Anemia in Children: Three Categories

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.