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In the name of god. CBC-STUDENT. Dr Goudarzipour. MCV:HCT/ RBC,fl MCH:Hb / RBC,pg MCHC:HCT/ Hb,gd RDW:anisocytosis. Neutropenia ? Anemia? Physiologic anemia?. NL PLT? WHATS MPV?. examples. 2 Y/O male WBC:6700:PMN:60,L:40 RBC:4.700.000 Hb:11.7 MCV:76 PLT:135000. Case -2.

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    cbc student


    Dr Goudarzipour



    • MCH:Hb/RBC,pg
    • MCHC:HCT/Hb,gd
    • RDW:anisocytosis


    • Anemia?
    • Physiologic anemia?

    NL PLT?

    • WHATS MPV?
    • 2 Y/O male
    • WBC:6700:PMN:60,L:40





    case 2
    Case -2
    • 3 month years ,female
    • WBC:6500,L:30,P:70




    case 3
    • 7 y/o,female
    • WBC:5390,P:63,L:37






    case 4
    CASE 4
    • 2 y/o male
    • WBC:14500,P;78,l;22








    back ground
    Back ground

    Iron deficiency is the most common nutritional deficiency in children and is worldwide in distribuiotion.

    The incidence of iron-deficiency anemia is high in infancy.

    40–50% of children under 5 years of age in developing countries.


    Babies are born with iron stored in their bodies. Because they grow rapidly, infants and children need to absorb an average of 1 mg of iron per day.

    • Since children only absorb about 10% of the iron they eat, most children need to receive 8-10 mg of iron per day. Breastfed babies need less, because iron is absorbed 3 times better when it is in breast milk
    tissue effects of iron deficiency
    Tissue Effects of Iron Deficiency
    • I. Gastrointestinal tract
    • Anorexia-common and an early symptom
    • Pica-pagophagia (ice) geophagia
    • Atrophic glossitis
    • II. Central nervous system
    • Irritability
    • Fatigue and decreased activity
    tissue effects of iron deficiency1
    Tissue Effects of Iron Deficiency
    • III. Cardiovascular system
    • Cardiac hypertrophy
    • IV. Musculoskeletal system
    • Deficiency of myoglobin and cytochrome C
    • Adverse effect on fracture healing
    • V. Immunologic system
    • Evidence of increased propensity for infection
    • Peak prevalence occurs during late infancy and early childhood
    • • Rapid growth with exhaustion of gestational iron
    • • Low levels of dietary iron
    • • Complicating effect of cow’s milk-induced exudative enteropathy
    • A second peak is seen during adolescence due to rapid growth and suboptimal iron intake.
    • This is amplified in females due to menstrual blood loss
    causes of iron deficiency anemia
    Causes of Iron-Deficiency Anemia
    • I. Deficient intake
    • Dietary (milk, 0.75 mg iron/l)
    • II. Inadequate absorption
    • Poor bioavailability: absorption of heme Fe.Fe2.Fe3; breast milk iron.cow’s milk
    • Antacid therapy or high gastric pH (gastric acid assists in increasing solubility of inorganic iron)
    • Cobalt, lead ingestion
    causes of iron deficiency anemia1
    Causes of Iron-Deficiency Anemia
    • III. Increased demand
    • Growth
    • pregnancy
    • IV. Blood loss

    The best sources of iron include:

    • Baby formula with iron
    • Breast milk (the iron is very easily used by the child)
    • Infant cereals and other iron-fortified cereals
    • Liver
    • Blue-tinged or very pale whites of eyes
    • Blood in the stools
    • Brittle nails
    • Decreased appetite (especially in children)
    • Fatigue
    • Headache
    • Irritability
    • Pale skin color (pallor)
    • Shortness of breath
    • Sore tongue
    • Unusual food cravings (called pica)
    • Weakness
    • Note: There may be no symptoms if anemia is mild.
    p e and lab
    P/E and lab
    • 1. Hemoglobin: Hemoglobin is below the acceptable level for age
    • 2. Red cell indices: Lower than normal MCV, MCH and MCHC for age.
    • 3.Increase RDW

    Blood smear: Red cells are hypochromic and microcytic with anisocytosis

    hemoglobin level falls below 10 g/dl.

    p e and lab1
    P/E and lab
    • Basophilic stippling can also be present but not as frequently
    • The RDW is high (.14.5%)
    • Reticulocyte count: The reticulocyte count is usually increase in bleeding).)normal
    • Platelet count: The platelet count varies from thrombocytopenia to thrombocytosis.
    • free erythrocyte protoporphyrin (FEP) levels.increase
    p e and lab2
    P/E and lab
    • The normal FEP level is 15.56 +-8.3 mg/dl. The upper limit of normal is 40 mg/dl
    • Serum ferritin: The level of serum ferritin reflects the level of body iron stores (below than 12).
    • Normal ferritin levels, however, can exist in iron deficiency when bacterial or parasitic infection, malignancy or chronic inflammatory conditions co-exist .because ferritin is an acute-phase reactant
    p e and lab3
    P/E and lab
    • Serum iron and iron saturation percentage:
    • limitations:
    • • Wide normal variations (age, sex, laboratory methodology)
    • • Time consuming
    • • Subject to error from iron ingestion
    • • Diurnal variation
    • • Falls in mild or transient infection.
    stages of iron depletion
    Stages of Iron Depletion

    1. Iron depletion:

    tissue stores are decreased

    • without a change in
    • hematocrit or serum iron level

    2. Iron-deficient erythropoiesis

    Iron decrease

    reticuloendothelial macrophage


    TIBC increase

    • With out change in HCT

    3. Iron-deficiency anemia:

    • Anemia
    • Increase RDW
    • Increase FEP
    • Oral Iron Medication
    • Dose: 1.5–2.0 mg/kg elemental iron three times daily.
    • In children with gastrointestinal side effects, iron once every other day
    • Duration: 6–8 weeks after hemoglobin level and the red cell indices return to normal.
    • Peak reticulocyte count on days 5–10 following initiation of iron therapy.
    • Following peak reticulocyte level, hemoglobin rises on average by 0.25–0.4 g/dl/
    • hematocrit rises 1%/day during first 7–10 days.
    • Thereafter, hemoglobin rises slower: 0.1–0.15 g/dl/day.
    failure to respond to oral iron
    Failure to respond to oral iron:
    • Poor compliance – failure or irregular administration of oral iron;
    • Inadequate iron dose
    • Ineffective iron preparation
    • Insufficient duration
    • Persistent or unrecognized blood loss
    • Incorrect diagnosis – thalassemia, sideroblastic anemia
    • Coexistent disease that interferes with absorption or utilization of iron
    • Impaired gastrointestinal absorption due to high gastric pH
    parenteral therapy
    Parenteral Therapy
    • Noncompliance or poor tolerance of oral iron.
    • Severe bowel disease (e.g., inflammatory bowel disease)
    • Chronic hemorrhage
    • Rapid replacement of iron stores is needed.
    • Erythropoietin therapy is necessary, e.g. renal dialysis.
    blood transfusion
    Blood Transfusion

    In children with sever infection specially with cardiac dysfunction or Hb less than 4 g/dl.



    • Glader B. Iron-deficiency anemia. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 455.
    • Heird WC. The feeding of infants and children. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th Ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 42.
    • O'Connor NR. Infant formula. Am Fam Physician. 2009;79:565-570.