●First - in the yolk sac

●Then - in the liver/spleen

●Finally—in the bone marrow

bone marrow hematopoiesis

extramarrow hematopoiesis

at birth

2~3 months old

3 months later

At birth - HbF (fetal hemoglobin) accounts for 70% HbA (adult hemoglobin) accounts for 30%

1 year old - HbF does not exceed 5%

At 2 years of age - no more than 2%.

number of cells

White blood cell classification

Similar to adults, about (150 ~300) ×10^9/L.

△At birth - blood volume accounts for about 10% of body weight, average 300ml.

△Children - about 8%~10%

△Adults - about 6%~8%.

Anemia means that the number of red blood cells or hemoglobin per unit volume in peripheral blood is lower than the normal standard.

World Health Organization (WHO)

my country Pediatric Hematology Conference Tentatively Scheduled

Anemia is classified into 4 degrees based on hemoglobin or red blood cell count ——Light, medium, heavy, extremely heavy

1. Insufficient production - iron deficiency anemia, megaloblastic anemia

2. Excessive destruction - hemolytic anemia

3. Excessive loss - blood loss anemia

The most iron is obtained from the mother in the last 3 months of fetal life, so premature birth, twins, fetal blood loss, etc. reduce iron reserves.

The main cause of iron deficiency anemia is often caused by not adding iron-rich complementary foods in time.

Babies, especially premature babies, grow and develop rapidly and are prone to iron deficiency anemia.

Unreasonable food combination can affect the absorption of iron, and chronic diarrhea increases iron excretion.

A small amount of intestinal bleeding caused by an infant's allergy to cow's milk protein can cause iron loss.

At this stage, the iron stored in the body has been reduced, but the iron supply for red blood cells to synthesize Hb has not yet been reduced.

During this period, stored iron is further depleted and the iron required for red blood cell production is also insufficient, but the amount of circulating Hb has not yet decreased.

The amount of Hb in this period is ↓, microcytic hypochromic anemia occurs, and non-blood system manifestations occur.

■The skin and mucous membranes gradually become pale, especially the lips, oral mucosa and nail beds.

■Easily tired and weak, not fond of activities.

■Older children may complain of dizziness, dark eyes, tinnitus, etc.

■The liver and spleen may be slightly enlarged

■Performances of hypoxia in various systems!

other

Blood routine

blood smear

Active proliferation

●Serum ferritin(SF)↓

●Barrow can be stained with iron↓

Reflects the iron deficiency period (ID) and sensitively reflects the decrease in iron storage.

●Erythrocyte free protoporphyrin (FEP)↑

●Serum iron(SI)↓

●Transferrin saturation (TS)↓

●Total Iron Binding Capacity (TIBC)↑

Reflects the stage of iron deficiency anemia (IDA)

Diagnostic criteria: Meet the following items 1 and At least two of items 2 to 8 can be diagnosed as iron deficiency anemia.

1. Thalassemia

⒉ Sideroblastic anemia

3. Pulmonary hemosiderinosis

Pharmaceutical preparations: Mainly taken orally; choose ferrous iron

Drug dosage: 4~6mg/kg·d based on elemental iron, taken orally in 2~3 times;

Precautions:

Efficacy evaluation

Timing of discontinuation: Continue taking iron supplements for 6 to 8 weeks after normal levels are reached to replenish stored iron

Indications for blood transfusion

Notice

① Provide feeding guidance, promote breastfeeding, and promptly add liver, lean meat, fish, iron-rich complementary foods with high absorption rates;

②Infant and young children’s food should be fortified by adding an appropriate amount of iron;

③Premature infants and low-birth-weight infants should be given iron prophylaxis starting from about 2 months of age.

macrocytic anemia

neuropsychiatric symptoms

Megaloblastic red blood cells appear in the bone marrow

Vitamin B12 or (and) folic acid is effective in treatment

Breastfeeding exclusively and not adding complementary foods on time,

Babies fed long-term goat milk.

Newborns, immature children and infants have increased requirements for folic acid due to their rapid growth and development.

Chronic diarrhea, small intestinal lesions, etc. can affect folic acid absorption and cause deficiency.

Long-term oral broad-spectrum antibiotics – some bacteria in the colon are eliminated, thus affecting the supply of folic acid.

Long-term use of anti-folate preparations (such as methotrexate) and certain anti-epileptic drugs, such as phenytoin, can lead to folic acid deficiency.

Congenital folate metabolism disorders are occasionally seen.

It is more common in infants and young children, most commonly between 6 months and 2 years old.

Most of them are puffy or accompanied by mild facial edema, with thin and yellow hair. In severe cases, there may be bleeding spots or ecchymosis on the skin.

Mild to moderate anemia accounts for the majority

Sallow complexion, palpebral conjunctiva, lips, nails, etc.

Often accompanied by hepatosplenomegaly.

Diarrhea, vomiting, glossitis, etc. appear earlier.

Vitamin B12 deficiency

Severe cases

Blood routine

blood smear

Active proliferation, obvious proliferation of erythroid cells, and megaloblastic changes in cells of all lines

Serum vitamin B12 (<100ng/L) or folic acid level (<3ug/L)

Cause, clinical manifestation, auxiliary examination, corresponding treatment is effective

pancytopenia

Pathological hematopoiesis

Nervous system disease

①Supplement vitamin B12:

②Supplement folic acid:

③Effectiveness evaluation after vitamin B12 and folic acid treatment

In the early stage of treatment, due to the large number of new red blood cells, extracellular potassium is transferred into the cells. It can cause hypokalemia and even sudden infant death due to hypokalemia, so preventive potassium supplementation is required.

Iron supplements should be added during the recovery period from anemia to avoid iron deficiency when red blood cell proliferation is strong.

If combined with iron deficiency anemia, iron treatment should be given at the same time.