Quick-Review Tables In Pediatric Hematology

Sep 2, 2025

Hemoglobins in the Fetus and Neonates

Hemoglobin	Chain Composition	Primary Site
Gower-1	χ2 χ2	Yolk sac
Gower-2,	α2 χ2	Yolk sac
Portland	χ2 ψ2	Yolk sac
Fetal (F)	α2 ψ2	Liver
Adult (A)	α2 π2	Marrow

Summary of Anemias

Microcytic Anemia

↓

Reticulocyte count

Low / Inadequate

High

Iron deﬁciency
Thalassemia trait
Chronic disease / inﬂammation
Lead poisoning
Sideroblastic anemias
Copper deﬁciency
IRIDA

Thalassemia syndromes
HbC and E disorders
Pyropoikilocytosis

Current WHO 2024 Cut-offs in Anemia

	Haemoglobin concentration (g/L)
Population	No anaemia	Mild anaemia	Moderate anaemia	Severe anaemia
Children, 6-23 months	≥ 105	95-104	70-94	<70
Children, 24-59 months	≥ 110	100-109	70-99	<70
Children, 5-11 years	≥ 115	110-114	80-109	<80
Children, 12-14 years, non-pregnant girls	≥ 120	110-119	80-109	<80
Children, 12-14 years boys	≥ 120	110-119	80-109	<80
Adult, 15-65 year, non-pregnant women	≥ 120	110-119	80-109	<80
Adults, 15-65 years men	≥ 130	110-129	80-109	<80
Pregnancy
First trimester	≥ 110	100-109	70-99	<70
Second trimester	≥ 105	95-104	70-94	<70
Third trimester	≥ 110	100-109	70-99	<70

Intravascular and Extravascular Hemolysis

Markers of extravascular hemolysis	Markers of intravascular hemolysis
Increased unconjugated bilirubin. Increased serum LDH. Decreased plasma Haptoglobin. Increased fecal and urinary urobilinogen. High rate of CO production.	High unconjugated bilirubin Increased serum LDH Absence to absent plasma Haptoglobin Hemosiderinuria due to the sloughing of iron-laden tubular cells into the urine. Increased plasma Hb Increased methemalbumin Increased plasma hemopexin-heme complex

Classiﬁcation of Severity hemolytic anemias

	Mild-HS	Moderate	Moderately Severe	Severe
Frequency	It is seen in 20-30% of the cases.	It is seen in 60-70% of the cases.	It is seen in 10% of the cases.	It is seen in less than 5% of the cases.
Inheritance	It has an autosomal dominant inheritance.	It has autosomal dominant inheritance and can also be caused due to de Novo mutations.	It has autosomal dominant inheritance and can also be caused due to de Novo mutations.	It has an autosomal recessive inheritance.
HB(g/dL)	It is more than 10.5 g/dL.	Hb levels are between 8-12 g/dL.	Hb levels are between 6-8 g/dL.	It is less than 6 g/dL.
Rectic Count	It is 1.5-6%.	It is equal to or more than 6%.	It is equal to or more than 10%.	It is equal to or more than 10%.
TSB (mg/dl)	It is less than 2mg/dl.	It is equal to or more than 2 mg/dL.	It is equal to or more than 2 mg/dL.	It is equal to or more than 3 mg/dL.
Spherocytosis	There will be occasional spherocytosis.	There will be spherocytosis.	There will be spherocytosis.	There will be signiﬁcant spherocytosis and poikilocytosis.
Osmotic Fragility	It is normal or mildly elevated.	It is elevated.	It is elevated.	It is severely elevated.
Need for BT	It is usually not required.	It is occasionally needed.	It is occasionally needed.	It is regularly needed. It is also called transfusion-dependent HS.
Splenectomy	It is usually not needed.	It is sometimes required, and partial splenectomy is done.	It is usually needed between 6-9 years.	It is often needed in children more than 3 years old.

