Anemia/lymphoma Flashcards
Reduction of hemoglobin conc or RBC volume below healthy
anemia
- Incr CO
- enhanced oxygen extraction
- shunting of blood flow to vital organs and tissues
- Incr 2,3-BPG w/in RBC (shifts curve to the RIGHT), affinity for oxygen decr, and transfer to tissue incr
- EPO and RBC incr
Physio response to anemia
Kids who drink lots of cows milk are at risk for…
Iron def anemia
Anemia:
- FH of anemia, splenomegaly, jaundice, early-age gallstones
- Clinical features: Hgb BELOW ____will see these
Pallor (tongue, nails, palms)
Sleepiness Irritability
Decr exercise tolerance
Flow murmur (incr CO)
7-8 g/dL
MCV low=?
normal=?
High?
What does the RDW tell us?
MCV low=microcytic
normal=normocytic
high=macrocytic
RDW: RBC distrib (ex: incr in lead poisoning)
Decreased RBC production, think…
Ineffective erythropoeisis (low MCV)
Incr destruction or loss of RBCs, think…
Hemolysis, sequestration (spleen), bleeding
Low or normal reticulocytes, think…
Bone barrow failure (ineffective erythropoiesis)
Incr reticulocytes, think..
(Normal bone marrow!)
Ongoing RBC destruction, sequestration, bleeding
TQ
- Pure red cell aplasia
- Reticulocytes low
- Incr MCV
- neonatal pallor
Diamond-Blackfan anemia
(macrocytic anemia w/ low reticulocytes)
TQ
- MCV>100
- Macrocytic, megaloblastic anemia
- Neuropathy, sore tongue
- Hypersegmented neuts
B12 deficiency
TQ
- MCV normal (78-100)
- Retic >3%
- bite cells
G6PD deficiency (enzymopathy)
TQ
- MCV normal (78-100)
- Retic >3%
Pyruvate kinase def (enzymopathy)
TQ
- Hyperpigmentation
- hypoplasia of thenar eminence
- dx by 8 yo
- cafe-au-lait spots, microsomy, LBW, eye prob
What kind of anemia?
Fanconi anemia
Microcytic anemia w/ reticulocytopenia, thrombocytopenia, or leukopenia
- pale and fussy newborn delivered by forceps
- Hgb at 9 g/dL (N:15-18)
- Incr head circumference
- Reticulocyte count and bilirubin normal
Cranial hemorrhage w/ forcep delivery (subgaleal bleed)
- Mediterranean 12 mo yo boy
- whole milk
- elevated wt for length
- Hgb=9.8
- MCV 70 (low)
- RDW 18 (high)
Microcytic anemia (prob thal)
How do you differentiate iron def from thalassemia?
Mentzer index=MCV/RBC
>13=iron def anemia
<13=thalassemia
- incr fatigue in normal wt Philippine child
- low grade fever
- nonspecific MSK pain
- pallor, pale conjunctivae
- scattered facial petechiae
- tachy + flow murmur
- Hbg 7.8, MCV 90, WBC 14000, reticulocyte low
- blasts on peripheral smear
Normocytic anemia petechiae=thrombocytopenia
low retic=BM LEUKEMIA
TQ
- constitute 97% of all childhood leukemias
- MC types of cancer under 15 yo
Acute leukemias
-AML or ALL
TQ
Child appears well and has had recent viral infx, what should be considered
Transient erythroblastopenia of childhood (TEC)
TQ
- MC malig in 15-19 yo
- lymphoreticular system
- Reed-sternberg cell!!!! (large cell w/ multiple/multilobulated nuclei)
- spreads in orderly fashion
HL
TQ
- painless, nontender, firm, rubbery, cervical/supraclavicular lymphadenopathy
- mediastinal involvement
What symptoms are seen??
B symptoms!!!!
- Unexplained fever 39 deg
- Wt loss >10% body wt 3 mo
- Drenching night sweats
Poor prognosis if relapse w/ these symptoms
TQ
- most present in advanced dz
- de novo
- 4 subtypes: Burkitt (abd, H/N), lymphoblastic (mediastinal), diffuse large B-cell lymphoma, anaplastic large cell lymphoma
- What immune def and genetic syndromes are associated???
NHL
- SCID, Wiscott-aldrich syn
- Ataxia-telangiectasia
TQ
- 4 yrs
- White>AA
- Male>female
- Assoc w/ trisomy 21, fanconi, ataxia telangiectasia
- EBV assoc
- Wiskott aldirch
ALL lymphoblastic leukemias
TQ
- Adolescent
- M=F, races=
- Assoc w/ trisomy 21, fanconi, ataxia-telangiectasia, diamond-blackfan, aplastic anemia
AML myeloid leukemias
TQ
MCV<78
Hypochromic microcytic w/ incr RDW
Peripheral smear shows target cells (central pallor)
PICA (eat dirt)
Iron deficiency anemia
TQ
MCV<78, low RDW
Basophilic stippling
hemolysis
reticulocytosis
S/S: hemolysis, pain crises, dactylitis, aplastic crises
Thalassemias
Microcytic hypochromic anemia
