ANAEMIA

Definition
Is reduced red cell mass.

Measurement
1. Haematocrit (PCV) 2. Haemoglobin concentration is more accurate Hb (1g/dl) = 37hct Reference values for adult Hb 15g/dl Hct 45%

Diference between anaemia in Children & Adults

1. Children are growing faster than adults, therefore required more haematinics 2. Haemopoetic equilibrium is less well established in children 3. Infection is common in children, causing marrow depression.

Age-related Definitions
Physiological anaemia Anaemia of prematurity Neonate : < 45% Infancy : < 30%, Childhood : < 35% Haematocrit is higher in venous than arterial capillary. It is higher at birth, 55 5% . Is SGA, it is higher Over the first 7 days of life, the fetal haemoglobin drops because fetal Hb higher oxygen affinity than adult hemoglobin Types of infants a. Preterm infant b. Term infant Generally, haematocrit of preterm infant is lower than that of term infants. This is because the preterm babies have low stores of haematinics (in 3rd trimester). The treatment usually involves blood transfusion. Large doses of erythropoietin is also used .

Anaemia of Prematurity

Phases of Blood formation (Haemopoeisis)

1. Mesoblastic phase yolk sac 2. Hepatic phase liver 3. Myeloid phase phase bone marrow

N.B Erythropoietin is produced by the juxtaglomerular cells.

Classification of Anaemia

This is based on the underlying mechanism a. Increased destruction b. Reducued production c. Blood loss

I. Anaemia Due to Increased destruction of red blood cells

a. Intracorpuscular (Intrinsic) 1. Defect in Red cell Membrane 2. Defect in Haemoglobin structure 3. Defect in Enzymes Extrinsic 1. Microangiopathic anaemia 2. Hyperslpenism 3. Burns 4. Paroxysmal Norcturnal Haemoglobin 5. Malaria

b.

II. Anaemia Due to Reduced Production (Deficiency anaemias)

1. 2. 3. 4. 5. 6. 7. Iron-deficiency Folate deficiency Vitamin 12 Deficiency Vitamin B6 Deficinecy Anaemia of Chronic infection /diseases Micronutrient and macronutrient deficiency (malnutrition) Blackfan diamond anaemia (pure Red cell Apasia) : Its features include hypocellularity Idiosyncratic hyperplasia Rare and some respond to drugs

Infections Bacteria : e.g Pneumonia, the bacterial toxins depress the bone marrow Viral : e.g acute aplastic anaemia produced by HPV-B-19 (Parvo-virus) infection. The retic count drops to zero. The virus switches off marrow for a week or two. 9. Leukaemias there is replacement of red cell population by the malignant white cell. The normal myeloid : Erythroid ratio is 4 : 1 10. Renal failure

8.

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Heavy metals e.g lead, mercury

III. Anaemia Due to Blood Loss

Can be divided into a. Coagulation defect : vWD, Haemophilia b. c. Platelet dysfunction : Idiopathic thrombocytopaenic purpura Abnormalities of blood vessels

d. Autoimmune disease : Autoimmune haemolytic anaemia, Coombs test is used to make the diagnosis. e. Haemorrhage In newborns, it can be a. Subdural b. Subgaleal c. Subperiosteal its swelling does not cross the suture line f. g. Rupture of spleen following fracture Acute Sequestration syndrome in HbS

Common Causes of Anaemia

a. Infancy i. Haemolytic disease of the newborn (Neonatal jaundice) ii. Infections iii. Iatrogenic : from blood samples being taken for investigations. It is commoner in low birth weight babies. As the total blood volume of newborn baby is 80mls/kg of body weight.

b. Children i. Malaria ii. Haemoglobinopathies iii. Infections : Septicaemia, Emphysema, Pneumonia, Osteomyelitis N.B Classical hemolytic anaemia : Increased bilirubin levels Increased reticulocytes count Post-circumcision bleeding - has nothing to do with haemorrhagic disorders, so also anaemia due to hookworm infection.

Investigations

1. Haematocrit/Packed cell volume can also be used to calculate MCV & MCHC in order to distinguish macrocytic from microcytic. 2. White blood cell count 3. Blood films Thick films for malarial parasites Thin film shows hypersegmented blood cells, elliptocytes, spherocytes 4. Stool microscopy check for hookworm ova, schistosoma mansoni ova, Entamoeba histolytical cyst etc. 5. Haemoglobin electrophoresis 6. Ferokinetic studies Serum iron, Free protoporphyrin 7. Serum folate level 8. Clotting profile : Prothrombin time 9. Platelet count 10. Bone marrow aspiration/biopsy 11. Drug level concentrations 12. Heavy metal concentration level especially lead. N.B the first 5 tests are very important.

Management
1. 2. 3. 4. Antimalarials Antibiotics Antihelminthics Replacement therapy for iron, folate, vitamin E, B12, B6(rarely) and vitamin C 5. Blood transfusion usedin life threatening anaemia. Before giving blood, you must do first 5 tests with G6PD screening.

Rules About Transfusion

1. Dont give a child > 20mls/kg body weight for whole blood & 10 -15mls/kg body weight for packed cells. 2. After giving, you wait for 24 -48 hours before you give more 3. Use whole blood for acute haemorrhage 4. Use fraction of blood when indicated e.g platelet concentrate for DIC 5. Give frusemide at the beginning of transfusion to contract the blood volume because of the cardiovascular compensation in anaemia.

Prevention
1. Malaria control

2. Proper weaning practices encourage high protein diet and prevent iron deficiency in the first 2 years of life 3. Immunisation 4. Control of infection 5. Good hygienic practices.