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Causes of Hypochromic Microcytic Anemia in Children and Evaluation of Laboratory Parameters in the Differentiation. J Pediatr Hematol Oncol 2019; 41:e221-e223. [PMID: 30557168 DOI: 10.1097/mph.0000000000001382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Most common causes of microcytic anemia in children are iron deficiency anemia (IDA) and thalassemia. Differentiation of these and detection of coexistence is essential for genetic counseling and to set a treatment plan. Aim is to characterize the frequency of IDA and thalassemia trait (TT) in children presenting with hypochromic, microcytic anemia and to define the significance of blood count parameters in differential diagnosis. Of the 200 enrolled, 107 were male (53.5%). In total 154 had IDA (77%), 27 had β-TT (13.5%), and in 11 (5.5%) both conditions coexisted. Eight patients had α-thalassemia gene mutations, 3 of these also had IDA. RBC, MCV, Mentzer index, serum iron, TIBC, ferritin were significantly different between IDA and β-TT patients (P<0.001); however, RDW was not different between the 2 groups (P>0.05). Sensitivity and specificity of Mentzer index for the detection of β-TT were 100% and 69.4%, respectively. The positive and negative predictive values of Mentzer index in diagnosing β-TT were 36.6% and 100%, respectively. Differential diagnosis of microcytic anemia is important in children, especially in regions where IDA and thalassemia are both prevalent. We found that 7% of children referred to our clinic for hypochromic, microcytic anemia had both TT and IDA. Our data showed that serum iron, ferritin, TIBC, MCV, and Mentzer index were all valuable markers in diagnosing IDA and were significantly different compared with β-TT patients; RDW was not different between the 2 groups.
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Sarbay H, Ay Y. Evaluation of children with macrocytosis: clinical study. Pan Afr Med J 2019; 31:54. [PMID: 30923599 PMCID: PMC6431413 DOI: 10.11604/pamj.2018.31.54.15498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/04/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Hakan Sarbay
- Diyarbakır Children Hospital, Paediatric Hematology and Oncology Diyarbakır, Turkey
| | - Yılmaz Ay
- Pamukkale University Faculty of Medicine, Paediatric Hematology and Oncology, Turkey
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Akande M, Audino AN, Tobias JD. Rasburicase-induced Hemolytic Anemia in an Adolescent With Unknown Glucose-6-Phosphate Dehydrogenase Deficiency. J Pediatr Pharmacol Ther 2017; 22:471-475. [PMID: 29290749 DOI: 10.5863/1551-6776-22.6.471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Rasburicase, used in the prevention and treatment of tumor lysis syndrome (TLS), may cause hemolytic anemia and methemoglobinemia in patients with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Although routine screening for G6PD deficiency has been recommended, given the turnaround time for test results and the urgency to treat TLS, such screening may not be feasible. We report a case of rasburicase-induced hemolytic anemia without methemoglobinemia in an adolescent with T-cell lymphoblastic lymphoma, TLS, and previously unrecognized G6PD deficiency. Previous reports of hemolytic anemia with rasburicase are reviewed, mechanisms discussed, and preventative strategies presented.
