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Chapter: Paediatrics: Haematology

Paediatrics: Anaemia

Red cell indices vary considerably with age.

Anaemia

 

Red cell indices vary considerably with age. Haemoglobin (Hb) at birth may be as high as 22g/dL, but then falls rapidly to about 11g/dL by 3mths. A mild hypochromic microcytic picture normally seen between 6mths and 6yrs. Sex differences in red cell indices do not appear until puberty.

 

Symptoms and signs of anaemia

 

·  Fatigue, lethargy.

 

·  Pallor.

 

·  Poor feeding, anorexia.

 

·  Poor growth.

 

·  Dyspnoea on exertion.

 

·  Rarely stomatitis or koilonychia.

 

Diagnostic approach to anaemia

 

History

 

·  Familial/ethnic causes (sickle cell, thalassaemia).

 

·  Diet (cow’s milk, vegan).

 

·  Overt blood loss.

 

·  Duration of symptoms.

 

·  Drug history, e.g. NSAIDs.

 

Examination

 

·  Height and weight (FTT, malabsorption).

 

·  Dysmorphic features, e.g. micrognathia, cleft palate, abnormal/absent thumbs (Fanconi’s anaemia, Diamond–Blackfan anaemia).

·  Jaundice (haemolysis).

 

·  Adenopathy/organomegaly (underlying malignancy).

 

FBC and film (See Table 17.2)

 

·  Red cell indices: mean cell volume (MCV), mean cell haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC) (anaemia may be microcytic, macrocytic, normocytic, and/or hypochromic).

 

·  RBC: spherocytes, sickle cells, Howell Jolly bodies.

 

Other cytopenias.


 

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Paediatrics: Haematology : Paediatrics: Anaemia |


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