Anemia Overview PDF

Blood: Blood is one of the body’s major fluid tissues. Pumped by the heart, it continuously circulates through the blood vessels, carrying vital elements to every part of the body. Blood is made of: A liquid component— plasma Cellular components— erythrocytes, leukocytes, and thrombocytes...

Blood: Blood is one of the body’s major fluid tissues. Pumped by the heart, it continuously circulates through the blood vessels, carrying vital elements to every part of the body. Blood is made of: A liquid component— plasma Cellular components— erythrocytes, leukocytes, and thrombocytes suspended in plasma. Components of blood: Each of blood’s components performs specific vital functions: Plasma carries antibodies and nutrients to tissues and carries wastes away. Erythrocytes, also called red blood cells (RBCs), carry oxygen to the tissues and remove carbon dioxide from them. Leukocytes, or white blood cells (WBCs), participate in the inflammatory and immune response.  The Hemoglobin and Hematrocrit are two factors normally measured with RBCs. Hemoglobin (Hgb) Hemoglobin is a protein found in the RBCs that gives blood its red color. Hemoglobin is the part of RBCs that picks up oxygen in the lungs and carries it to the body’s cells. Hemoglobin also carries away carbon dioxide waste.  Hematocrit (Hct) The hematocrit shows how much of the blood is made up of red blood cells. Test results are given as a percentage. The hematocrit value goes up and down as the hemoglobin goes up and down. Anemia Anemia is a condition in which the hemoglobin concentration, hematocrit or RBC count is lower than normal; it reflects the presence of fewer than the normal number of erythrocytes within the circulation. As a result, the amount of oxygen delivered to body tissues is also diminished. Anemia may result from decreased RBC production, increased RBC destruction, or blood loss. Diagnosis of the type of anemia may be assisted by relating the measurements of red blood cell count, hematocrit and hemoglobin to derive the mean corpuscular volume (MCV) and the mean corpuscular hemoglobin concentration (MCHC).  Erythrocytes that have a normal size or volume (normal MCV) are called normocytic, When the MCV is high, they are called macrocytic. When the MCV is low, they are termed microcytic.  Erythrocytes containing the normal amount of hemoglobin (normal MCHC) are called normochromic. When the MCHC is abnormally low they are called hypochromic, and when the MCHC is abnormally high, hyperchromic. -The terms above are used together to describe different forms of anemia. -For example, iron deficiency anemia is described as microcytic and hypochromic, whereas vitamin B12 deficiency is macrocytic and normochromic. ü Anemia is often a symptom of a disease rather than a disease itself. ü Anemia usually develops due to the presence of one of the following: Excessive blood loss or hemorrhaging Deficient production of red blood cells Excessive red blood cell destruction Both decreased production and excessive destruction of red blood cells Sequestration (the pooling of red cells in the spleen). What Are The Symptoms Of Anemia? Most symptoms of anemia are a result of the decrease of oxygen in the cells or hypoxia. Because red blood cells, as hemoglobin, carry oxygen, a decreased production or number of these cells result in hypoxia. Many of the symptoms will not be present with mild anemia as the body can often compensate for gradual changes in hemoglobin. The following are the most common symptoms for anemia: Abnormal paleness or lack of color of the skin Increased heart rate Breathlessness, or difficulty catching a breath Lack of energy, or tiring easily (fatigue) Dizziness, or vertigo, especially when standing Headache Irritability Irregular menstruation cycles Absent or delayed menstruation Sore or swollen tongue Jaundice, or yellowing of skin, eyes, and mouth Enlarged spleen or liver (splenomegaly, hepatomegaly) Slow or delayed growth and development Impaired wound and tissue healing What Causes Anemia? Generally, anemia may be caused by several problems, including the following: Infection Certain diseases Certain medications Poor nutrition What Are The Different Types Of Anemia? Iron deficiency anemia Megaloblastic anemia Hemolytic anemia Sickle cell anemia Thalassemia Aplastic anemia What Is Iron-Deficiency Anemia In Children? Anemia is a common health problem in children. The most common cause of anemia is not