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.