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Anemia

APPROACH TO ANEMIA
 
Anemia in infancy and childhoodhas many causes. It is important to find the route cause and to initiate early and acute treatment, for very often anemia can be a typical presentation of a typical disease. 
In anemic child who is iron deficient looks pale, tired, anorexic, with behavioral abnormalities (irritability confusion, with poor attention and learning span). These children also have tachy cardia, heart murmur, palpable spleen, under poor weight gain etc. 
Iron deficiency which is typical in Indian setting go through stages of Iron depletion, iron deficient erythropoiesis, and then iron deficiency. 
Complete and often extensive investigations are required for children which have multisystemic presentation with anemia. The following tabulations give a simple approach to a patient with anemia.   
 
 
**Diagnosis of anemia : erythrocyte forms in blood smears
 
Normal form
 
Anosocytosis                         Anemias                                                                                               
 
Poilkilocytosis                       Severe anemias
 
Hemolytic anemia with macro- or microangiopathy, e.g. hemolytie uremic syndrome (HUS)
 
Hereditary pyropoikilocytosis
 
Hereditary elliptocytosis of neonates
 
Anulocytes                             Hyperchromic anemia
 
Microspherocytes                 Hereditary spherocytosis
 
Elliptocytes                            Hereditary elliptocytosis, thalassemia, megaloblastic anemia
 
Sickle cells                            Sickle cell anemia
 
Target cells                            Hypochromic anemia, β thalassemias,  hemoglobin C disease
 
 
 
**Biological errors that may be the cause of primarily reduced measurements
Parameter
Variation in result
Upwards (false positive)         Downwards (false negative)
 
 
 
Erythrocyte count
High leukocytosis
Platelet aggregation
Marked microcytosis
(+ fragmentation)
Agglutination (counted as leukocytes)
Hemolysis
 
Leukocyte count
Platelet aggregation
(antibodies)
Normoblasts
Agglutination of the leukocytes
Platelet count
Hemolysis
Leukemias
Microcytosis
Cryoglobulinemia
Lipid infusion
Platelet Aggregation
Macrothromocytosis
Platelet adhesion
 
Hb
In vivo hemolysis
Hyperbillirubinemia
Hyperlipidemia
 
MCV
Agglutination
Hyperglycemia (Osmolality)
 
 
Treatment
 
1) Severe anemia may require blood transfusion
 
2) Moderate to low anemias require oral supplementation of iron and vitamins. The dose is calculated with regards the body weight of the child. (3 ml / kg per day of elemental iron)
 
3) Response to therapy begins with decreased irritability and improved appetite within 24 hrs. Followed by an increase in retic count within 3 days. Hemoglobin increased within 5 – 7 days.
 
4) Patient education, nutritional counseling, ruling out common cause such as pica and warm infestation is important.