getting enough iron. A child who is anemic does not have enough red blood cells or enough hemoglobin. Hemoglobin is a protein that lets red blood cells carry oxygen to other cells in the body. Iron is needed to form hemoglobin. https://www.mypathologyreport.ca/ar/iron-deficiency-anemia/ What Causes Iron-Deficiency Anemia In A Child? Iron-deficiency anemia can be caused by: Diets low in iron. A child gets iron from the food in the diet. But, only a small amount of the iron in food is actually absorbed by the body. Body changes. When the body goes through a growth , it needs more iron for making more red blood cells. Gastrointestinal tract problems. Poor absorption of iron is common after some forms of gastrointestinal surgeries. Blood loss. Loss of blood can cause a decrease of iron. What Are The Symptoms Of Iron-Deficiency Anemia In A Child? These are the most common symptoms of iron-deficiency anemia: Pale skin Irritability or fussiness Lack of energy or tiring easily (fatigue) Fast heart beat Sore or swollen tongue Enlarged spleen Wanting to eat odd substances, such as dirt or ice (also called pica) How Is Iron-Deficiency Anemia Diagnosed In A Child? In most cases, anemia is diagnosed with simple blood tests. Routine anemia screening is done because anemia is common in children and they often have no symptoms. Blood tests for anemia may be done during routine physical exam or checkups in children of any age. Most anemia in children is diagnosed with these blood tests: Hemoglobin and hematocrit. This is often the first screening test for anemia in children. It measures the amount of hemoglobin and red blood cells in the blood. Complete blood count (CBC). A complete blood count checks the red and white blood cells, blood clotting cells (platelets), and sometimes, young red blood cells (reticulocytes). It includes hemoglobin and hematocrit and more details about the red blood cells. Peripheral smear. A small sample of blood is examined under a microscope. Blood cells are checked to see if they look normal or not. Iron studies. Blood tests can be done to measure the amount of iron in the child's body. How Is Iron-Deficiency Anemia Treated In A Child? Treating iron-deficiency anemia includes: Iron supplements. Ø Iron drops or pills are taken over several months to increase iron levels in the blood. Ø Iron supplements can irritate the stomach and discolor bowel movements. Ø They should be taken on an empty stomach or with orange juice to increase absorption. The vitamin C helps the body absorb the iron. Ø If the child can’t take drops or pills, IV iron may be needed, but this is very unusual.  Iron-rich diet. Eating a diet with iron-rich foods can help treat iron-deficiency anemia. Good sources of iron include: Iron-enriched cereals, breads, pasta, and rice Meats, such as beef, pork, lamb, liver, and other organ meats Poultry, such as chicken, duck, turkey, (especially dark meat), and liver Fish, such as shellfish, including clams, mussels, and oysters, sardines, and anchovies Leafy greens of the cabbage family, such as broccoli, kale, turnip greens, and collards Legumes, such as lima beans and green peas; dry beans and peas, such as pinto beans, black-eyed peas, and canned baked beans Yeast-leavened whole-wheat bread and rolls https://www.emedicinehealth.com/what_foods_are_the_highe st_in_iron/article_em.htm What Are Possible Complications Of Iron-Deficiency Anemia In A Child? Iron-deficiency anemia may cause delayed growth and development. What Can I Do To Prevent Iron-Deficiency Anemia In My Child? You can often prevent iron-deficiency anemia through screening and taking iron supplements. What Is Megaloblastic Anemia In Children? Anemia is a problem in which there are not enough red blood cells or hemoglobin. In megaloblastic anemia, the bone marrow makes fewer cells. And the cells that are formed don’t live as long as normal. The red blood cells: Are too large May be abnormally shaped https://www.mypathologyreport.ca/megaloblastic-anemia/ What Causes Megaloblastic Anemia In A Child? ü There are many causes of megaloblastic anemia. ü The most common cause in children is lack of folic acid or vitamin B-12. ü Other causes include: o Digestive diseases. These include and chronic infectious enteritis. o Pernicious anemia is a type of megaloblastic anemia. It’s caused when the body can't absorb vitamin B-12. o A substance called intrinsic factor is normally made in the stomach. This substance