Anemia is a common syndrome in the pediatric period and refers to a lower hemoglobin (HB) concentration, red blood cell count (RBC) and red blood cell pressure (HCT) per unit volume of peripheral blood than the normal standards for the same age, sex and region.
Normal values of hemoglobin
The World Health Organization (WHO) has set the normal value of hemoglobin for children aged 6 months to 6 years at ≥110 g/L, and for children aged 6 years to 14 years at ≥120 g/L. The Chinese Pediatric Hematology Group has set the normal value of HB for infants and children under 6 months, and for newborns (within 10 days) at ≥145 g/L. days or less) ≥ 145 g/L, 1 month – 4 months infants HB ≥ 90 g/L, 4 months – 6 months infants HB ≥ 100 g/L. where for every 1 km increase in altitude, the hemoglobin value rises by 4%.
Anemia HCT low limit value
The erythropoietic cell pressure (HCT) of anemia in children is also regulated, and the low limit of HCT for infants and children aged 6 – 23 months is 0.31; for children aged 2 – 5 years, the low limit of HCT is 0.34; for children aged 6 – The low limit of HCT for children aged 6 – 14 years is 0.37.
Anemia Scale
Many diseases manifest with anemia, so it is especially important to find the cause of anemia. There are three causes of anemia: insufficient production of red blood cells and hemoglobin, increased destruction of red blood cells (hemolysis) and excessive loss of red blood cells.
Clinical manifestations of anemia
Diagnosis of anemia
The importance of medical history for the diagnosis of anemia cannot be overstated, as it provides important clues for the examination of anemia and consideration of the condition.
If anemia is present at birth, prenatal hemorrhage or hemorrhage at delivery should be considered; if anemia is present within 48 hours after birth with jaundice, neonatal hemolytic disease should be considered; if anemia is present in infancy, it may be nutritional or genetic anemia; if anemia is present in childhood, it may be due to blood loss, reocclusion or other causes.
The course of the disease and accompanying symptoms are also extremely important to the diagnosis, and the child’s symptoms should be carefully observed, as shown in the following chart.
In the diagnosis, firstly, we should ask the feeding history of the child in detail such as the time of adding supplementary food, the quality and quantity of diet, and the food combination, which is beneficial to the diagnosis of nutritional anemia; secondly, we should ask the history of infection (tuberculosis, hookworm), chronic diseases (kidney disease, rheumatism, etc.), the history of medication (chloramphenicol, sulfonamide, etc.), and finally, we should not forget to ask whether there is hereditary anemia in the family history.
Physical examination of the child
It is important to check in detail the development of the child, whether there are any disorders and special facial features; and pay attention to the nutritional status, because children with nutritional anemia usually have poor nutritional status; observe whether the skin and mucous membranes are bleeding or pale; do not ignore the changes of nails and hair; pay attention to whether the liver and spleen lymph nodes of the child are enlarged.
Laboratory tests
The initial laboratory test for anemia is blood smear. Blood smear is used to help determine the cause of anemia based on blood cell morphology (size, heterotype, target type, staining); RBC and HB can determine the presence and degree of anemia; WBC and PLT can help determine the cause of anemia; reticulocytes are used to determine hemolysis or hematopoietic function.
In addition to blood smear, there are also bone marrow diagnostic tools for anemia. The bone marrow diagnostic features of common anemia are as follows.
1, hemolytic anemia: the bone marrow cells are actively proliferating, mainly with an increase in young red blood cells.
2. Aplastic anemia: The bone marrow is hypoproliferative and the cellular components of the myeloid, red and megakaryocytic lineages are significantly reduced, while the non-hematopoietic lineage cells such as lymphocytes and plasma cells are increased.
3. Iron deficiency anemia: Myeloproliferation is mainly in the red lineage, with an increase in basophilic juvenile erythrocytes. Granulocyte production is not significantly altered, and megakaryocytes are sometimes increased. Iron staining reveals the disappearance of extracellular iron and the marked decrease or disappearance of iron granulocytes.