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    Pallor

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    Awatef Abushhiwa
    This document discusses pallor in children and provides information on causes, evaluation, and case scenarios. It defines pallor and lists hematological and non-hematological causes. An approach to evaluation of an anemic child is outlined including relevant history taking and physical exam points. Three case scenarios are presented and diagnoses of iron deficiency anemia, hemolytic anemia, and Fanconi anemia are discussed.

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    Pallor

    Uploaded by

    Awatef Abushhiwa
    928 views27 pages
    This document discusses pallor in children and provides information on causes, evaluation, and case scenarios. It defines pallor and lists hematological and non-hematological causes. An approach to evaluation of an anemic child is outlined including relevant history taking and physical exam points. Three case scenarios are presented and diagnoses of iron deficiency anemia, hemolytic anemia, and Fanconi anemia are discussed.

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    This document discusses pallor in children and provides information on causes, evaluation, and case scenarios. It defines pallor and lists hematological and non-hematological causes. An approach to evaluation of an anemic child is outlined including relevant history taking and physical exam points. Three case scenarios are presented and diagnoses of iron deficiency anemia, hemolytic anemia, and Fanconi anemia are discussed.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    928 views27 pages

    Pallor

    Uploaded by

    Awatef Abushhiwa
    This document discusses pallor in children and provides information on causes, evaluation, and case scenarios. It defines pallor and lists hematological and non-hematological causes. An approach to evaluation of an anemic child is outlined including relevant history taking and physical exam points. Three case scenarios are presented and diagnoses of iron deficiency anemia, hemolytic anemia, and Fanconi anemia are discussed.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 27

    a Child with pallor

    Dr. Houwayda Al Hagi


    2016

    objectives
    To list the different causes of pallor.

    awearing about the relevant points

    in the history to reach a diagnosis.


    To

    stress on the relevant finding in


    the examination that enable you to
    reach a diagnosis.
    To know how to approach different
    scenario.

    Contents:
    Pallor(definition

    and causes).
    Classification of anemia.
    Approach to anemic child(history
    and examination).
    Three case scenario.

    :PALLOR
    The

    development of pallor can be acute


    and associated with a life-threatening
    illness, or it can be chronic and subtle

    Causes:
    Hematological
    hematological
    (anemia)

    non
    - shock
    - anaphylaxis
    - resp. failure
    - hypoglycemia

    ?Where to look for pallor


    conjunctiva
    mucous membrane: - lips
    - nail bed
    - palm & soles

    ANEMIA

    Anemia is defined as a condition in


    which the hemoglobin (Hb) and/or
    HTC concentration is below 2 SD in
    peripheral blood lower than normal
    for age, sex, and pregnancy state of
    the subject.
    Neonate: Hb <14g/dl
    1-12 months: Hb <10g/dl
    1-12 years: Hb <11g/dl.

    MCV

    HCT

    110

    55 (4565)
    36 (3141)
    37 (3342)

    100
    70-74

    Hgb
    .

    16.8(13.7-

    AGE

    At birth

    20.1)

    12 (9.514.5)
    12 (10.514)

    76 -80 38(34-40) 13 (11-16)

    3 Month
    6 Mo6yr
    7-12 yr
    Adult

    80
    80

    47(42-52)
    42(37-47)

    16(14-18)
    14(12-16)

    Male
    Female

    CLASSIFICATION

    Blood loss: acute and chronic


    deficiency of haemopoieotic
    factors: iron ,folate and B12
    deficiency.
    Hemolysis:
    Bone marrow failure: congenital or
    acquired.
    Infiltration/infection/inflammation
    / chronic illness.

    Approach to a child with


    anemia

    History
    M/C: pallor: onset, duration, progression
    association (fever, yellowish
    discoloration, abd. Pain/distension,
    change inbowel habit and color of urine ,.
    Activity of child , headache, sleep and
    mode disturbance.
    H/O blood loss (nose, gum, GIT,
    menstruation if adolescent girl.

    PMH:

    anemia before, blood


    transfusion, medication.
    Development and schooling.
    Diet history: type of food
    ,eating behavior, milk amount
    and type ,pica (pagophagia).
    Drug history:(eg: anticonvalsent).
    F/H: same illness, splenectomy,
    GS, Bl.Tx.
    S/H: consanguinity, economic
    status. etc.

    Examination
    Well

    or unwell?
    Vital signs and growth parameters.
    associated congenital anomalies
    Pallor, jaundice, glossitis, angular
    stomatitis, skin stigmata, a
    koilonychia, other signs of
    nutritional deficit,
    hepatosplenomegaly, and LAP.

    Case (1)
    A

    22 month old boy presents with pallor. A


    visiting relative who has not seen the child for
    5 months told his mother that the boy appears
    pale. he is an active toddler, with no recent
    fatigue, increase in sleeping, or exercise
    intolerance. He has had no blood in his diapers
    and no black or tarry stool. He is a picky eater,
    taking only small amounts of chicken, beaf,and
    some vegetables, but loves milk and drinks six
    to eight bottles of whole milk daily; Family
    history reveals no H/O splenectomy, gall stones
    at an early age, or other anemia in the family.
    What is the diagnosis?

    Diagnosis: neutrional iron


    deficiency anemia
    Why?
    Investigation:
    - CBC, blood film, Retic`s count.
    S.iron, S. Ferritin , TIBC
    Stool for occult blood.
    Treatment: diet modification,
    ferrum supplement.

    Case (II)
    3yr old girl, mother noticed
    pallor and yellowish eyes,
    decreased activity for the last
    one month. 2D ago has fever and
    become more weaker. Sought
    medical advice in polyclinic, the
    recommendation was to give
    honey but she didn`t improved.
    O/E: average built, pale
    jaundiced, normal vital signs,
    spleen 6cm BCM

    ?What is the diagnosis


    Hemolytic

    anemia:

    1)Membrane defect: Heridetary


    Sepherocytosis,
    2) Enzyme defect: G6PDH, pyruvate
    kinase def.
    3) hemoglobinopathy: - sickle cell
    anemia
    - -thalassaemia
    major
    4)Immune: AIHA

    :Investigations
    CBC
    Blood

    film
    raised reticulocyte count
    elevated unconjugated bilirubin.
    excess urinary urobilinogen.
    positive direct antiglobulin test
    DCT(only if an immune cause).

    Case (III)
    7

    year old boy referred from


    orthopedist with anemia Hb=
    7g/dl, he presented to him
    because of Rt. thumb deformity.
    O/E: short stature, pale, not
    jaundiced, multiple coffee auilat
    spots and multiple bruises all
    over the body and no
    organomegaly no
    lymphadenopathy

    Fanconi anemia

    ?What is next work up

    CBC, blood film, low Retic count.


    hemoglobin electrophoresis
    BMA & B
    U/S abd. & Echocardiography.
    Chromosomal breakage
    gene analysis
    arrange for BMT

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