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Affiliation(s)
- Manzilat Akande
- Division of Pediatric Critical Care Medicine (MA), Nationwide Children's Hospital, Columbus, Ohio, Department of Pediatrics (MA, ANA), The Ohio State University College of Medicine, Columbus, Ohio, Division of Pediatric Hematology/Oncology/BMT (ANA), Nationwide Children's Hospital, Columbus Ohio, Department of Anesthesiology & Pain Medicine (JTD), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology & Pain Medicine (JTD), The Ohio State University College of Medicine, Columbus, Ohio
| | - Anthony N Audino
- Division of Pediatric Critical Care Medicine (MA), Nationwide Children's Hospital, Columbus, Ohio, Department of Pediatrics (MA, ANA), The Ohio State University College of Medicine, Columbus, Ohio, Division of Pediatric Hematology/Oncology/BMT (ANA), Nationwide Children's Hospital, Columbus Ohio, Department of Anesthesiology & Pain Medicine (JTD), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology & Pain Medicine (JTD), The Ohio State University College of Medicine, Columbus, Ohio
| | - Joseph D Tobias
- Division of Pediatric Critical Care Medicine (MA), Nationwide Children's Hospital, Columbus, Ohio, Department of Pediatrics (MA, ANA), The Ohio State University College of Medicine, Columbus, Ohio, Division of Pediatric Hematology/Oncology/BMT (ANA), Nationwide Children's Hospital, Columbus Ohio, Department of Anesthesiology & Pain Medicine (JTD), Nationwide Children's Hospital, Columbus, Ohio, and Department of Anesthesiology & Pain Medicine (JTD), The Ohio State University College of Medicine, Columbus, Ohio
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Herrador Z, Sordo L, Gadisa E, Buño A, Gómez-Rioja R, Iturzaeta JM, de Armas LF, Benito A, Aseffa A, Moreno J, Cañavate C, Custodio E. Micronutrient deficiencies and related factors in school-aged children in Ethiopia: a cross-sectional study in Libo Kemkem and Fogera districts, Amhara Regional State. PLoS One 2014; 9:e112858. [PMID: 25546056 PMCID: PMC4278675 DOI: 10.1371/journal.pone.0112858] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 10/15/2014] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION The present study describes the distribution of selected micronutrients and anaemia among school-aged children living in Libo Kemkem and Fogera (Amhara State, Ethiopia), assessing differences by socio-demographic characteristics, health status and dietary habits. METHODS A cross-sectional survey was carried out during May-December 2009. Socio-demographic characteristics, health status and dietary habits were collected. Biomarkers were determined for 764 children. Bivariate and multivariable statistical methods were employed to assess micronutrient deficiencies (MD), anaemia, and their association with different factors. RESULTS More than two thirds of the school-aged children (79.5%) had at least one MD and 40.5% had two or more coexisting micronutrient deficiencies. The most prevalent deficiencies were of zinc (12.5%), folate (13.9%), vit A (29.3%) and vit D (49%). Anaemia occurred in 30.9% of the children. Children living in rural areas were more likely to have vit D insufficiency [OR: 5.9 (3.7-9.5)] but less likely to have folate deficiency [OR: 0.2 (0.1-0.4)] and anaemia [OR: 0.58 (0.35-0.97)]. Splenomegaly was positively associated with folate deficiency and anaemia [OR: 2.77 (1.19-6.48) and 4.91 (2.47-9.75)]. Meat and fish consumption were inversely correlated with zinc and ferritin deficiencies [OR: 0.2 (0.1-0.8) and 0.2 (0.1-0.9)], while oil consumption showed a negative association with anaemia and deficiencies of folate and vitamin A [0.58 (0.3-0.9), OR: 0.5 (0.3-0.9) and 0.6 (0.4-0.9)]. Serum ferritin levels were inversely correlated to the presence of anaemia (p<0.005). CONCLUSION There is a high prevalence of vitamin A deficiency and vitamin D insufficiency and a moderate prevalence of zinc and folate deficiencies in school-aged children in this area. The inverse association of anaemia and serum ferritin levels may be due to the presence of infectious diseases in the area. To effectively tackle malnutrition, strategies should target not only isolated micronutrient supplementation but also diet diversification.
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Affiliation(s)
- Zaida Herrador
- National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain
| | - Luis Sordo
- National Centre of Epidemiology, ISCIII, Madrid, Spain
- Department of Preventive Medicine and Public Health, Faculty of Medicine, Complutense University, Madrid, Spain
- Network Biomedical Research Centers, Epidemiology and Public Health (CIBERESP in Spanish), Madrid, Spain
| | | | | | | | | | | | - Agustín Benito
- National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain
| | - Abraham Aseffa
- Armauer Hansen Research Institute, Addis Ababa, Ethiopia
| | - Javier Moreno
- National Centre of Microbiology, ISCIII, Madrid, Spain
| | | | - Estefania Custodio
- National Centre of Tropical Medicine, Instituto de Salud Carlos III (ISCIII), Madrid, Spain
- Tropical Diseases Research Network (RICET in Spanish), Madrid, Spain
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[Aplastic crisis due to parvovirus B19 and Epstein-Barr virus in a patient with hereditary spherocytosis]. An Pediatr (Barc) 2014; 82:e102-7. [PMID: 24629905 DOI: 10.1016/j.anpedi.2013.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 12/20/2013] [Indexed: 11/21/2022] Open
Abstract
Anemic syndrome in childhood requires a diagnosis and urgent treatment guided by systematic protocols that can avoid unnecessary additional testing. The case of a 4 year-old girl with fatigue and intermittent fever of 7 days duration, accompanied by abdominal pain is presented. She had regular general health status, with mucocutaneous jaundice, a grade III/VI/iv murmur, and painful abdomen with hepatosplenomegaly. The blood analysis showed a hypo-regenerative anemia with increased LDH and indirect bilirubin. The Coombs Test was negative, with spherocytes being observed in the peripheral blood smear. The IgM and IgG were positive for parvovirus B19 IgM and Epstein Barr virus, leading to the diagnosis of aplastic crisis in a patient with hereditary spherocytosis. No specific treatment was required. Under the suspicion of anemic syndrome in emergencies, the ABCDE sequence must be followed. Through the history, physical examination and basic laboratory tests, an initial diagnostic approach can be made. Specific etiological tests should be based on this first study.
