ANEMIA PADA ANAK

Dr. Irma Rezky Ratu, T, spA

 ANEMIA
 Angka eritrosit atau Hb ↙ → kapasitas angkut oksigen ↙
Anak Normal Anemia
Ringan Sedang Berat
Bayi 6-59 bln ≥11 10-10,9 7-9,9 <7
Anak 5-11 thn ≥11,5 11-11,4 8-10,9 <8
Anak 12-14 thn ≥12 11-11,9 8-10,9 <8
Perempuan tidak ≥12 11-11,9 8-10,9 <8
hamil (≥15 thn)
Perempuan hamil ≥11 10-10,9 7-9,9 <7
Laki-laki (≥15 y) ≥13 11-12,9 8-10,9 <8

 Konfirmasi klinis
 ERITROSIT & HEMOGLOBIN

Mesin
Kerangka
O2 CO2 NO Angka eritosit atau Hb ↙
Hb
Kursi kapasitas angkut oksigen ↙
 ETIOLOGI ANEMA

ERITROSIT

Produksi ↙ Kehilangan ↗ Destruksi ↗

Sutul Nutritiona Perdarahan Hemolisis

Supresi, aplasi Defisiensi Intrinsik, ekstrinsik

 Ketidakseimbangan pemenuhan vs. kebutuhan

 Problem sumsum tulang, sirkulasi, keduanya
 TURNOVER BESI TUBUH (mg/hari))
ADB, hemolitik, penyakit kronik, gangguan absorpsi
SINTESIS & DESTRUKSI Hb
Anemia karena defisiensi besi & hemolitik
Eritrosit

Hb
Molekul Hb

Heme + globin
DEPOSIT
BESI
Fe + Porfirin rantai  + ,, 

Bilirubin
 TANDA & GEJALA ANEMIA
 Tanda umum kapasitas angkut oksigen rendah, kompensasinya
 Terkait kausa (produksi, kehilangan, destruksi eritrosit/Hb)
 Organomegali?
 Konfirmasi laboratorium penting
o Darah rutin (DL, CBC)
o Morfologi darah tepi
o Parameter lab. terkait kausa (profil besi, LFT, RFT, perdarahan, dll)
o Dilakukan serial (evaluasi respon terapi)
LAB : Indeks eritrosit
Based on entire RBC population
• Hb
• Hct
• MCV
• MCH
• RDW
Biochemical parameter
• Serum iron
• Ferritin
• Transferin
• Transferin saturation (TSAT)
• Hepcidin
Based on reticulocyte population
• Reticulocyte Hemoglobin (RET-
He/CHr)
LAB : Indeks eritrosit
LAB: MCV

(BMJ Best Practice, 2018)

 LAB: MCV
Age Type of Anemia
Microcytic Normocytic Macrocytic
Neonates a-thalassemia Acute blood loss Congenital aplasia
Isoimmunization (antibody-mediated hemolysis)
Congenital hemolytic anemia (spherocytosis, G6PD def)
Congenital infection (parvovirus B19)

Infants IDA Concurrent infection Vit. B12 or folate def.

Concurrent infection Acute blood loss Hypothyroidism
and Thalassemia IDA Hypersplenism
toddlers Sickle cell disease Congenital aplasia
RBC enzyme defects (G-6-PD, PK-deficiency,)
RBC membrane defects (spherocytosis, elliptocytosis)
Acquired hemolytic anemia
Autoimmune hemolytic anemia
Hypersplenism
Transient erythroblastopenia of childhood
Bone marrow disorders (leukemia, myelofibrosis)

Older IDA Acute blood loss Vit. B12 or folate def.

ACD IDA Hypothyroidism
children Thalassemia ACD (Anemia of chronic disease)
Acquired hemolytic anemia
Sickle cell disease
Bone marrow disorders (leukemia, myelofibrosis)
LAB: Low MCV

(AAFP, 2016)
LAB: Normal MCV

(AAFP, 2016)
LAB: High MCV

(AAFP, 2016)
 Iron deficiency anemia

-Diet low in heme iron

-GI disease or surgery
-Excessive cow’s milk intake
Inadequate -Excessive dietary tanin, phytates, starch
absorption -Competition with other metals (copper,
lead)
-Antacid therapy

Iron Deficiency Anemia

-low iron intake
-GI blood loss
Causes of -rapid growth in
-GU blood loss
Iron infancy and
-Pulmonary blood
adolescence
loss Deficiency
-menstruation,
-Other : trauma,
Faillure to pregnancy
surgery
Increased meet
loss increased
requirements
IDA: Absorpsi & metabolisme besi
IDA: MCV & iron studies

NO iron deficiency anemia

Iron deficiency anemia

(AAFP, 2013)
Tx IDA

(AAFP, 2013)
Ret-He/CHr, Hct

Menilai respon tx
(CHr vs. profil besi):
lebih awal & ekonomis
 TRANSFUSI
• Benefit melebihi cost
• Kondisi mengancam jiwa, unstable, dependent
• Reaksi & komplikasi transfusi
• PRC vs. whole blood
• Produk apheresis
• Lama transfusi < 4 jam/kantong
 TAKE HOME MESSAGES
• Anemia = kondisi ketidakseimbangan
• Terapi sesuai kausa
• Situasi sutul, sirkulasi, keduanya
• Indeks eritrosit bermanfaat untuk dx
dan monitor respon tx
TERIMA KASIH