pedia hema anemia
TRANSCRIPT
FACTORS AFFECTING SKIN COLOR
HEMOGLOBIN CONCENTRATION
STATE OF CONSTRICTION
DILATATION OF PERIPHERAL VESSELS
PIGMENTATION AND SCT FLUID
FUNCTION OF THERED CELL
TO DELIVER AND RELEASE ADEQUATE QUANTITIES OF OXYGEN TO THE TISSUES TO MEET THEIR METABOLIC DEMANDS
CRITERIA FOR IDENTIFYING CHILDREN WITH LOW HgB & HCT
VALUESAGE Hgb(g/dl) Hct (%) 6-23 MOS < 10 < 312-5 YRS < 11 <346-12 YRS < 12 < 37
HEMOGLOBIN LEVELAND SYMPTOMS
Hgb ( g ) SYMPTOMS 9 – 11 little to no dysfunction 5 – 7 exertional dyspnea 6 . 0 some weakness 3 . 0 dyspnea at rest 2 - 2.5 cardiac failure
EVALUATION OF THEANEMIC PATIENT
HISTORY
PHYSICAL EXAMINATION
LABORATORY TESTS CBC RBC INDICES RETICULOCYTE COUNT EXAMINATION OF THE PERIPHERAL SMEAR
RED BLOOD CELLINDICES
MCV = VOLUME OF PRC (hct) ___________________ X 1000 RBC COUNT
NV = 80 - 100 fl
CORRECTED RC ORRETICULOCYTE INDEX
ACTUAL HCT X OBSERVED RC ----------------------- ( % ) DESIRED HCT
NV = 1 – 1.5 %
PERIPHERAL SMEAR HYPOCHROMIA , MICROCYTOSIS , ANISOPOIKILOCYTOSIS , TARGET CELLS , THROMBOCYTOSIS , THROMBOCYTOPENIA
CHEMICAL STUDIES DECREASED SERUM IRON INCREASED TOTAL IRON – BINDING CAPACITY TRANSFERRIN SATURATION IS BELOW 15 % SERUM IRON BELOW 5O ug / dl
CLASSIFICATION OF ANEMIA ACCORDING TOFUNCTIONAL DISTURBANCES
1.DISORDERS OF EFFECTIVE RC PRODUCTION
2. DISORDERS WITH RAPID ERYTHROCYTE
DESTRUCTION OR RC LOSS
DISORDERS OF EFFECTIVERC PRODUCTION
DEPRESSED NET RATE OF RC PRODUCTION DISORDERS OF ERYTHROCYTE MATURATION INEFFECTUAL ERYTHROPOIESIS ABSOLUTE FAILURE OF ERYTHROPOIESIS
ANEMIA
INIT
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NIN
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DIA
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CO
NF
IRM
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IRS
AD
DIT
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AL
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TU
DIE
SRED CELL INDICES
MCV, MCHC, MCH, RDW, HDW
PERIPHERAL SMEAR
RETICULOCYTE COUNT AND INDICES
DIRECT ANTI GLOBULIN TEST
G6PD screening test Osmotic
fragility
Hb ISOELECTROFOCUS
ING & OTHER TESTS FOR
RARE Hb VARIANTS
HISTORYPHYSICEL EXAMINATIONNON-HEMATOLOGICAL
DISEASES:(Renal, Thyroid, Metabolic,
Others)
HbELECTROPHO
RESISBone MarrowAspirate/Blopsy
Test for unstable Hbs
CYTOGENETIC STUDIES
Indirect bilirubinLDH, Heptogloblin,Serum B12Serum, RBC FolateSerum ferritin, iron,TIBCCirculating transferrinReceptorSerum Lead and RBC ZPP
RBC Enzyme Panel
Membrane protein studies
DISTRIBUTION OF IRON AVERAGE ADULT - 3 - 5 g ( BALANCE = DIETARY UPTAKE AND LOSS ) LOSSES : SKIN - 1 mg/ day MENSTRUATION - 2 mg /day
ETIOLOGY OF IRONDEFICIENCY
A. INADEQUATE SUPPLY OF IRON 1 . LACK OF IRON STORES AT BIRTH
( LBW ,PT , TWIN OR MULTIPLE BIRTHS , SEVERE
IDA IN MOTHER , FETAL BLD LOSS ,
BLEEDING FROM THE 1ST FEW DAYS OF LIFE ) 2. INADEQUATE INTAKE-DEFICIENT DIETARY IRON
ETIOLOGY OF IRON DEFICIENCY
B . IMPAIRED ABSORPTION 1. CHRONIC OR RECURRENT DIARRHEA 2. MALABSORPTON SYNDROME 3 . GASTROINTESTINAL ABNORMALITIES
ETIOLOGY OF IRONDEFICIENCY ANEMIA
C. EXCESSIVE DEMANDS FOR IRON FOR GROWTH AS SEEN IN PT , LBW , INFANTS , ADOLESCENT AND PREGNANCY
ETIOLOGY OF IRON DEFICIENCY ANEMIA
D . BLOOD LOSS
1. ACUTE OR CHRONIC HEMORRHAGE
2 . PARASITIC INFECTION (HOOKWORM TRICHURIS trichiura )
FACTORS THAT MODIFYIRON ABSORPTION
PHYSICAL STATE ( BIOAVAILABILITY ) HEME > Fe 2+ > Fe 3 + INHIBITORS PHYTATES , TANNINS , SOIL , LAUNDRY STARCH , IRON OVERLOAD COMPETITORS COBALT, LEAD , STRONTIUM FACILITATORS ASCORBATE, CITRATE , AMINO ACIDS
