Paediatrics: Anaemia

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.