빈혈 (Anemia)

- Phyysiologic adjustment to anemia: Cardiac output 증가, oxygen extraction 증가, vital organ & tissue로 blood shunting, EPO 생성증가

 

1) Hx and P/Ex

- 성별, 나이, 인종, 식이습관, 약물 복용력, 만성질환유무, 감염유무

- 빈혈로 인한 임상증상은 Hb이 7-8g/dL 미만이 되어야 보통 나타남.

- 창백(혀, 손톱, 결막, 손바닥, 손바닥 주름), 기면, 보챔, 운동능력저하

- 더 진행되면 쇠약감이 심해지고, 빈호흡, 빈맥, high-output heart failure 까지 진행가능

 

2) Lab 

- Hb, Hct, RBC indices, WBC, PLT, reticulocyte count, PBS 

 

3) DDx 

- RBC morphology & physiology 

- MCV: microcytic, normocytic, macrocytic 

- reticulocyte % 및 RPI (0.5~2.5%가 normal range. 2% 이상인 경우 adequate response, 2% 미만이면 hypoproliferation)

 

Nelson Textbook of Pediatrics, 21st ed.

 

 

4) Physical findings and anemia 

*skin

- hyperpigmentation: fanconi anemia, congenital dyskeratosis

- Cafe au lait spots: fanconi anemia 

- Vitiligo: vitamin B12 deficiency

- Jaundice: hemolysis, hepatitis

- Petechiae, purpura: bone marrow infiltraion, autoimmune hemolysis, HUS 

- Erythematous rash: Parvovirus, EBV 

- Butterfly rash: SLE 

 

*Head 

- Frontal bossing: Thalassemia major, severe IDA, chronic subdural hematoma

- Microcephaly: Fanconia anemia, Diamond-Blackfan syndrome

 

* Eyes

- Micophtalmia: fanconi anemia

- Retinopathy: hemoglobin SS, SC disease 

- Optic atrophy, blindness: osteropetrosis

- K-F ring: wilson disease

- blue sclera: IDA 

 

* Mouth 

- Glossitis: vitamin B12 deficiency, iron deficiency

- Angular stomatitis: IDA 

- Cleft lip, palate: Diamond-Blackfan syndrome

- Pigmentation: Peutz-Jeghers syndrome

- Telangiectasia: Osler-Weber-Rendu syndrome

- Leukoplakia: Dyskeratosis congenital

 

* Chest

- Shield chest or widespread nipples: Diamon-Blackfan syndrome

- Murmur: Endocarditis, prosthetic valve hemolysis

 

* Abdomen

- Hepatomegaly: hemolysis, infiltrative tumor, chronic disease, hemangioma, cholecystitis

- Splenomegaly: hemolysis, sickle cell disease, malaria, lymphoma

- nephromegaly: Fanconi anemia

- Absent kidney: Fanconi anemia

 

* Extremities

- Absent thumbs: Fanconi anemia

- Thenar eminence hypoplasia: Diamond-Blackfan syndrome

- Spoon nails: IDA

- Beau line (nails): heavy metal intoxication, severe illness

- Mees line (nails): Heavy metal, severe illness, sickle cell anemia

- Dystrophic nails: Dyskeratosis congenitla

 

* Rectal

- Hemorrhoids: Portal hypertension

- Heme-positive stool: Intestinal hemorrhage

 

* Nerves

- Irritable, apathy: IDA

- Peripheral neuropathy: vitamin B1 and B12 deficiency, lead poisoning

- Dementia: vitamin B12 and E deficiency

- Ataxia; Vitamin B12 deficiency and E 

- Stroke: Sickle cell anemia, paroxysmal nocturnal hemoglobinuria

 

Nelson Textbook of Pediatrics, 21st ed.