approchtoachildwithanaemia

approchtoachildwithanaemia - 13.11.2060 13.11.2060 Appraoch...

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Unformatted text preview: 13.11.2060 13.11.2060 Appraoch to a child with anaemia Dr. Pushpa Raj Sharma Professor of Child Health Institute of Medicine De finitio n o f a na e m ia • The c o nditio n o f ha ving to o fe w re d b lo o d c e lls . • It is a re duc tio n o f the re d c e ll vo lum e o r he m o g lo bin c o nc e ntra tio n b e lo w -2S D fo r a g e , ra c e a nd s e x. • Mic ro s c o pic : no rm o c ytic ,m ic ro c ytic ,no rm o c hro m ic m a c ro c ytic o r s pe c ific a bno rm a litie s (s phe ro c yte ,s ic kle c e ll,ta rg e t c e ll) C a s e • Nine m o nths o ld “Ra i” fe m a le , s ing le c hild • Re c urre nt fe ve r • Ma s s in a b do m e n with pa llo r • No his to ry o f ra s h, b le e ding , pe rs is te nt dia rrho e a , drug , ja undic e , pic a , • Ha d b lo o d tra ns fus io n 2 da ys b a c k • No c o ns a ng uity o f m a rria g e • No fa m ily his to ry o f g a ll s to ne s , ja undic e . • No lo s s o f we ig ht, e xc lus ive bre a s t fe e ding S um m a ry o f e xa m ina tio n finding • 9 Kg. • Mild pallor • No purpuric rash, lymphadenopathy, abnormal facies, • Gross spleenomegaly Diagnostic Approach-History • Age : Iron def rare without blood loss before 6mo in term infants. • Family Hist & Genetics: (1)X-linked: G6PD def (2)Aut dominant: Spherocytosis (3)Aut recessive: Sickle cell,Fanconi anemia (4)Family member with early age of cholecystectomy/splenectomy (5)Ethnicity: Thalassemia; G6PD def Diagnostic Approach-History • Diarrhoea: -Malabsorption of VitB12/E/Fe. Inflammatory bowel disease and anemia of chronic disease with or without blood loss. -Milk protein intolerance induced blood loss -Intestinal resection: Vit B12 def • Infection:- Giardia: iron malabsorption -Intestinal bacterial overgrowth: VitB12def -EBV,CMV,Parvovirus: BM suppression -Mycoplasma,Malaria: hemolysis -Hepatitis: aplastic anaemia -Endocarditis, HIV Diagnostic Approach-History • Nutrition: (1)Cows milk diet:iron def. (2)Strict vegetarian:Vit B12 def. (3)Goats milk: Folate def. (4)Pica: Plumbism,Iron def. (5)Cholestasis,malabsorption:VitE def • Drugs: (1)G6PD:oxidants(sulfa, primaquine, henna) (2)Immune...
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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approchtoachildwithanaemia - 13.11.2060 13.11.2060 Appraoch...

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