1. Audace NIYIGENA
Intern in pediatrics
In King Faisal Hospital in Kigali
Supervised by
Dr SABITI Stephen

2. PLAN
Overview
Etiologies
Assessment
Managment
Prognosis
Conclusion

3. ANEMIA
 is a decrease in number of red blood cells(RBCs) or less
than the normal quantity of hemoglobin in the blood.
 The normal range varies with age, so anaemia can be
defined as:
 Neonate: Hb <14g/dl
 1-12 months: Hb <10g/dl
 1-12 years: Hb <11g/dl.
 ˃12years: <12g/dl
Hb
 Anemia is not a disease, but an expression of an underlying
disorder or disease.

4. ETIOLOGIES
 Production defects:
 Nutritional deficiencies - Vitamin B12, folate or iron
deficiency.
 Inflammation/chronic disease.
 bone marrow disorders- pure red cell
aplasia,myelodysplasia.
 Blood loss
 Hemorrhage
 Chronic GI blood loss
 Blood destruction.
 haemolysis
 Sequestration (hypersplenism)-usually associated
with mild pancytopenia

5. ASSESSMENT
 diagnosis is made by:
 Patient history
 Patient physical exam
 Hematologic lab findings
 Identification of the cause of anemia is
important so that appropriate therapy is used to
treat the anemia.

6. Patient History
 Dietary habits
 Medication
 Possible exposure to chemicals and/or toxins
 Description and duration of symptoms
 Tiredness
 Headache and vertigo (dizziness)
 Dyspnia from exertion
 G I problems
 Overt signs of blood loss such as hematuria (blood
in urine) or black stools

7. Physical Exam
 Hepato or splenomegaly
 Heart abnormalities
 tachycardia
 Gallop rhythm
 Bounding pulse
 Skin pallor
 malnutrition and neurological changes
 Jaundice
 Angina
 Trauma evidence

8.  Patients with acute and severe anemia
appear in distress, with tachycardia,
tachypnea, and hypovolemia.
 Patients with chronic anemia are
typically well compensated and usually
asymptomatic

9. Hematologic Lab Findings
 Hematocrit (Hct) or packed cell volume in %
 The normal range is 42-60%
 Hemoglobin (Hgb) concentration in
grams/deciliter
 The normal range is 13.5-20 g/dl
 An RBC count:
 The normal range is 13.5-20 g/dl
 Reticulocyts :
 The normal range is 0.5% to 1.5%

10.  Mean corpuscular volume (MCV)
 Hct (in %)/RBC (x 1012/L) x 10
 At birth the normal range is 98-123
 In old child and adults the normal range is 80-100
 The MCV is used to classify RBCs as:
 Normocytic (80-100)
 Microcytic (<80)
 Macrocytic (>100)

11.  Mean corpuscular hemoglobin concentration
(MCHC) – is the average concentration of
hemoglobin in g/dl (or %)
 Hgb (in g/dl)/Hct (in %) x 100
 The normal range is 30-36
 The MCHC is used to classify RBCs as:
 Normochromic (30-36)
 Hypochromic (<31)
 hyperchromic, not (>37), they just have decreased
amount of membrane.

12.  Mean corpuscular hemoglobin (MCH) – is the
average weight of hemoglobin/cell in picograms
(pg= 10-12 g)
 Hgb (in g/dl)/RBC(x 1012/L) x 10
 At birth the normal range is 31-37
 In adults the normal range is 26-34
 This is not used much anymore because it does not take
into account the size of the cell.

13.  Red cell distribution width (RDW) – is a
measurement of the variation in RBC cell size
 Standard deviation/mean MCV x 100
 The range for normal values is 11.5-14.5%
 A value > 14.5 means that there is increased variation in
cell size above the normal amount
 A value < 11.5 means that the RBC population is more
uniform in size than normal.

15. Using MCV to Characterize Anemia
 Microcytic  Normocytic  Macrocytic
 Iron deficiency  Acute blood loss  Normal newborn
anemia  Infection  Increased
 Thalassemia erythropoiesis
 Renal failure
 Post-splenectomy
 Sideroblastic anemia  Liver disease
 Liver disease
 Chronic infection  Early iron  Obstructive
 Severe Malnutrition deficiency jaundice
 Hypothyroidism

18. Managment
 Acute anemia usually warrants immediate medical
attention.
 Treatment depends on the severity and underlying
cause of the anemia
 Supportive measures, such as supplemental oxygen for
decreased oxygen-carrying capacity, fluid resuscitation
for hypovolemia, and bed rest or activity restriction for
fatigue, may be required

19. When to transfuse?
PRBC dose is 15-20 ml/kg over 3-4 hours. the rate of
transfusion can be modified according to the clinical situation.
Give PRBCs if:
Hb˂5g/dl
Hb ≤7 g/dl with
regardless of
clinical signs of
clinical signs of
anemia
anemia

20. Iron Deficiency Anemia
 Dx:
 Smear: microcytic & hypochromic
 additional diagnostic tests
 serum ferritin (decreased)
 serum iron (decreased)
 Iron binding capacity (increased)
 Iron saturation (decreased)

21.  Tx:
 oral iron supplementation: 6mg/kg/day of elemental
iron
 for at least 3 months
 check retic count after 2 weeks
 Iron Dextran
 provides 50mg/ml elemental iron
 Dose(ml) =0.0442 (desired Hgb - Observed Hgb) x Wt +
(0.26 x W)
 Ferrlecit (sodium ferrous gluconate)
 each 10cc provides 125mg elemental iron
 dilute 10ml in 100ml 0.9NS and administer IV over 1 hour
 repeat for up to 8 sessions

22. B12/Folate Deficiency
 Dx:
 Smear: Macrocytic (High MCV) RBCs,
 B12
 Low serum B12,
 Anti-IF Abs,
 Folate
 Serum folate level-- can normalize with a single good meal
 Tx:
 B12 deficiency: B12 1 mg/month IM, or 1-2 mg/day PO
 Folate deficiency: Improved diet, folate 1 mg/day

23. Thalassemias
 Genetic defect in hemoglobin synthesis
 synthesis of one of the 2 globin chains ( or )
 “Ineffective erythropoiesis”
 Dx:
 Smear: microcytic/hypochromic, RBCs
 Fe stores are usually elevated
 Tx:
 Mild: None
 Severe: RBC transfusions + Fe chelation, Stem cell transplants

24. Prognosis
 The prognosis depends on the severity and acuteness
with which the anemia develops and the underlying
cause of the anemia.
 Mortality and morbidity rates vary according to the
underlying pathologic process causing the anemia, the
degree of severity, and the acuteness of the process.

25. CONCLUSION
 Anemia is not a desease but, a condition caused by
various underlying pathologic processes
 A proper history and physical examination is more
important in an easy way of approaching a child with
anemia
 Lab exams leads to definitive cause of anemia
 All cases of anemia are not necessary to be transfused

26. REFERENCES
 Illustrated textbook of paediatrics 3rd edition, Tom
Lissauer and Graham Clayden, 2010
 First aid for Pediatric clerkship, LATHA G. STEAD et al
 Pocket medicine 4th edition, Mare S. Sabatine, 2011
 Emedicine.medscape.com/article/954506
 Pedinreview.com