helps the body absorb B-12. A person with pernicious anemia does not have enough of this substance. o Inherited congenital folate malabsorption. A genetic problem in which infants can’t absorb folic acid. o Medicines. Certain medicines, like those that prevent seizures, can interfere with how folic acid is absorbed. o Diet. Certain restrictive diets can lead to low levels of folate or B-12 because the child What Are The Symptoms Of Megaloblastic Anemia In A Child? These are some of the symptoms associated with megaloblastic anemia: Pale or yellow skin Fast heart beat Shortness of breath Lack of energy, feeling tired Decreased appetite Irritability or fussiness Stomach upsets, nausea, diarrhea, gas, constipation Trouble walking Numbness or tingling in hands and feet Smooth and sore tongue Weak muscles How Is Megaloblastic Anemia Diagnosed In A Child? The child may have tests, such as: Hemoglobin and hematocrit. Complete blood count, or CBC. Peripheral smear. Other blood tests. For example, the child may need bilirubin or other liver tests, folate and B-12 blood tests, and iron tests. Rarely, a bone marrow aspiration, biopsy, or both may be done to look at the number, size, and maturity of blood cells and abnormal cells. How Is Megaloblastic Anemia Treated In A Child? Treatment will depend on the specific cause of the anemia, the child’s symptoms, age, and general health. It will also depend on how severe the condition is. If the anemia is caused by a digestive tract problem, it may need to be treated first. Most children with megaloblastic anemia are given B-12 or folic acid supplements. Vitamin B-12 supplements are best absorbed when given by injection. Folic acid supplements are given by mouth. Foods that have natural folate include: Oranges, orange juice Dark green and leafy vegetables Liver Beans, peas, lentils Peanuts Cereals, breads, pastas, and rice are fortified with man-made folic acid. Meat and dairy products have the most vitamin B-12. https://www.bioanalyt.com/vitamin-b9-phosphorus/ What Are Possible Complications Of Megaloblastic Anemia In A Child? In general, anemia may cause: Problems with growth and development Fatigue Poor exercise tolerance An enlarged heart or heart failure, if the anemia is severe What Is Hemolytic Anemia In Children? Hemolytic anemia is a group of disorders in which the red blood cells are destroyed faster than the bone marrow can make them. The term for destruction of red blood cells is hemolysis. https://www.saintlukeskc.org/health-library/when-your-child-has-hemolytic-anemia What Causes Hemolytic Anemia In A Child? Hemolytic anemia has 2 types of causes: Intrinsic. This is when the destruction of red blood cells is due to a flaw (defect) within the red blood cells. This type is often inherited. It includes sickle cell anemia, thalassemia, or erythrocytosis. These conditions produce red blood cells that don't live as long as normal red blood cells. Extrinsic. This is when the destruction of red blood cells is from a cause outside of the cells. This is also called autoimmune hemolytic anemia.  Some of the causes are: Infections from bacteria or viruses Medicines such as antibiotics like penicillin or sulfonamides, medicines for malaria. Cancers such as leukemia, lymphoma, or other tumors Autoimmune disorders such as systemic lupus erythematous (SLE or lupus), rheumatoid arthritis, or ulcerative colitis. Hypersplenism, a condition in which the spleen destroys more red blood cells than normal. What Are The Symptoms Of Hemolytic Anemia In A Child? These are the most common symptoms of hemolytic anemia: Pale skin Jaundice, or yellowing of the skin and eyes Dark-colored urine Fever Weakness Dizziness Confusion Intolerance to physical activity Enlargement of the spleen and liver Fast heart beat How Is Hemolytic Anemia Diagnosed In A Child? the child may have these tests: Hemoglobin and hematocrit. Complete blood count (CBC). Peripheral smear. Other blood tests. These tests will check for lactate dehydrogenase, bilirubin, and haptoglobin which can causes ongoing hemolysis. Certain tests can find antibodies that cause hemolysis. Urine tests. These tests can check for hemoglobin from red blood cells breaking down.  