Paediatric-History taking & Physical examination of a patient with anemia

Paediatric-History taking & Physical examination of a patient with anemiaCreated OnApril 27, 2020Last Updated OnApril 27, 2020byadmin You are here: Main Clinical Examination Paediatric-History taking & Physical examination of a patient with anemia < All Topics Table of Contents History taking: Ask about patient’s information: name, age, gender, ancestry or ethnicity Age – consider age-specific causes of anemia Gender – males are prone to X-linked: G6PD and pyruvate kinase deficiencies Ancestry or race Thalassemia in persons of Mediterranean origin β-thalassemia in persons of Mediterranean, African, or Asian descent α-thalassemia in those of African and Asian descent G6PD deficiency in blacks, Greeks, and people of Middle Eastern origin SC and SS in African descent Ask about the chief complaint and relevant history of presenting illness Symptoms of anemia: Asymptomatic (chronic anemia) Pallor and palpitation Fatigue and lethargy Reduced exercise tolerance Irritability, excessive sleeping and poor oral intake (infants) Dizziness and anorexia Syncope and fainting Symptoms of hemolysis – jaundice and dark colored urine, abdominal mass (splenomegaly) Symptoms of bleeding – dark stool, fresh blood in stool, severe or chronic nose bleeding, menorrhagia in adolescent girls, Symptoms of hypothyroidism – cold intolerance, lethargy, easy weight gain, constipation, menorrhagia (adolescent girl) Constitutional symptoms – fever (infection, hematological malignancy), loss of weight, loss of appetite Sudden onset of severe abdominal pain – splenic sequestration in a child with sickle cell anemia or hereditary spherocytosis Ingestion of strong oxidants in a child with G-6-PD deficiency – Ingestion or sniffing of a mothball is most common Ask about systemic review Ask about menstruation history (female) – age of menarche, regularity, amount of blood loss, duration of bleeding and presence of blood clots Ask about antenatal and birth histories Severe maternal anemia and intrauterine infection during pregnancy Mother’s blood group (ABO) and type (Rh) – isoimmune or alloimmune hemolytic anemia Gestational age (prematurity may lead to anemia) History of assisted delivery and birth trauma (subgaleal hematoma) Duration of birth hospitalization – phototherapy, blood transfusion History of neonatal jaundice or anemia in the newborn period Review the results of newborn screening for anemia (if it was done) Ask about past medical or surgical history Recent illness or recurrent infections History of a viral infection such as mycoplasma or Ebstein-Barr virus (EBV) – may precede paroxysmal cold hemoglobinuria History of infection by Streptococcus pneumonia – may cause autoimmune hemolytic anemia History of blood transfusion (transfusion reaction due to major blood group incompatibility which may occur a few days to 1 week after blood transfusion) Ask about travel history Travel to or from areas of endemic infection (tuberculosis, hepatitis, malaria) Ask about drug and toxin exposure (current and past medications) Nitrofurantoin and anti-malarial agents – hemolysis in G6PD deficiency Penicillin – immune-mediated hemolysis Chemotherapy – bone marrow suppression Phenytoin – megaloblastic anemia Traditional medicine or supplement History of toxins exposure – lead and nitrates in well water Ask about immunization history – ask if the child has completed the immunization Ask about feeding history age of infant at the time of discontinuation of formula or breast milk ask about type of diet, type of formula milk (if iron fortified) Amount and type of milk the patient is taking Cow’s milk diet: iron deficiency Strict vegetarian: vitamin B12 deficiency Goat’s milk diet: folate deficiency Pica (eating ice): plumbism, iron deficiency Cholestasis, malabsorption: vitamin E deficiency Ask about developmental history ask the parents if their child has reached age-appropriate developmental milestones iron deficiency, vitamin B12 or folic acid deficiency and Fanconi anemia can lead to developmental delay Ask about family history Any family members who suffer from jaundice, gallstones or splenomegaly? Any family member who have undergone cholecystectomy or splenectomy (inherited hemolytic anemia)? Any family history of autoimmune disease and bleeding disorders Any family history of inflammatory bowel disease, intestinal polyps and colorectal cancer (cause GI bleeding)? Ask about social history Education levels of the patient’s parents Evaluate the level of care to the child by the care taker Assess the relationship between the child and the family members Monthly household income Physical examination: General examination: to look for features of anemia as well as the tell-tale signs of the causes assess the mental status – altered mental status, confused or coma patient may appear to be in respiratory distress assess the vital signs – tachycardia, tachypnea, low blood pressure (hypovolemia), low body temperature (hypothyroidism) System/structure Observation Significance Skin Hyperpigmentation Fanconi anemia, dyskeratosis congenita Skin Café au lait spots Fanconi anemia System/structure Observation Significance Skin Vitiligo Vitamin B12 deficiency System/structure Observation Significance Skin Partial oculocutaneous albinism Chediak-Higashi syndrome Skin Jaundice Hemolysis Skin Petechiae, purpura Bone marrow infiltration, autoimmune hemolysis with autoimmune thrombocytopenia, hemolytic uremic syndrome, hemophagocytic Skin Erythematous rash Parvovirus or Epstein-Barr virus infection Skin Butterfly rash SLE antibodies System/structure Observation Significance Skin Bruising Bleeding disorder, non-accidental trauma, scurvy Skin Dry skin Hypothyroidism Head and neck Frontal bossing Thalassemia major, severe iron deficiency, chronic subdural hematoma System/structure Observation Significance Head and neck Microcephaly Fanconi anemia Head and neck Distended neck vein Heart failure Head and neck Thinning of the hair Hypothyroidism Eyes Microphthalmia Fanconi anemia Eyes Retinopathy Hemoglobin SS, SC disease Eyes...

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