Kuliah Anemia

Approach to Anemia

How to efficiently and accurately work up the anemic children

Anemia

Is a sign of diseaseNot a final diagnosis

04/21/2023 www.brainybetty.com 2

The goal of the diagnostic evaluation is to determine the cause of anemia

Definition of Anemia

Reduction in the hemoglobin concentration or red blood cells per

cubic millimeter.


ANEMIA (WHO criteria)

Age Hb (g/dl)

6 mo - < 5 yrs < 11

> 5 yrs < 12

Anemic Child

It is important to establish :A single cell line problem (red blood

cells)Or

A multiple cell line problem (red cell, white cell, and platelets)

Usually indicates bone marrow involvement,

immunologic disorders, peripheral destruction of cells


Physiologic classification of anemia

1. Disorders of effective red cell production2. Disorders of increased red cell

destruction3. Blood loss


a. Marrow failureb. Impaired erythropoietin productionc. Abnormalities of cytoplasmic

maturationd. Abnormalities of nuclear maturatione. Dyserythropoietic.

a. Defects of hemoglobinb. Defects of the red cell membranec. Defects of red cell metabolismd. Antibody-mediatede. Mechanical injury to the erythrocytef. Thermal injury to the erythrocyteg. Oxidant-induced red cell injuryh. Paroxysmal nocturnal hb-uriai. Hypersplenism

The investigation of Anemia

1. Detailed history and physical examination

2. Complete blood count.3. Determination of morphologic

characteristics and RDW.4. BMP (if required).5. Determination of underlying cause

of anemia by additional test.


Important features in the history of the anemic child

1. Maternal history 2. Family history3. Patient history


Pregnancy/delivery complications

Drug ingestionPica/ nonfood product ingestionAnemic during pregnancy

Anemia Jaundice SplenomegalyGallstones Cancer TransfusionBleeding disorders

Hyperbilirubinemia, Prematurity, Diet history, Medications, Acute or recent infection, Evidence of chronic disease/ infection, Endocrinopathy, Liver disease, Easy bruising/blood loos

Physical examination

Several clues to the etiology : Tachycardia acute process with poor

compensation. Normal HR more chronic process Jaundice hemolytic process Splenomegaly inherited hemolytic

anemia, malignancy, portal hypertension


Morphology classification of Anemia

BLOOD SMEAR Microcytic Anemia (MCV<80fl) Normocytic Anemia (MCV 80-

100 fl) Macrocytic Anemia (MCV >100

fl)


Reference Range of MCV

Age (yrs) MCV (fl)

1 - 3 days 95 - 121

0.5 – 2 70 - 84

2 – 4 73 - 85

5 – 7 75 - 87

8 – 11 77 - 90

12 – 14 78 - 91

15 – 17 78 - 94

18 – 19 80 - 100



ANEMIA

MCV

MICROCYTIC NORMOCYTIC

MACROCYTIC

Iron Deficiency

Thalassemia

Chronic disease

Lead poisoning

Reticulocyte count

High

Bilirubin

Normal

Hemorrhage

High

Hemolytic

Coombs test

Coombs TestNegative Positive

Hb-pathy

Membrane defect

Secondary : drugs, infection

Autoimmune

Isoimmune


ANEMIA

MCV

MICROCYTIC NORMOCYTIC MACROCYTIC

Reticulocyte

Leukocyte & Platelets

Low Normal Increased

Malignancy

Aplastic Anemia

Pure red cell aplasia Diamond Blackfan Transient erythroblastopenia

Infection


ANEMIA

MCV

MICROCYTIC MACROCYTIC NORMOCYTIC

Folate deficiency Vit B12 defic. Aplastic anemia Preleukemia Liver disease

Other lab examination

RDW (Red cell distribution width) = variation of the erythrocyte volume distribution.

(N = 11.5 – 14.5%)Normal RDW = homogen, slight

anisocytosis RDW = heterogen, anisocytosis (++)Reticulocyte = indicator of bone marrow activities

Anisocytosis = variation in sizePoikilocytosis = variation in shape


Anemia Mikrositik

Perhatikan : jumlah eritosit, RDW, retikulosit, gambaran sediaan apus darah tepi.

Juml Eri RDW Retik Slide

Trait Thal N poikilositosis (+)

ADB N / N / anisositosis (+),

hipokromThal poikilositosis,

anisositosis (++)hipokrom


Kuliah Anemia

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