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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