Maharajgunj Nursing campus

Apsara Kandel
ANAEMIA
• Anaemia in children is defined as hemoglobin concentration
below established cut off levels.These levels vary according to
the age of child and the lab in which blood is tested.

• The level of hemoglobin below which anaemia is said to be

present are less than 11gm/dl in children aged 1 to 2 years
and less than 11.2g/dl in children between aged 3 to 5
years(WHO).
• Hemoglobin level below 11g/dl in children between 6 months
to 6 years of age or below 12g/dl in older children is
suggestive of anaemia.(O.P Ghai)
• Age Hb level(g/dl)
At birth 16.5

1-3 days 18.5

7days 17.5

14days 16.5

1month 14

1year 12

2-6 years 12.5

6-12 years 13.5

CLASSIFICATION
• Anaemia during infancy and early childhood can be classified
acording to the morphology of red cells or the cause of
anaemia.
 According to the morphology of red cells
A. Microcytic Hypochromic Anaemia
i. Iron deficiency anemia
 During infancy:nutritional and post hemorrhagic
 Older children:post hemorrhagic and nutritional
ii. Ineffective erthropoiesis
 Thalassemia
 Pyridoxine responsive anemia
 Dyserythropoietic anemia
 Lead poisoning
B. Normocytic Normochromic Anemia:RBC normal in shape
i. Impaired cell production
 Leukocytes and platelets normal:physiological anemia of
infancy,infections and pure red cells aplasia
 Leukocytes and platelets are normal or decreased:chronic
renal and liver disease and hypothyroidism
 Leukocytes and platelets reduced:aplastic anemia and
myeloproliferative leukemia
ii. Hemolysis
 Intracorpuscular defects:
- Heriditary red cell enzyme deficiency i.e G6PD
deficiency ,pyruvate kinase deficiency
- Heriditary defect of red cell membrane i.e
heriditary spherocytosis
- Ineffective erythropoiesis i.e thalassemia
- Sickle cell disease
 Extra corpuscular defect
- Iso immunization;Rh and ABO ,auto immunization
- Infections:Malaria,kala azar, chronic infections
C. Macrocytic Anaemia
i. Megaloblastic erythropoiesis
 Nutritional deficiency;vit B12 deficiency,folate
deficiency,kwashiorkor
 Toxic effect of drugs i.e methotrexate therapy and
anticonvulsant therapy(phenytoin)
 Malabsorption
ii. Non megaloblastic erythropoiesis
 Chronic hemolytic anemia,liver disease
 hypothyroidism
 According to the causes of anemia
A. Anemia due to impaired RBC:
i. Deficiency of substances needed for erythropoiesis: Iron and
folic acid deficiency
ii. Disturbance of proliferation and differentiation of stem
cells:aplastic anemia and aplasia of pure red cells
iii. Disturbance of bone marrow function or due to systemic
disease: infection,worm infestation,renal and liver
disease,malignancy,endocrinopathies
iv. Anemia due to bone marrow dysfunction:leukemia
myelosclerosis,multiple myeloma
v. Congenital anemia:sickle cell disease,congenital
dyserythropoetic anemia
B. Anemia due to increased red cell destruction(hemolysis)
i. Genetic
 Heriditary spherocytosis
 G6PD deficiency,pyruvate kinase deficiency,sikle cell disease
ii. Acquired
 Autoimmune hemolysis
 Hemolytic disease of the new born(malaria,septicemia) and
blood transfusion reaction
 Drug,toxins and hypersplenism
 Thermal injury or burn
C. Anemia due to blood loss
i. Blood loss due to injury or accident
ii. GI bleeding
iii. Heavy menstrual loss in girls
Mechanism Of Development of
Anemia
• Causes of anemia
• Sufficient iron is not found for Hb synthesis
• Decreased Hb production
• As Hb production decreases newly formed RBC become
smaller(microcytic) and contains less Hb(hypochromic)
• Now blood has reduced Hb level and oxygen carrying
capacity.Anaemia is developed in 3 phases:
i. Phase 1: characterized by depletion of hemosiderin,ferritin
and other iron storage in the bone marrow,liver and spleen
ii. Phase 2:lack of transport of iron resulting in decrease of iron
saturation of transferrin
ii. Phase 2:lack of transport of iron resulting in decrease of iron
saturation of transferrin

iii. Phase 3:marked deficit in transport of iron,inhibiting the

production of hemoglobin
Patho physiology
• Decreased RBCs due to any reasons such as change in
morphology,loss of blood or increased destruction

• Oxygen carrying capacity of blood decreases leading to

hypoxia

• Persistent and severe reduction of RBC cause hemo dilution

and decreased peripheral resisrance

• Cardiac workload is increased during

exercise,infection,emotional stress that result in marked
reduction of Hb and cardiac failure.