![]() What is the epidemiology of pica, and where is it most commonly seen? Answer 1 ![]() What are the diagnostic criteria for pica? Question 4 How might a patient with pica present? Question 3 Blood tests including full blood examination (FBE), iron studies and serum lead levels were also recommended. Behaviour modification strategies and speech and occupational therapy were recommended by the consulting paediatrician. He was known to bite other children during playtime when overly excited. He presented with hyperactivity inattention developmental delay including receptive and expressive language delay, motor delay, cognitive delay, delayed social skills and sensory-seeking behaviour and, most notably, the mouthing of non-food objects including toilet paper, tyres of toy cars, pencils and pens. Increased susceptibility of progenitor cells in bone marrow leads to increased apoptosis, progressing to pancytopeniaĪverage age of diagnosis is 8 years, but associated congenital abnormalities may facilitate early diagnosis (e.g.A boy aged 3.5 years presented to the paediatric clinic of a metropolitan teaching hospital with a 14-month history of pica and behavioural problems. Macrocytic anemia with low reticulocyte count Neonatal pallor progressing to symptomatic anemia average age of diagnosis is 3 months about 30 percent have other abnormalities Normocytic anemia with low reticulocyte countĬongenital pure red cell aplasia resulting from increased apoptosis in erythroid precursors Pallor, irritability, and other findings associated with infection (e.g., deafness) Parvovirus B19, human immunodeficiency virus, syphilis, rubella, sepsis Low enzyme activity with hemolysis, smear may show poikilocytosis, reticulocytosis, Heinz bodies, and bite cells (in G6PD deficiency) or spur cells (in pyruvate kinase deficiency) Rh incompatibility occurs in 10.6 per 10,000 live births 50 percent of these infants develop anemia Positive Coombs test elevated bilirubin level normocytic anemia with elevated reticulocyte count Jaundice and mild anemia infants with severe isoimmunization (e.g., untreated Rh incompatibility) may present with hydrops fetalis Tachypnea, pallor, and mental status change (irritability, poor feeding) > 20 percent loss of blood volume results in shock and cardiopulmonary collapseĪnemia with normal indices reticulocyte count is initially normal, then increases positive Kleihauer-Betke test in maternal-fetal hemorrhageĪccounts for 5 to 10 percent of all cases of severe neonatal anemia Hemorrhage (placental abruption, subgaleal, traumatic) maternal-fetal and twin-twin transfusion A peripheral smear can provide additional information in patients with anemia of any morphology. Common tests used in the evaluation of macrocytic anemias include vitamin B 12 and folate levels, and thyroid function testing. A low reticulocyte count suggests aplasia or a bone marrow disorder. If the reticulocyte count is elevated, the patient should be evaluated for blood loss or hemolysis. Workup of normocytic anemia is based on bone marrow function as determined by the reticulocyte count. Normocytic anemia may be caused by chronic disease, hemolysis, or bone marrow disorders. Other tests used in the evaluation of microcytic anemia include serum iron studies, lead levels, and hemoglobin electrophoresis. If the anemia is severe or is unresponsive to iron therapy, the patient should be evaluated for gastrointestinal blood loss. Mild microcytic anemia may be treated presumptively with oral iron therapy in children six to 36 months of age who have risk factors for iron deficiency anemia. Anemia is classified as microcytic, normocytic, or macrocytic, based on the mean corpuscular volume. Screening is recommended only for high-risk children. Most children with anemia are asymptomatic, and the condition is detected on screening laboratory evaluation. Anemia is defined as a hemoglobin level of less than the 5th percentile for age.
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