CONSEQUENCES OFIRON DEFICIENCY ANEMIA
1. ANEMIA 2 . GROWTH AND DEVELOPMENTAL RETARDATION 3 . EPITHELIAL CHANGES 4 . MISCELLANEOUS.
STAGES OF IRON DEFICIENCY
1 . PRELATENT IRON DEFICIENCY
2. LATENT IRON DEFICIENCY
3. FRANK IRON DEFICIENCY
STAGES OF IRON DEFICIENCY
PRELATENT IRON DEFICIENCY
DEPLETED STORES WITHOUT A CHANGE IN HCT OR SERUM IRON LEVELS RARELY DETECTED
STAGES OF IRON DEFICIENCY
LATENT IRON DEFICIENCY DECREASED SERUM IRON LEVEL TOTAL IRON - BINDING CAPACITY INCREASES WITHOUT A CHANGE IN THE HCT DECREASED TRANSFERRIN SATURATION
STAGES OF IRON DEFICIENCY
IRON DEFICIENCY ANEMIA
ASSOCIATED WITH ERYTHROCYTE MICROCYTOSIS AND HYPOCHROMIA
EFFECTS OF IRON DEFICIENCY
ANEMIA
GROWTH AND DEVELOPMENTAL RETARDATION EPITHELIAL CHANGES
MISCELLANEOUS
EFFECTS OF IRONDEFICIENCY
ANEMIA IMPAIRS TISSUE OXYGEN WEAKNESS , FATIGUE , PALPITATIONS AND LIGHTHEADEDNESS REACTIVE THROMBOCYTOSIS
EFFECTS OF IRONDEFICIENCY
GROWTH AND DEVELOPMENT GROWTH AND DEVELOPMENTAL ABNORMALITIES IMPAIRS NEUROLOGIC FUNCTIONS ( BEHAVIORAL ABNORMALITIES , MOTOR INCOORDINATION AND SEIZURE )
EFFECTS OF IRONDEFICIENCY
EPITHELIAL CHANGES ANGULAR STOMATITIS ,GLOSSITIS , FLATTENED AND ATROPHIC LINGUAL PAPILLAE , PLUMMER- VINSON ( FORMATION OF POSTCRICOID ESOPHAGEAL WEB ) , KOILONYCHIA OR SPOONING OF THE FINGERNAILS
EFFECTS OF IRON DEFICIENCY
MISCELLANEOUS PICA ( CONSUME LAUNDRY STARCH, ICE AND SOIL CLAY ) MASSIVE HEPATOSPLENOMEGALY , POOR WOUND HEALING AND BLEEDING DIATHESIS ZINC DEFICIENCY LEAD INTOXICATION PSEUDOTUMOR CEREBRI
DIAGNOSIS IN INFANTS : HIGH INDEX OF SUSPICION 1. PREMATURITY 2 . BLOOD LOSS 3 . FED EXCLUSIVELY ON MILK 4 . CHRONIC DIARRHEA
PREVENTION 1. ADMINISTRATION OF IRON TO EXPECTANT MOTHERS 2. EARLY INTRODUCTION OF SOLID FOOD 3 . SUPPLEMENTAL IRON : 1O – 15 MG OF ELEMENTAL IRON / DAY ( 6 -8 WKS OF AGE )
SPECIFIC TREATMENTOF IRON DEFICIENCY
ANEMIA 1. ORAL SUPPLEMENTATION
2. PARENTHERAL IRON REPLACE MENT
TREATMENT( ORAL IRON )
ORAL FERROUS SULFATE : 6 MG / KG / DAY ( 6 – 8 WKS AFTER NORMAL HGB VALUE IS ATTAINRD ) OLDER CHILDREN : 1OO – 2OO MG / DAY OF ELEMENTAL IRON
POOR RESPONSETO ORAL IRON
NONCOMPLIANCE ONGOING BLOOD LOSS INSUFFICIENT DURATION OF THERAPY HIGH GASTRIC pH INHIBITORS OF IRON ABSORPTION / UTILIZATION INCORRECT DIAGNOSIS
INHIBITORS OF IRONABSORPTION
LEAD INTOXICATION ALUMINUM INTOXICATION (HEMODIALYSIS )
CHRONIC INFLAMMATION NEOPLASIA
PARENTHERAL IRONREPLACEMENT
INDICATIONS
1. POORLY TOLERATED ORAL IRON
2 RAPID REPLACEMENT IRON STORES
3. GI IRON ABSORPTION IS COMPROMISED
IRON DEXTRAN ADMINISTERED BY IM OR IV ROUTE “ Z- TRACK “ INJECTION TO MINIMIZE SC LEAK 10 -15 % - TRANSIENT ARTHRALGIA RETICULOCYTOSIS IN IO DAYS COMPLETE CORRECTION IN 3 -4 WKS
TREATMENT( BLOOD TRANFUSION )
INDICATION : SEVERE ANEMIA
DEBILITATED FROM INFECTION
SIGNS OF CARDIAC DECOMPENSATION
EFFECT ON THE FETUSOF MATERNAL IRON
DEFICIENCY “ MATERNAL IRON STATUS DETERMINES THE IRON STORES OF THE NEONATE . “
SYSTEMIC DEFECTSIN IRON DEFICIENCY
ANEMIA OF CHRONIC INFLAMMATION :
1. INEFFECTIVE IRON UTILIZATION
2. LOW PLASMA ERYTHROPOIETIN LEVELS