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7/26/2019 K11 IKA Anemia
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AnemiaDivisi Hematologi-Onkologi
I.Kesehatan Anak FK USU Medan
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What is Anemia?
ANEMIA IS NEVE NOMA!
ed"#tion $elo% no&mal in the mass o'&ed $lood #ells in the #i"lation
Hemoglo$in #on#ent&ation( hemato#&it(
)* #o"nt
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++
Hemoglo$in and Hemato#&it !evels )elo%
%hi#h Anemia is ,&esent in ,o"lation( HO
/001
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22
3lo$al Anemia ,&evalen#e and N"m$e&
o' Individ"al A''e#ted(HO /004
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5he 5h&ee *a"ses o' Anemia
De#&eased &ed $lood #ell
&od"#tion
In#&eased &ed $lood #elldest&"#tion
ed $lood #ell loss
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De#&eased )* &od"#tion
!a#k o' i&on( )1/( 'olate
Ma&&o% is d6s'"n#tional '&om
m6elod6slasia( t"mo& in'ilt&ation( alasti#
anemia( et#.
)one ma&&o% is s"&essed $6
#hemothe&a6 o& &adiation
!o% levels o' e&6th&ooeitin( th6&oid
ho&mone( o& and&ogens
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In#&eased )* dest&"#tion
)*s live a$o"t 100 da6s
A#7"i&ed8 a"toimm"ne hemol6ti# anemia(
55,-HUS( DI*( mala&ia
Inhe&ited8 she&o#6tosis( si#kle #ell(
thalassemia
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)* !oss
)leeding9
O$vio"s vs o##"lt
Iat&ogeni#8 venese#tion e.g. dail6 *)*(s"&gi#al( hemodial6sis
et&oe&itoneal
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N"t&itional de'i#ien#ies
*h&oni# $lood loss d"e to intestinala&asiti# in'e#tion
Mala&ia
HIV
3eneti# hemoglo$inoathies
:
5he high &evalen#e o' Anemia in
Develoing #o"nt&ies
( Gillespie and Johnston,1998; CDC,1998 ;UNICEF 1997
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SKRT 19958 &evalen#e o' anemia
among "nde& 'ives %as 20;
HKI/GOI Nutrition Surveillance
Sstem !NSS" 1999# &evalen#eanemia among "nde& 'ives %as 40
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Anemia in s&ecial case
,eole %ho live at high altit"de have
g&eate& )* vol"me
Smoke&s have in#&eased H*5
A'&i#an-Ame&i#an H3)s a&e 0.4 to 1.0g=d!
lo%e& than *a"#asians
Athletes >in#&eased lasma vol"me( Fe
de'i#ien#6( hemol6sis( ol6#6themia( "se
o' e&'o&man#e enhan#ing agents?
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Histor
Is the atient $leeding@ NSAIDs( ASA
,ast medi#al histo&6 o' anemia@ Famil6
histo&6@
N"t&itional 7"estions
!ive&( &enal diseases
Ethni#it6
Envi&onmental toins >ie lead?
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A&&roach to Anemia
)OOK AT TH*
S+*AR,,,,
*onvenient to
sea&ate into th&ee#lasses $ased on the
siBe o' the )*
M*V and D
Mi#&o#6tosis8 C
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Hemoglo$in and hemato#&it
ed #ell indi#es
,e&ihe&al $lood smea& eti#"lo#6te #o"nt
Meas"&es o' hemol6sis
12
!a$o&ato&6
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5o kno% s6mtoms and signs
hematologi#al and non hematologi#al
!ook at the smea&. *onside& the etiolog6 $ased on )*
mo&holog6 and la$.st"dies M*V val"e
D
14
3ene&al A&oa#h to Management
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1
Every child with significant
anemia
Imo&tant Notes 'o& ,ediat&i#ian
Recognizedthe MCVvariation
Review peripheral bloodsmear
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Anemia
Response toTrial of iron
History, physical examination,CBC
Compatible with iron deciency
MCV
Irondeciency
eripheralsmear
!e"trophils,
platelets
In#esti$ateBlood loss
%pecic tests
&ictated by history,physical, ' red cellmorpholo$y
"re red cellaplasia orme$aloblaticanemia
(aboratorye#al"ation of
microcyticanemia
Bone marrow
fail"re
(ow(ow
(ow
yes
yes
!o
Hemolysis
!ormal or hi$h!ormal or hi$h
Hi$h
!ormal or hi$h
!oHemolysis
sting, C. ne!ia ,
" He!atolog#$%n&olog# Hand'oo, )**) ; )
(ow
!o
!oHemolysis
eripheral
smear
Investigation O' Anemia )ased
On M*V
Investigation O' Anemia )ased
On M*V
Retic"locyte co"nt
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