Bone marrow aspiration, , or both. A small amount of bone marrow fluid (aspiration), solid bone marrow tissue (called a core biopsy) often from the hip bones, or both are checked for the number, size, and maturity of blood cells. This test may also look for abnormal cells. How Is Hemolytic Anemia Treated In A Child? Treatment will depend on your child’s symptoms, age, and general health. It will also depend on how severe the condition is. The treatment for hemolytic anemia will vary depending on the cause of the illness and how severe the anemia is. Some children do not need treatment. For those that do, treatment may include: Blood transfusions Corticosteroid or steroid medicines Intravenous immune globulin (IVIg) Rituximab, a medicine to control the immune system Antibiotics to treat the infection if that is the underlying cause Other medicines, depending on the type of hemolytic anemia In some children, who don't respond to other therapy, these treatments may be needed: Splenectomy. This is surgery to remove the spleen. Immunosuppressive therapy. This is the use of other medicines to control the immune system. Plasmapheresis. This is the removal of antibodies from the blood that are destroying red blood cells. Stem cell transplant. In severe cases, abnormal bone marrow cells are replaced with donor bone marrow. What Are Possible Complications Of Hemolytic Anemia In A Child? Complications depend on the cause of the hemolytic anemia and include: Side effects of medicines. For example, the increased risk of infection with corticosteroids. Gallstones or stones in the gallbladder Blood clots and blood clots in the lungs (pulmonary emboli) Kidney failure Shock Heart failure What Is Sickle Cell Disease In Children? Sickle cell disease (SCD) is a blood disorder that a child is born with. It's passed down through a parent’s genes. Children with SCD make an abnormal type of hemoglobin. Healthy red blood cells with normal hemoglobin are round and move easily through blood vessels. When a child has SCD, the red blood cells are hard and sticky. They are shaped like the letter C (and like a farm tool called a sickle). These damaged red blood cells (sickle cells) clump together. They can’t move easily through the blood vessels. They get stuck in small blood vessels and block blood flow.  This blockage can cause pain. It can also damage major organs. Sickle cells die sooner than healthy cells. Normally the spleen helps filter infections out of the blood. But sickle cells get stuck in this filter and die. Having fewer healthy red blood cells causes anemia. The sickle cells can also damage the spleen. Without a healthy spleen, children are more at risk for serious infections.  There are several complex types of the sickle cell gene. Some don’t cause symptoms or severe problems, but others do. Most children with SCD will start showing symptoms during the first year of life, often around 5 months. What Causes Sickle Cell Disease In A Child? ü Sickle cell is present at birth. It is inherited when a child has 2 sickle cell genes, 1 from each parent. ü A child who has only one sickle cell gene is healthy. But they are a carrier of the disease. ü If 2 carriers have a child, there is a chance their child will have sickle cell disease. Which Children Are At Risk For Sickle Cell Disease? o Having a family history of SCD increases a child’s risk for the disease. o SCD mainly affects people whose families came from Africa, and Hispanics whose families are from the Caribbean. o But the gene has also been found in people whose families are from the Middle East, India, Latin America, and Mediterranean countries. o It has also been found in American Indians. What Are The Symptoms Of Sickle Cell Disease In A Child? Most children with SCD will start to have symptoms during the first year of life, often around 5 months. Each child’s symptoms may vary. They may be mild or severe. Symptoms can include: Anemia. This is the most common symptom. Anemia can make a child pale and tired. Yellowing of the skin, eyes, and mouth (jaundice). Pain crisis, or sickle crisis. When sickle cells move through small blood vessels, they can get stuck. This blocks blood flow and causes pain. This sudden pain can happen anywhere, but most often occurs in the chest, arms, and legs. Babies and young children may have painful finger and toe swelling. Blocked blood flow may also cause tissue death.  