Anemia

Divisi Hematologi-Onkologi
I.Kesehatan Anak FK USU Medan

What is Anemia?
ANEMIA IS NEVER NORMAL
Reduction below normal in the mass of
red blood cells in the circulation
Hemoglobin concentration, hematocrit,
RBC count

Hemoglobin and Hematocrit Levels Below

which Anemia is Present in Population, WHO
2001

Global Anemia Prevalence and Number

of Individual Affected,WHO 2005

The Three Causes of Anemia

Decreased red blood cell
production
Increased red blood cell
destruction
Red blood cell loss

Decreased RBC production

Lack of iron, B12, folate
Marrow is dysfunctional from
myelodysplasia, tumor infiltration, aplastic
anemia, etc.
Bone marrow is suppressed by
chemotherapy or radiation
Low levels of erythropoeitin, thyroid
hormone, or androgens

Increased RBC destruction

RBCs live about 100 days
Acquired: autoimmune hemolytic anemia,
TTP-HUS, DIC, malaria
Inherited: spherocytosis, sickle cell,
thalassemia

RBC Loss
Bleeding!
Obvious vs occult
Iatrogenic: venesection e.g. daily CBC,
surgical, hemodialysis
Retroperitoneal

The high prevalence of Anemia in

Developing countries

Nutritional deficiencies
Chronic blood loss due to intestinal
parasitic infection
Malaria
HIV
Genetic hemoglobinopathies
( Gillespie and Johnston,1998; CDC,1998 ;
UNICEF 1997

Indonesia : high prevalence of anemia

among young children in urban and rural area

SKRT 1995: prevalence of anemia

among under fives was 40%
HKI/GOI Nutrition Surveillance
System (NSS) 1999 : prevalence
anemia among under fives was 50
85%
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Anemia in special case

People who live at high altitude have
greater RBC volume
Smokers have increased HCT
African-American HGBs are 0.5 to 1.0g/dL
lower than Caucasians
Athletes (increased plasma volume, Fe
deficiency, hemolysis, polycythemia, use
of performance enhancing agents)

History
Is the patient bleeding?
NSAIDs, ASA

Past medical history of anemia? Family

history?
Nutritional questions
Liver, renal diseases
Ethnicity
Environmental toxins (ie lead)

Approach to Anemia
LOOK AT THE
SMEAR!!!!
Convenient to
separate into three
classes based on the
size of the RBC
MCV and RDW

Microcytosis: < 80 fL
Normocytosis: 80-100
fL
Macrocytosis: >100 fL
CBC, reticulocyte
count, Fe, Ferritin,
TIBC, folate, B12,
LDH, CMP, ESR

Laboratory
Hemoglobin and hematocrit
Red cell indices
Peripheral blood smear
Reticulocyte count
Measures of hemolysis

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General Approach to Management

To know symptoms and signs
hematological and non hematological
Look at the smear.
Consider the etiology based on RBC
morphology and lab.studies MCV value
& RDW

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Important Notes for Pediatrician

Every child with significant
anemia
the MCV variation
Review peripheral blood smear

Recognized

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Investigation Of Anemia Based

On MCV

Anemi
a
MCV

Low
Low

Normal
Normal or
or high
high
Reticulocyte count

History, physical examination,

CBC
Compatible with iron deficiency

Peripheral Low
smear

No

High

Peripher
al
smear

yes
No
Hemolysis
Neutrophil
s,
platelets

Response to
Trial of iron

No
Hemolysis
Investigate
Blood loss

Hemolysis
yes
Iron
deficiency

No

Specific tests
Dictated by history,
physical, & red cell
morphology

Laboratory
evaluation of
microcytic
anemia

asting, C. Anemia ,
n: Hematology/Oncology Handbook, 2002 ; 2

Low
Bone marrow
failure

Normal or high
Pure red cell
aplasia or
megaloblatic
anemia

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