ANEMIA IN

CHILDREN

DR.Dr. Sri Mulatsih, Sp.AK

Pediatric Department, Faculty of
Medicine/ Sardjito Hospital
smulat@gmail.com

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 CLASSIFICATION

ANEMIA DURING
NEONATAL PERIODE

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Regulare Program 13 December 2010 3
 PRODUCTION

DESTRUCTION

MORPHOLOGY
BLEEDING

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 • APLASTIC ANEMIA
• INFECTION
APLASTIC • MALIGNANCY

• IRON AND FOLIC ACID DEFFICIENCY

• CHRONIC INFLAMATION
• CHRONIC RENAL FAILURE
ERYTHOPOEISIS

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 EXTRA-
CORPUSCULAR
CORPUSCULAR
• MEMBRANE • INTRA-
• Spherocytosis VASCULAR
• ENZIME • Immune
• G6PD • Non-Immune
• HB-PATHY • EXTRA-
• Thalassemia VASCULAR

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CHRONIC
ACUTE

FETO-MATERNAL
CONGENITAL

SYSTEMIC
LOCAL

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 MICROCYTIC
HYPOCHROMIC

NORMOCYTIC
NORMOCHROMIC

MACROCYTIC
NORMOCHROMIC

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 Microcytic-
hypochromic Iron Deficiency
Thalassemia
Chronic Infection
Hb-E trait
Sideroblastic Anemia
Severe Malnutrition

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 Normocytic-
normochromic Acute Bleeding
Infection
Renal Failure
Liver Disease
Malignancy
Early Iron Deficiency
Aplastic Anemia
Dyserythropoietic anemia

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 Macrocytic-
normochromic Newborn baby
Post-splenectomy
Liver Disease
Obstruction icteric
Aplastic anemia
hypothiroidism
Megaloblastic anemia

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SINGLE CELL- LINE ?

MULTIPLE CELL-LINE ?

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 HISTORY TAKING

PHYSICAL EXAMINATION

CBC, PERIPHERAL BLOOD

SMEAR

BONE MARROW
EVALUATION

ADDITIONAL
EXAMINATION

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 MATERNAL

FAMILY

PATIENT

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 BLOOD
HEAD- GI LOSS
WEAKNESS DYSPNEA
ACHE PROBLM (URINE OR
FECES)

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 ANEMIA

ICTERIC

TACHYCARDIA

TACHYPNEA

ORTHOSTATIC HYPOTENSION

SYSTOLIC EJECTION MURMUR

GLOCYTIS

SPLEEN ENLARGMENT

LIVER ENLARGMENT

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 Hb

WBC

Platelet

MCV

MCH

Reticulocyte

RDW

Peripheral blood smear

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 ANEMIA

MCV

MICROCYTIC NORMOCYTIC MACROCYTIC

RETICULOCYTE
IRON
DEFICIENCY
INCREASE
Thalassemia
Chronic infection
Bilirubin
Lead poisoning
Normal INCREASE

BLEEDING HEMOLYTIC Coombs test

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 ANEMIA

MCV

MICROCYTIC NORMOCYTIC MACROCYTIC

Retikulosit 

Leukocyte&
Platelet

decrease Normal increase

Pure red cell aplasia

Malignancy
Diamond Blackfan infection
Aplastic Transient
Anemia erythroblastopenia

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 Reticulocyte Reticulocyte
increase decrease

Occult •B12/Folic acid def

Bleeding ? •Chronic disease
•Liver, kidney, Thyroid
disease
yes No

• Hemolytic
Consider:
• PBS
BMA
•Coombs’ test

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 BLOOD LOSS

INCREASE D
DESTRUCTION

DECREASED
PRODUCTION

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 OBSTRETICAL
FETO-MATERNAL
TRANSFUSION
FETO-PLACENTAL
TRANSFUSION
TWIN-TWIN
TRANSFUSION
INTERNAL
HEMORRHAGE
IATROGENIC
HEMORRHAGE

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 INTRINSIC EXTRINSIC

• ENZIME • IMMUNE
• G6PD HEMOLYSIS
• MEMBRAN • Rh, ABO
• Spherocytosis • ACQUAIRED
• HP-PATHY HEMOLYSIS
• Thalassemia • Infection
• Vit E Def

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 PREMATURITY

APLASTIC

BM SUPRESSION

NUTRITIONAL

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 PRC
TRANSFUSION

LIMIT BLOOD
DRAWING - TEST

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