Classiﬁcation of Pancytopenia

Pancytopenia with Hypocellular or Acellular Bone Marrow

Pancytopenia with Cellular BM

Inherited BM failure syndromes e.g. Fanconi’s anemia and DKC (Dyskeratosis Congenita)
It also includes the categories of acquired aplastic anemia and the hypoplastic variant of myelodysplastic syndrome

It can be seen due to acute leukemia.
It can also happen in autoimmune conditions, particularly SLE.
It can be seen in hypersplenism, where the increased splenic function is responsible for pancytopenia.
It can also be seen in sarcoidosis and severe infections.
It can also be seen in nutritional causes.
- The two important nutritional causes are vitamin B12 and folate deﬁciency.
The sub-category included in pancytopenia with Cellular BM is:
- - Pancytopenia with bone marrow inﬁltration will be seen in bone marrow metastasis.
  - It is seen in storage disorders. The typical storage disorders are Gaucher's disease and NPD.
  - It can be seen in myeloﬁbrosis and osteopetrosis.

Platelet or Clotting Factor Bleeding

Platelet Factor Bleeding	Clotting Factor Bleeding
Superﬁcial mucocutaneous bleeds, e.g., Petechiae and epistaxis.	Deeper internal organ-based bleeds, e.g., hemarthrosis.
The most common sites are skin, ENT mucosa, and GIT mucosa.	The most common sites are soft tissues, muscles, and joints.
Petechiae are usually present.	Petechiae are absent.
Ecchymosis is superﬁcial.	Ecchymosis is deep.
Common in trivial trauma.	Rare in Trivial trauma.
Postoperatively they show immediate bleeding.	Post-operative, they show delayed bleeding on the 1^st to 3^rd day.

ASH 2019 Treatment Guidelines Summary TTP

Category	Symptoms / Treatment Options
Newly diagnosed ITP or Persistent ITP	No mild bleeding: Close observation (grade IB) Moderate bleeding: Short course steroids IVIG/ anti D Ig Severe bleeding: Short course Steroids / IVIG anti Dig (along with platelet transfusion in life threatening bleeds)
Chronic ITP	No mild bleeding	Observation
Moderate to severe bleeding	Available therapies include: TPO receptor agonists (Romiplostim, Eltrompobag) High dose dexamethasone Rituximab Other immunosuppressive agents Splenectomy (along with platelet transfusion in the threatening bleeds)

Speciﬁc Types - Treatment Guidelines Hemophilia

Type	Hemophilia A-Factor VIII Conc	Hemophilia B-Factor IX Conc
Hemarthrosis	50-60 IU/kg on D1, then 20 IU/kg on D2. Alternate day therapy till joint normalizes. Consider prophylaxis	80-100 IU/kg on D1, then 40 IU/kg on D2. Alternate day therapy till joint normalizes. Consider prophylaxis
Muscle/Large SC Hematoma	50 IU/kg on D1, then 20 IU/kg alternate day till resolves	80 IU/kg OR 40 IU/kg for 2-3 days 40 IU/kg + Antifibrinolytic Rx
Epistaxis	Apply pressure for 15-20 min; pack with petrolatum gauze; give antifibrinolytic therapy If fails- 20 IU/kg Concentrates	Apply pressure for 15-20 min; pack with petrolatum gauze; give antifibrinolytic therapy If fails- 30 IU/kg Concentrates
Major Surgery CNS/Life-Threatening Hemorrhage	50-75 IU/kg on D1, then 25 IU/kg every 8-12 hrly to maintain trough level >50 IU/dL for 5-7 d Then 50 IU/kg OD to maintain trough >25 IU/dL for 7 days	80-120 IU/kg on D1, then 50-60 IU/kg every 8-12 hrly to maintain trough level >40 IU/dL for 5-7 d Then 50 IU/kg OD to maintain trough >30 IU/dL for 7 days
Iliopsoas hemorrhage	50 IU/kg on D1, then 25 IU/kg BD until asymptomatic; then 20 IU/kg alternate day, for a total of 10-14 days	100 IU/kg on D1, then 25 IU/kg BD until asymptomatic; then 50-60 IU/kg alternate day, for a total of 10-14 days
Hematuria	Bed Rest, Maint fluids × 1.5 times 20 IU/kg single dose	Bed Rest, Maint fluids × 1.5 times 40 IU/kg single dose
Prophylaxis	20-40 IU/kg every alternate day to achieve trough level ≥1%	30-50 IU/kg every alternate day to achieve trough level ≥1%

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