Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
1 of 3
http://emedicine.medscape.com/article/954506-cl...
History
The acute development of anemia in the pediatric age group commonly occurs in 2
situations, (1) acute blood loss and (2) acute hemolysis.
Rapid hemolysis
When taking the history, keep the following factors in mind:
Isoimmune or alloimmune hemolytic anemia (ABO incompatibility or Rh
incompatibility in neonates) (1) Mothers blood group (ABO) and type (Rh);
(2) minor Rh antigen incompatibility such as c, E, may cause severe hemolytic
anemia (even if there is no ABO or D incompatibility), therefore do direct
antiglobulin test (DAT) whenever there is a suspicion
Autoimmune hemolytic anemia (1) History of a viral infection such as
mycoplasma or Ebstein-Barr virus (EBV) may precede paroxysmal cold
hemoglobinuria; (2) an infection with Streptococcus pneumoniae may cause
autoimmune hemolytic anemia due to exposure of cryptic T antigen on the red
blood cells by the bacterial neuraminidase
Transfusion reaction due to major blood group incompatibility - Usually due to
clerical error or misidentification of patient delayed transfusion reaction due to
previously unrecognized antibodies to red blood cell antigens (may occur a
few days to 1 wk after previous transfusion)
Ingestion of strong oxidants in a child with G-6-PD deficiency - Ingestion or
sniffing of a mothball is most common
Splenic sequestration in a child with sickle cell anemia or hereditary
spherocytosis - Sudden onset of severe abdominal pain; shocklike state with a
drop in hemoglobin and platelet count
Physical Examination
Check vital signs. Patients with acute and severe anemia appear in distress, with
tachycardia, tachypnea, and hypovolemia. Patients with chronic anemia are typically
well compensated and usually asymptomatic.
To evaluate chronicity, plot growth parameters; this may affect the urgency of
treatment. Also, note pallor, jaundice, edema, and signs of bleeding (eg, stool occult
blood, frequent epistaxis, petechiae, bruising).
Patients with significant anemia often have a systolic ejection murmur. Look for signs
of congestive heart failure (CHF), such as tachycardia, gallop rhythm, tachypnea,
cardiomegaly, wheezing, cough, distended neck vein, and hepatomegaly.
Splenomegaly can be found in many hemolytic anemias or may reflect infiltration in
malignancy. In young patients with sickle cell disease, splenic sequestration can
manifest with a sudden enlargement of the spleen and/or abdominal pain and
distension together with an exacerbation of anemia and thrombocytopenia. Passive
congestion of the spleen may complicate CHF.
Note any dysmorphic features and other congenital anomalies. Facial bony
prominences (eg, frontal bossing) are signs of extramedullary hematopoiesis
associated with chronic, severe, hemolytic anemias and thalassemias. Some
congenital bone marrow failure syndromes (eg, Fanconi anemia and, less often,
Diamond-Blackfan anemia) may be associated with facial, limb, and other anomalies.
3/15/2016 9:01 AM
2 of 3
http://emedicine.medscape.com/article/954506-cl...
Signs of hypothyroidism include low body temperature, failure to thrive, dry skin,
constipation, and thinning of the hair.
Differential Diagnoses
References
1. Dowling MM, Quinn CT, Plumb P, et al. Acute silent cerebral ischemia and infarction during acute anemia in
children with and without sickle cell disease. Blood. 2012 Nov 8. 120(19):3891-7. [Medline]. [Full Text].
2. Parkin PC, DeGroot J, Maguire JL, Birken CS, Zlotkin S. Severe iron-deficiency anaemia and feeding
practices in young children. Public Health Nutr. 2015 Jun 1. 1-7. [Medline].
3. Niemeyer CM, Baumann I. Myelodysplastic syndrome in children and adolescents. Sem in Hematol. 2008
Jan. 45(1):60-70. [Medline].
4. Ballin A, Hussein A, Vaknine H, Senecky Y, Avni Y, Schreiber L. Anemia associated with acute infection in
children: an animal model. J Pediatr Hematol Oncol. 2013 Jan. 35(1):14-7. [Medline].
5. Sherry B, Mei Z, Yip R. Continuation of the decline in prevalence of anemia in low-income infants and children
in five states. Pediatrics. 2001 Apr. 107(4):677-82. [Medline].
6. Cusick SE, Mei Z, Freedman DS, et al. Unexplained decline in the prevalence of anemia among US children
and women between 1988-1994 and 1999-2002. Am J Clin Nutr. 2008 Dec. 88 (6):1611-7. [Medline].
7. Mujica-Coopman MF, Brito A, Lopez de Romana D, Ros-Castillo I, Coris H, Olivares M. Prevalence of
Anemia in Latin America and the Caribbean. Food Nutr Bull. 2015 Jun. 36 Suppl 2:S119-28. [Medline].
8. Cusick SE, Mei Z, Cogswell ME. Continuing anemia prevention strategies are needed throughout early
childhood in low-income preschool children. J Pediatr. 2007 Apr. 150(4):422-8, 428.e1-2. [Medline].
9. Hare GM, Tsui AK, McLaren AT, Ragoonanan TE, Yu J, Mazer CD. Anemia and cerebral outcomes: many
questions, fewer answers. Anesth Analg. 2008 Oct. 107(4):1356-70. [Medline].
10. Gibson BE, Todd A, Roberts I, Pamphilon D, Rodeck C, Bolton-Maggs P. Transfusion guidelines for
neonates and older children. Br J Haematol. 2004 Feb. 124(4):433-53. [Medline].
11. Amendments and corrections to the 'Transfusion Guidelines for neonates and older children' (BCSH, 2004a);
3/15/2016 9:01 AM
3 of 3
http://emedicine.medscape.com/article/954506-cl...
and to the 'Guidelines for the use of fresh frozen plasma, cryoprecipitate and cryosupernatant' (BCSH,
2004b). Br J Haem atol. 2007 Feb. 136(3):514-6. [Medline].
12. Bateman ST, Lacroix J, Boven K, et al. Anemia, blood loss, and blood transfusions in North American children
in the intensive care unit. Am J Respir Crit Care Med. 2008 Jul 1. 178(1):26-33. [Medline].
13. Carson JL, Carless PA, Hebert PC. Outcomes using lower vs higher hemoglobin thresholds for red blood cell
transfusion. JAMA. 2013 Jan 2. 309(1):83-4. [Medline].
14. Villanueva C, Colomo A, Bosch A, Concepcion M, Hernandez-Gea V, Aracil C. Transfusion strategies for
acute upper gastrointestinal bleeding. N Engl J Med. 2013 Jan 3. 368(1):11-21. [Medline].
15. Ohlsson A, Aher SM. Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth
weight infants. Cochrane Database Syst Rev. 2006 Jul 19. CD004863. [Medline].
3/15/2016 9:01 AM