Anemia in Children: Pathology and Diagnosis

by Brian Alverson, MD

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    00:01 Another valuable test that we do in patients with anemia is we can actually look at the blood under the microscope.

    00:08 And the blood under the microscope, it’s hard to say whether the blood cells are small or big or have a normal distribution, that’s what the machine is for.

    00:16 But the blood cells can give us clues as to what’s going on.

    00:20 Do you see this picture here? This is a patient who is having an acute hemolytic anemia that’s an intravascular problem.

    00:27 They got helmet cells and cells are being clearly ripped apart.

    00:33 Here’s an example of a patient with a multi-lobular white blood cell, that’s going to tell me a little bit that this patient may have B12 deficiency.

    00:42 Here’s another example of where the picture might help us.

    00:45 Look at this slide carefully and you can see especially on the top right, next to that one little purple dots, this is called basophilic stippling.

    00:54 We sometimes see this in lead poisoning.

    00:57 So if saw this under the microscope, I know, “Uh-oh, better worry about lead poisoning.” Here’s another example of a picture.

    01:05 This patient has very abnormal shaped cells.

    01:09 So here’s a last one.

    01:11 This one should be pretty obvious to you.

    01:13 If you look at it carefully, you can see that some of the cells are long and thin instead of round.

    01:20 Yeah, this person has sickle cell disease and you can see it if you step back even if you look at the farther away view, you can see lots of little sickled cells.

    01:31 Even looking at this mirror might tell you how bad off they are right now, how much sickling is going on.

    01:39 Okay.

    01:40 So we’ve got a CBC, we know their reticulocyte and we know their MCV and we have sense of the RDW as well.

    01:49 Let’s break it down in terms of what might be going on.

    01:52 So I got a CBC in this patient, they had a high reticulocyte count, they are making lots of red blood cells, but they are microcytic.

    02:01 This is going to be a thalassemia.

    02:03 It’s a chronic indolent problem where the hemoglobin doesn’t quite work right and it breaks down easily, but they are trying to make more.

    02:11 If they have a high MCV, it’s big cells, this might be a membrane disorder or they may have G6PD or an autoimmune disease or sickle cell disease or hemolytic uremic syndrome.

    02:24 Perhaps they have DIC or disseminated intravascular coagulation or they could be suffering from chronic blood loss.

    02:32 We’ll use our history to start to get into this or if we are still unsure, we can do some tests to make sure.

    02:38 For example, for sickle cell disease, we could easily check hemoglobin.

    02:42 Or for G6PD, we could look for signs of G6PD on the smear or we can get a history that will clarify that or we can test for the enzyme.

    02:51 Now, here’s a CBC with diff where we going to have a low or a normal reticulocyte count.

    02:58 In other words, this patient is not cranking out cells.

    03:01 They have a low MCV, they may have ongoing iron deficiency.

    03:06 It’s hard for them to make reticulocyte counts, so it’s low.

    03:09 They may have lead poisoning or thalassemia trait or perhaps anemia of chronic disease.

    03:15 If they have large cells, once again, they may have aplastic anemia, transient erythroblastopenia of childhood, sickle cell disease, membrane disorders or autoimmune disease.

    03:28 You can see how these values are going to start to tweak our understanding or guessing of what things are and if you understand the disease, you’ll be able to put it together.

    03:37 So knowing that lead poisoning causes microcytic anemia and is a long indolent thing and prevents the production of reticulocyte counts, you can predict where it falls in this table.

    About the Lecture

    The lecture Anemia in Children: Pathology and Diagnosis by Brian Alverson, MD is from the course Pediatric Hematology. It contains the following chapters:

    • Anemia – Pathology
    • Anemia – Diagnosis

    Included Quiz Questions

    1. Lead poisoning
    2. Folate deficiency
    3. Hereditary eliptocytosis
    4. G6PD enzyme deficiency
    5. Sickle cell disease
    1. Helmet cells
    2. Multi-lobulated WBCs
    3. RBCs with basophilic stippling
    4. Target cells
    5. Sickle shaped cells
    1. Thalassemia
    2. Lead poisoning
    3. G6PD
    4. Aplastic anemia
    5. Iron deficiency

    Author of lecture Anemia in Children: Pathology and Diagnosis

     Brian Alverson, MD

    Brian Alverson, MD

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