Prevalence and Management of microcytic anaemia in children

Prevalence and mangement of anaemia
in children seen at RCWMCH
 Martie Wege
 Rudzani Muloiwa, Patricia Hartley
Introduction:
 Anaemia is a well known public health problem in children
 Actual prevalence for anaemia in children from Cape Town
remain unclear.
 Full Blood Count (FBC) is a frequently performed test on
children as part of evaluation for other disease processes
 Anaemia in hospitalized children is usually an incidental
finding.
Research Aim:
To describe the prevalence of anaemia in
children 6-36months of age presenting to MEU,
SSW and MOPD at RCWMCH, as well as the
management of children with suspected Iron
deficiency anaemia.
What is anaemia?
Classification of anaemia:
 For this study purpose:
Hb ≤ 10.5 for all children
6months to 3 years
 Case definition for
Microcytosis:
MCV of 70 fl PLUS 1fl for
each year

Mild anaemia:
Hb 10 – 10.5g/dl

Moderate anaemia:
Hb 8.0 – 9.9g/dl
 6-12m: 70fl
 1-2yr: 71fl
 2-3yr: 72fl

Severe anaemia:
Hb <8g/dl
Selection and sampling of patients:
75 954
36 898
12 218
2 661
540
502
• All FBC’s done for 2011&2012 at RCWMCH
• After dropping all duplicates and FBC’s done during 2011
• Only keep patients that had their first FBC done at MEU/SSW/MOPD.
• Exclude all children <6months or >36 months of age
• 50% of anaemic patients were sampled
• Folders located for a detailed review
Prevalence of anaemia in age categories:
100
90
80

This was in keeping
with a 10% decline
in the prevalence
of anaemia with
increase in age
category.

RR10,9 (CI 0,840.95)
70
60
50
40
30
20
10
0
All
6-12months
Anaemia
1-2 years
No Anaemia
2-3 years
Anaemia in different wards
Anaemia
No anaemia
(χ2p = 0.001)
70%
100%
60%
90%
50%
80%
40%
70%
60%
30%
50%
20%
40%
10%
30%
0%
20%
10%
0%
MEU (872/2042) MOPD (216/619)
Folder review:
Severity of Anaemia at RCWMCH:
11%
36%
53%
Mild
Moderate
Severe
Correlation between Pallor and laboratory
confirmed anaemia
91
18%
28
6%
No
Unknown
383
76%
Yes
Folder review: Morphology of anaemia
Microcytic
Normocytic
Macrocytic
2
1%
172
34%
328
65%
Treatment of microcytic anaemia
Iron ≤ 1/12
Iron > 1/12
No iron
75
23%
180
55%
73
22%
Causes for anaemia:
400
350
300
250
200
150
100
50
0
-50
Anaemia
Anaemia of
not
prematurity
investigated
Causes
365
3
Chronic
disease
Epistaxis
Iron
deficiency
50
1
73
Iron
Pulmonary
Sickle cell
deficiency,
Malignancy Haemosider
B12
anaemia
osis
deficiency
2
1
1
1
Sickle cell
anaemia,
Iron
deficiency
1
Specific Thalassaemi
cause not
a, Iron
found
deficiency
1
3
Causes for anaemia:
400
350
300
250
200
150
100
50
0
-50
Anaemia
Anaemia of
not
prematurity
investigated
Causes
365
73%
3
Chronic
disease
Epistaxis
Iron
deficiency
50
10%
1
73
15%
Iron
Pulmonary
Sickle cell
deficiency,
Malignancy Haemosider
B12
anaemia
osis
deficiency
2
1
1
1
Sickle cell
anaemia,
Iron
deficiency
1
Specific Thalassaemi
cause not
a, Iron
found
deficiency
1
3
Conclusion:
 Prevalence of anaemia at RCWMCH 40.8%
 Anaemia in unwell children at RCWMCH are almost double the
predictable prevalence for children in SA
 Anaemia is significantly more prevalent in younger children
 The more acutely ill children presenting to RXH are more likely to
be anaemic
 More than 75% of children with suspected iron deficiency received
NO iron or ≤ 1/12 of iron
 A FBC is a frequently performed test on children presenting to the
MEU/MOPD at RCWMCH and the information is under-utilized by
physicians.
Aknowledgement…

NHLS haematology Laboratory at RCWMCH
 Dr Muloiwa and Prof Hartley