP.flvBMP adult. flv.bmp
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