Acute chest syndrome. This is when sickle cells stick together and block oxygen flow in the tiny vessels in the lungs. This can be deadly. Splenic sequestration (pooling). The spleen becomes enlarged and painful when sickle cells get stuck and build up there. How Is Sickle Cell Disease Diagnosed In A Child? ü SCD may be found as part of newborn screening, check newborn babies for abnormal hemoglobin. ü The family history, the child's medical history, and a physical exam are all included in the diagnosis. ü If the screening test shows SCD, a blood test called hemoglobin electrophoresis may be done. It can tell if the child is a carrier of sickle cell. It can also tell if the child has any of the diseases linked to the sickle cell gene. How Is Sickle Cell Disease Treated In A Child? v Treatment will depend on the child’s symptoms, age, and general health. It will also depend on how severe the condition is. v Early diagnosis and preventing further problems is important in treating this disease. v Treatment may include:  Pain medicines. These are used for pain crises. Drinking plenty of water daily (8 to 10 glasses). This helps prevent and treat pain crises. In some cases, IV (intravenous) fluids may be needed. Blood transfusions. These are used to treat anemia. Vaccines and antibiotics. These are used to prevent infections. Folic acid. This helps prevent severe anemia. Regular eye exams. These are done to screen for an eye condition called retinopathy. Stem cell transplant. Transplants can cure some children with SCD. Hydroxyurea. This is a medicine that can reduce the number of sickle cells in the blood. It reduces complications, painful episodes (crises), and hospital stays. What Are Possible Complications Of Sickle Cell Disease In A Child? Complications of SCD include: Long-term anemia. This may lead to delayed healing and delayed growth and development. Pain crisis, or sickle crisis. In severe cases, the child may need treatment in a hospital. Acute chest syndrome. Over time, many episodes of acute chest syndrome can cause lasting (permanent) lung damage Splenic sequestration (pooling). When red blood cells build up in the spleen, it becomes enlarged and painful. The spleen can be damaged and scarred after many episodes of splenic sequestration. By age 8, many children with SCD have had their spleen removed.  Stroke. If the blood vessels to the brain are blocked, a stroke can occur. Serious long-term problems may result. A child who has had a stroke is more likely to have another one. Infections. Babies and children with SCD have a higher risk for infections. What is Pediatric Thalassemia? Thalassemia is a genetic blood disorder where proteins that form hemoglobin don’t work properly. Thalassemia causes the body to not make enough hemoglobin, leading to anemia that causes pallor, fatigue and stunted growth. In it’s most severe forms, thalassemia can cause bone pain, skeletal deformities and a swollen abdomen. Kids with thalassemia may need blood transfusions to give their body healthy hemoglobin to support their growth and development. https://doctorlib.info/physiology/pathophysiology/114.html What causes Pediatric Thalassemia? Ø Thalassemia, an inherited blood disorder, is caused by mutations in the DNA that produce hemoglobin. Ø Although the disorder is not limited to any ethnic background, people who have Greek ancestry or come from the Mediterranean regions are more likely to have beta thalassemia. Ø People who come from Southeast Asia, Africa and the Middle East are more likely to have alpha thalassemia. What are the different types of Pediatric Thalassemia? Alpha thalassemia Silent carrier, which means you have a genetic mutation for alpha thalassemia, but it doesn't cause symptomatic anemia. Alpha thalassemia trait, which can cause mild anemia. Hb H disease, which causes mild to moderate anemia and an enlarged spleen (splenomegaly). Alpha thalassemia major, the most severe form of alpha thalassemia. If this is diagnosed before the child is born, the baby can have a blood transfusion while still in the womb, which is needed for survival. Kids with this condition will need ongoing blood transfusions and long-term monitoring and care. This condition can be cured with a bone marrow transplant. Beta thalassemia Beta thalassemia trait, which can cause mild to moderate anemia. Thalassemia major (Cooley’s anemia), the most severe form of beta thalassemia. Kids with this condition will need ongoing blood transfusions and long-term monitoring and care. This condition can be cured with a bone marrow transplant. What are the signs and symptoms of Pediatric Thalassemia? Patients with less severe types of the disorder might not have any symptoms, while patients with the more severe types of