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Anemia in Children : Summarized





 
                                                            ANEMIA


EVALUATION

  • Age of onset
  • Sex
  • Family H/O hemolytic anemia, neonatal jaundice, exchange transfusion, cholelithiasis, cholecystectomy
  • Nutritional History: Pica, Vegan diet, intake of goat’s milk,
  • H/O Drug intake: Antimalarials, phenytoin, penicillins, cytotoxic drugs
  • H/O Chronic Diarrhea (Celiac, intestinal resection, IBD, CMP allergy)
  • H/O worm infestation
  • Pallor, listlessness, effort intolerance
  • Behavioral problems, irritability
  • WT, Ht, OFC, MUAC
  • Dysmorphism
  • Pallor in palms, nails, conjunctiva, mucous membranes
  • Jaundice, LN, Liver, Spleen
  • Tachycardia, gallop, systolic murmur
  • Signs of systemic disease (edema, joint pains)

LAB WORK

  • Hb, TLC, DLC, platelet count, reticulocyte count, RBC morphology
  • PCV, MCV, MCH, MCHC
  • S/ iron, TIBC, Ferritin
  • Hb F, Hb electrophoresis
  • S. creatinin, bilirubin, ANA, folate & B12 levels
  • Stool C/E & occult blood
  • Coomb’s test, osmotic fragility test
  • Bone marrow aspiration / trephine biopsy

MANAGEMENT


  • Admit the Patient.
  • Maintain I/V line
  • Send investigations.
  • Hb, TLC, DLC, Platelet & Reticulocyte Counts.
  • RBC and WBC morphology by the hematologist in the morning hours
  • (make slide if transfused in emergency)
  • If urgent investigations are not possible, save 2ml EDTA vial sample(for peripheral smear) and 5ml non-heparinized blood in refrigerator. In addition to this , save 5 cc of EDTA vial blood sample for Hb electrophoresis.
  • Get Hb done on urgent basis. If
·         Hb level < 4g% ® transfuse the patient in emergency even if without                                             sings and symptoms of CCF.
·         If Hb level 4-6g% ® transfuse only if CCF present.
·         If Hb level > 6g% ® wait for investigations (usually do not require transfusion on urgent basis)
·         If Transfusion is Required:-

  • Send blood for grouping & cross matching & screening,
  • Sign grouping, cross matching the screening card from the blood bank
  • Transfuse 10ml /kg of packed cell transfusion over 2-3 hours
  • Inj. Lasix 1 mg/kg- IV before transfusion in severely anemic patients & mid transfusion in others
  • Complete transfusion in 4 hour. (keep adrenaline, hydrocortisone, avil and paracetamol at hand.)
  • Stop transfusion if fever with shivering occurs. Give IV Inj. avil ½ -1ml & Hydrocortisone 20 mg/kg stat.  Get the blood re-cross-matched.
Restart Blood after lowering the temperature. Discard the blood if fever occurs again. Discard if the bag remains open for more than 4 hours.

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