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Liem RI, Anand R, Yin W, Alonso EM. Risk factors for chronic anemia in pediatric orthotopic liver transplantation: analysis of data from the SPLIT registry. Pediatr Transplant 2012; 16:137-43. [PMID: 22188527 PMCID: PMC3288717 DOI: 10.1111/j.1399-3046.2011.01631.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Risk factors for chronic anemia in the post-transplant period have not been clearly delineated in pediatric liver transplant recipients. We analyzed data from children transplanted from 2000 to 2008 with at least two consecutive hemoglobin values from follow-up between six months and five yr post-transplant. A multivariate model was derived to determine independent risk factors associated with chronic anemia. Of 1026 children in this analysis, 242 (23.6%) were found to have chronic anemia. On multivariate analysis, GI bleeding (OR 11.83 [2.08-67.49], p = 0.0054), presence of leukopenia (OR 9.55 [95% CI 3.71-24.62], p < 0.0001), use of cyclosporine (OR 3.69, [95% CI 1.56-8.76], p = 0.0039) and corticosteroids (OR 2.90 [95% CI 1.94-4.33], p < 0.0001), and cGFR <90 mL/min/1.73 m(2) (OR 4.62 [95% CI 2.47-8.67], p < 0.0001) represented the most significant risk factors for chronic anemia. Use of antihypertensive medications (OR 1.89 [95% CI 1.23-2.91], p = 0.0039) was also significantly associated with a higher risk. In summary, chronic anemia is common in children following liver transplant. Our findings underscore the need to define the mechanisms by which these risk factors, some of which are modifiable, result in chronic anemia in pediatric liver transplant recipients.
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Affiliation(s)
- RI Liem
- Divisions of Hematology, Oncology & Stem Cell Transplant; Children’s Memorial Hospital; Department of Pediatrics, Northwestern University Feinberg School of Medicine; Chicago, Illinois
| | - R Anand
- The EMMES Corporation; Rockville, Maryland
| | - W Yin
- The EMMES Corporation; Rockville, Maryland
| | - EM Alonso
- Divisions of Gastroenterology, Hepatology & Nutrition; Children’s Memorial Hospital; Department of Pediatrics, Northwestern University Feinberg School of Medicine; Chicago, Illinois
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Hematology and Oncology in Critical Illness. PEDIATRIC CRITICAL CARE STUDY GUIDE 2012. [PMCID: PMC7178863 DOI: 10.1007/978-0-85729-923-9_38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
This chapter will focus on a variety of hematologic issues pertinent to the care of critically ill children. This is an area of intense research with the pathophysiology underlying these clinical conditions becoming progressively better understood. This improved understanding has resulted in new therapeutic strategies that are being assessed in multicenter clinical trials. The chapter will begin by describing the incidence and pathophysiologic significance of anemia in the pediatric intensive care unit (PICU) providing a differential diagnosis of the many conditions that may present with anemia in this setting. The chapter will next consider disseminated intravascular coagulation (DIC) focusing on the pathophysiology of a condition that has been associated with much morbidity and mortality. The underlying conditions predisposing to DIC will be detailed as well as a number of treatment options that have been implemented in clinical trials. In addition to DIC, thrombocytopenia may be caused by a number of other clinical conditions important to the pediatric critical care provider. The clinical and prognostic significance of thrombocytopenia will be addressed and a focused differential diagnosis will be provided. Thrombotic disorders are becoming increasingly recognized in children and are a particular concern for the pediatric intensivist. The epidemiology of thromboembolism in children will be reviewed focusing on the conditions most commonly associated with these thromboses. Finally, a chapter on hematologic issues in the critically ill child would not be complete without a discussion of sickle cell disease. Acute chest syndrome, one of the most frequent complications of sickle cell disease resulting in the need for intensive care services, will be discussed in detail.