thalassemia can have: Noticeably pale skin (pallor) or yellowing of their skin and eyes (jaundice) A swollen or large abdomen due to enlargement of the spleen and/or liver Very prominent face bones Stunted growth Exercise/activity intolerance Heart murmur (abnormal sounds in the heart due to their anemia) How is Pediatric Thalassemia diagnosed? The screening can detect the most common and severe forms of thalassemia. How is Pediatric Thalassemia treated? Blood transfusions Children who have severe forms of the disease need lifelong blood transfusions and careful monitoring for the complications of blood transfusion. These transfusions give the child healthier hemoglobin, which reduces their symptoms. Surgery Some children with thalassemia may have an enlarged spleen. Removing the spleen (a surgery called splenectomy) can improve their anemia. Kids can live active lives without a spleen, but it will put them at higher risk for infection. Bone marrow transplant A bone marrow transplant replaces the child’s diseased blood-forming cells with healthy, new cells.  Aplastic Anemia in Children What Is Aplastic Anemia? Aplastic anemia occurs when the bone marrow produces too few of all types of blood cells: red cells, white cells, and platelets. A reduced number of red blood cells causes the red cell number and hemoglobin to drop. A reduced number of white blood cells causes the patient to be susceptible to infection. A reduced number of platelets can cause the blood not to clot the way it should. http://www.medexpert.sg/en/medical-specialities/haematology/aplastic-anaemia-marrow-failure/ https://www.healthshots.com/brand-posts/what-is-aplastic-anemia-and-what-is-the-best-treatment-for-it/ What Causes Aplastic Anemia? ü Aplastic anemia in children has multiple causes. Some of these causes are idiopathic. ü Other causes are secondary, resulting from a previous illness or disorder. Very often there is an immunological dysfunction (immune system problem) or malignant (cancerous) change in the cells. ü Many childhood cases of aplastic anemia occur for no known reason. Acquired causes, however, may include: History of specific infectious diseases, such as hepatitis, Epstein-Barr virus (EBV), cytomegalovirus (CMV), or human immunodeficiency virus (HIV) History of taking certain medications Exposure to certain toxins, such as heavy metals Exposure to radiation History of an autoimmune disease, such as lupus A developing acute lymphocytic leukemia What Are The Symptoms Of Aplastic Anemia? The following are the most common symptoms of aplastic anemia. However, each child may experience symptoms differently. Symptoms may include: Headache Dizziness Nausea Shortness of breath Bruising Lack of energy or tiring easily (fatigue) Abnormal paleness or lack of color of the skin Blood in stool Nosebleeds Bleeding gums Fevers Enlarged liver or spleen Oral thrush (white patches on a red, moist, swollen surface, occurring anywhere in the mouth) How Is Aplastic Anemia Diagnosed? In addition to a complete medical history and physical examination of the child, diagnostic procedures for aplastic anemia may include: Blood tests Bone marrow aspiration and/or biopsy. Treatment For Aplastic Anemia Specific treatment for aplastic anemia will be determined by the child's doctor based on: Your child's age, overall health, and medical history The extent of the anemia Cause of the anemia Your child's tolerance for specific medications, procedures, or therapies Expectations for the course of the anemia Supportive therapy may include: Blood transfusion (both red blood cells and platelets) Preventative antibiotic therapy Meticulous handwashing Special care to food preparation (such as only eating well-cooked foods) Hormones or medications (to stimulate the bone marrow to produce cells) Immunosuppressive therapy Preventing Infection And/Or Bleeding Activities which put children with aplastic anemia at risk for infection or bleeding should be avoided. These activities include things like the following: q Dental work (until your child's white blood cell counts rise) q Contact sports (for example, football, hockey, skiing, or rollerblading) q Traveling to high altitudes (children with a low red blood cell count will have increased fatigue and need for oxygen in high altitudes) https://www.childrens.com/specialties-services/conditions/thalassemia https://www.nationwidechildrens.org/conditions/health-library/pediatric-blood-disorders THANK YOU