G187(P) Causes of Severe Anaemia (Hb <5 G/dL) in Children (<18 Years) Between 2006 and 2009

Abstract

Severe anaemia in childhood may be associated with significant morbidity and mortality. We defined the characteristics of patients (<18 year) with Hb<5 g/dl presenting to a large Scottish paediatric teaching hospital between 2006 and 2009. All patients meeting these criteria were included, irrespective of the aetiology ofanaemia. Patient characteristics, including final diagnosis, management and outcome at 2 year of follow-up were collected retrospectively. Ninety-three patients fulfilled study criteria; mean age 5 years (range 1 days to 17 years). Diagnoses were: 33/93 leukaemia (25/33 acute lymphoblastic, 7/33 acute myeloid, 1/33 juvenile myelomonocytic leukaemia); 23/93 iron deficiency anaemia (IDA); 12/93 hereditary blood disorders (including 7/12 hereditary spherocytosis with 6/12 associated parvovirus); 25/93 'other' including 6/25 haemolytic-uraemic syndrome and 3/25 transient erythroblastopaenia. Of leukaemia patients 5/33 had a presenting WCC >100 × 109/l - all were transfused, though 3/5 after steroid therapy. Of IDA patients 19/23 had nutritional IDA (nIDA). 17/19 nIDA were aged <3 year and 11/17 were of Pakistani origin (vs. 3.5% of Glasgow population). Linking residential postcode with Scottish Index of Multiple Deprivation, 11/ 17 nIDA lived in the most (lowest 20%) deprived areas, rising to 9/11 in more severe nIDA (Hb<4 g/dl). All patients with IDA were prescribed iron supplementation, received dietetic review and 17/23 transfused red-cells (all those with Hb <4 g/dl). Only 9/23 IDA resolved within 1 year though a further 3/23 had no repeat Hb recorded. Of the whole cohort 10/93 have died, with diagnoses of acute leukaemia (3/ 10), other malignancy (2/10), cardiac arrest (2/10), Hirschsprungs disease, autoimmune enteropathy or chronic liver disease (each 1/10). Severe anaemia is most commonly caused by acute leukaemia in this population and is associated with significant mortality. nIDA due to poor infant-feeding practice is an important preventable cause. Dietary intervention is important though not all infants are followed-up. As expected, infants from the most deprived areas or of Pakistani origin are over-represented in the nIDA group.