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Mourad S, Rajab M, Alameddine A, Fares M, Ziade F, Merhi BA. Hemoglobin level as a risk factor for lower respiratory tract infections in Lebanese children. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2010; 2:461-6. [PMID: 22558548 PMCID: PMC3339108 DOI: 10.4297/najms.2010.2461] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pneumonia is the biggest single cause of childhood death under the age of 5 years, and anemia affects approximately 30% of infants and children all over the world. AIM Determination of the relationship between anemia and lower respiratory tract infection as a risk factor in Lebanese children. PATIENTS AND METHODS A total number of two hundred infants and children aged nine months to twelve years were included; One hundred cases were hospitalized for lower respiratory tract infection in Department of Pediatrics, Makassed General Hospital, and one hundred healthy, age and sex matched controls, were selected from outpatient department. Complete blood count, iron level, ferritin level, and total iron binding capacity were taken if hemoglobin level less than eleven gram per deci-liter. In addition peripheral blood smear, chest radiograph and C-reactive protein were done to hospitalized cases. Definition of iron deficiency anemia and normal laboratory values were predetermined. RESULTS Anemia was found in 32% of hospitalized cases and 16% of healthy controls. Mean hemoglobin level was 9.99 ± 0.62 gram per deci-liter and 11.99 ± 0.92 gram per deci-liter in anemic and non-anemic group respectively with a significant P-value of 0.001. C-reactive protein levels and number hospitalization days were similar among the anemic and non-anemic group. History of recurrent chest infections was significantly higher in both anemic group and hospitalized cases compared to non-anemic group and healthy controls. Low hemoglobin level was a risk factor for lower respiratory tract infection with a P-value of 0.008. CONCLUSION Anemic children were two times more susceptible to lower respiratory tract infection compared to the control group, and iron deficiency anemia was predominating. Accurate diagnosis and prevention of anemia, whatever its etiology, is essential.
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Affiliation(s)
- Sawsan Mourad
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Mariam Rajab
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Aouni Alameddine
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Mohammad Fares
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Fouad Ziade
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
| | - Bassem Abou Merhi
- Department of Pediatrics, Makassed General Hospital, Beirut, Lebanon
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Santiago M. Thalassemia trait: what every NP should know. Nurse Pract 2009; 34:14-22. [PMID: 19952582 DOI: 10.1097/01.npr.0000365122.66033.3e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Kashyap AS, Anand KP, Kashyap S. Case 3-2009: a 9-month-old boy with seizures. N Engl J Med 2009; 360:1572; author reply 1573-4. [PMID: 19357417 DOI: 10.1056/nejmc090378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Perkins SL, Reddy VBV, Reichard KK, Thompsen MA, Dunphy CH. Recommended curriculum for teaching hematopathology to subspecialty hematopathology fellows. Am J Clin Pathol 2007; 127:962-76. [PMID: 17509994 DOI: 10.1309/6c41q30m5rm83qmh] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
The performance and interpretation of clinical hematology and hematopathology laboratory tests and diagnosis of benign or malignant hematolymphoid disorders present unique challenges to hematopathology fellow trainees. To assist hematopathology fellowship program directors in preparing trainees to meet these challenges, a task force of pathologists with expertise in hematopathology developed a suggested training curriculum that includes a comprehensive list of topics in the areas of analytic hematology, bone marrow pathology, lymph node pathology, splenic pathology, lymphoma diagnostics, cytogenetics, and molecular diagnostics. This report also includes recommendations for training experiences that will facilitate the transition of subspecialty residents to practicing consultants in hematopathology.
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Affiliation(s)
- Sherrie L Perkins
- Department of Pathology, University of Utah, Salt Lake City , UT 84132, USA
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