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

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Global Anemia Prevalence and Number
of Individual Affected,WHO 2005

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 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

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 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 • Microcytosis: < 80 fL

SMEAR!!!! • Normocytosis: 80-100
• Convenient to fL
separate into three • Macrocytosis: >100 fL
classes based on the • CBC, reticulocyte
size of the RBC count, Fe, Ferritin,
• MCV and RDW 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
Recognized the MCV variation
Review peripheral blood smear

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 Investigation Of Anemia Anemia
Based On MCV
MCV
Low Normal or high

History, physical examination, CBC Reticulocyte count

Compatible with iron deficiency

Peripheral Low High Peripheral

smear smear
No
yes
No Hemolysis No
Response to
Neutrophils, Hemolysis
Trial of iron
platelets Investigate
Blood loss
Hemolysis

yes No •Specific tests

•Dictated by history, physical,
Iron Laboratory
& red cell morphology
deficiency evaluation of
microcytic anemia

Low Normal or high

Hasting, C. Anemia , Bone marrow failure Pure red cell aplasia or

In: Hematology/Oncology Handbook, 2002 ; 2 megaloblatic anemia
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