Pediatric anemia (tut 9)

Etiologies:

• Nutritional deficiencies of iron, folate, vit B12.

• Blood loss

• CKD due to dysregulation of iron absorption & erythropoietin production (EPO)

• Chronic inflammatory condition

• Erythrocyte destruction (hemolytic anemia)

Screening & diagnosis of pediatric anemia involves:

• CBC

• MCV

• Total reticulocyte count

all this to diagnose and differentiate type of anemia

Differentiate anemia types.

Normal MCV—→ reticulocyte count low—→ WBC/platelets count low—→ Aplastic anemia

Low MCV—→ serum ferritin low—→ iron deficiency anemia

High MCV—→ either Vit B12 or folate deficiency.

Screening & diagnosis of anemia.

Microcytic anemia: serum iron/ serum ferritin/total iron binding capacity/transferrin saturation

Normocytic anemia: reticulocyte count & CBC

Macrocytic anemia: folate & Vit B12 measurement/ intrinsic factor measurement

Differentiate macrocytic anemia types.

Megaloblastic anemia: form either vit B12 or folate deficiency. large, immature RBC.

Pernicious anemia: from intrinsic factor deficiency despite adequate vit B12 dietary intake.

Pharmacological therapy: oral or parenteral (IM or SC) Vit B12 (cyanocobalamin) & folate intake.

Prevention: A diet rich in these components.

Microcytic anemia is mostly due to…………………

iron deficiency. RBCs are hypochromic and microcytic.

RF for iron deficiency anemia (IDA).

• Premature birth

• Exclusively breast-fed infants

• Infants not fed iron-fortified formula

• Early introduction of cow’s milk

Elemental iron supplementation for pediatric IDA.

If pre-term infant, at 1 month of life, 2mg/kg/day

If exclusively breast fed infant, at 4 months, 1 mg/kg/day

Infants, 1-3 yr old, child >4 yrs, preferred ferrous sulfate of 3 mg/kg/day

Adolescents, 65-130 mg once daily.

Anemia of CKD is caused because of……………………

decreased renal production of erythropoietin (EPO).

Uremia decreasing RBC lifespan.

Iron deficiency and blood loss from lab test and hemodialysis.

Pharmacological therapy of CKD caused anemia.

• Iron supplement

• Recombinant human epoetin

Acc. to dialysis status, iron supplementation is given to maintain serum ferritin level at:

• Hemodialysis: above 200 ng/ml

• No hemodialysis or peritoneal dialysis: above 100 ng/ml

In both TSAT should be above 20%.