Anemia in Children: Three Categories

by Brian Alverson, MD

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    00:01 In this lecture, we’re going to review anemia in children.

    00:05 It’s a complicated topic and broad, but we’re going to try and cover it in a systematic way.

    00:11 So anemia is a drop in hemoglobin or hematocrit by more than 2 standard deviations.

    00:18 There are three major categories that we think of anemia as being in.

    00:22 One is impaired production.

    00:24 If you can’t make red blood cells, you’ll have fewer of them.

    00:27 Another is increased destruction.

    00:30 If you’re destroying them, you’ll have fewer of them.

    00:32 And the last is just general blood loss.

    00:35 Okay.

    00:36 So if we’re looking at the area of impaired production of cells, there’s a couple of different ways this can go.

    00:44 The first is the patient could have a true red cell aplasia.

    00:48 They’re simply not making red blood cells.

    00:51 Causes of this include the parvovirus B19 infection.

    00:55 So the virus comes in, it actually suppresses bone marrow production.

    01:00 Patients may have a congenital inability to actually make red blood cells, a congenital erythroblastopenia such as Blackfan-Diamond anemia.

    01:10 Or children can get a unique disease usually in the first few years of life called transient erythroblastopenia of childhood.

    01:19 In this condition, they transiently stop making red blood cells and then recover from that a few months later.

    01:26 Very rare, patients could have aplastic anemia, Fanconi anemia, leukemia, there are other causes.

    01:34 Moving on, patients can have ineffective erythropoiesis.

    01:38 This can be because of a problem with actually just making the red cells.

    01:42 They're having a difficulty at some stage.

    01:45 One is obviously iron deficiency.

    01:48 Patients could also be folate or B12 deficient.

    01:51 Chronic inflammation such as juvenile idiopathic arthritis can cause an ineffective erythropoiesis.

    01:59 Chronic renal failure can decrease EPO production and thus, there will be ineffective erythropoiesis.

    02:05 And lead poisoning can interfere with red cell production and cause an ineffective erythropoiesis.

    02:11 Very rarely, patients may have a myelodysplastic syndrome.

    02:16 Okay. What about increased destruction? Well, there are red cell membrane disorders like hereditary spherocytosis or hereditary elliptocytosis and we’ll go through those.

    02:28 Patients may have red cell enzyme disorders like glucose-6-phosphate dehydrogenase deficiency.

    02:34 In that case, they are having attack of the red blood cells because of uncontrolled oxidative stress.

    02:41 Patients may have hemoglobinopathy, something like a thalassemia or sickle cell disease.

    02:47 Or there can be an autoimmune attack on the red blood cell such as autoimmune hemolytic anemia or hemolytic anemia of the newborn.

    02:56 In terms of blood loss situations, babies at birth can experience blood loss through a difficult labor and loss of blood through the umbilical stump.

    03:06 In GI disease, patients may have polyps or a Meckel’s diverticulum that’s causing excessive bleeding out of the anus and they’re losing blood that way.

    03:15 Or there can be other causes of blood if a patient especially has a bleeding disorder like Von Willebrand or hemophilia or just a really bad trauma.

    About the Lecture

    The lecture Anemia in Children: Three Categories by Brian Alverson, MD is from the course Pediatric Hematology.

    Included Quiz Questions

    1. Glucose-6-phosphate dehydrogenase deficiency
    2. Parvovirus B19
    3. Blackfan-Diamond syndrome
    4. Transient erythroblastopenia of childhood
    5. Chronic renal insufficiency
    1. Lead poisoning
    2. Parvovirus B19
    3. Blackfan-Diamond anemia
    4. Fanconi anemia
    5. Leukemia and transient erythroblastopenia of childhood
    1. Bleeding disorder
    2. Thalassemia
    3. Red cell aplasia
    4. Aplastic anemia
    5. Iron deficiency anemia

    Author of lecture Anemia in Children: Three Categories

     Brian Alverson, MD

    Brian Alverson, MD

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