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Chapter: Paediatrics: Haematology

Paediatrics: Anaemia

Red cell indices vary considerably with age.



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




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


·  Diet (cow’s milk, vegan).


·  Overt blood loss.


·  Duration of symptoms.


·  Drug history, e.g. NSAIDs.




·  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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