Bilirubin and Anemia, pediatrics (Tucker)

Question 1

what is jaundice

Answer 1

Yellowing of the skin and sclera due to elevation of bilirubin. Bilirubin levels Greater than 95%tile of nomogram.

Question 2

in the newborn, the primary clinical issues of excess bilirubin are what>

Answer 2

ABE (acute bilirubin encephalopathy)

BIND (bilirubin induced neurologic dysfunction- kernicterus)

Question 3

opisthotonus

Answer 3

position of babies with kernicterus

Question 4

whey does elevation of bilirubin occur in the normal newborn

Answer 4

increased cell mass

shorter 1/2 life of red cells with fetal hemoglobin

decreased clearance due to lack of induction of infant’s liver enzymes

enterohepatic circulation

Question 5

what is the etiology of increased production of bilirubin in the newborn

Answer 5

1) ABO incompatability or Rh
2) Red cell membrane defects (spherocytosis or eliptocytosis
3) G6PD, pyruvate kinase deficiency, congenital erythropoetic porphyria
4) Sepsis
5) Polycythemia, hematoma
6) IDM resulting in polycythemia or ineffective erythropoiesis

Question 6

what is the etiology of decreased clearance of bilirubin

Answer 6

1) Crigler Najjar type 1 or 2
2) Gilbert’s
3) G6PD plus Gilbert’s
4) Hypothyroidism, galactosemia
5) Increased enterohepatic circulation

Question 7

what are the risk factors that require treatment

Answer 7

1) Jaundice in first 24 hrs
2) Total bilirubin in high risk zone at discharge
3) Early discharge
4) Prematurity
5) ABO incompatability with positive DAT, Rh, G6PD
6) Sibling requiring phototherapy
7) Significant bruising or Cephalohematoma
8) Exclusive breast feeding, especially if not going well or excessive weight loss
9) East Asian race

Question 8

what are tests you do to evaluate jaundice

Answer 8

1) Total and possibly fractionated bilirubin (peak usually at 72-96 hrs, later in preterm)
2) CBC with smear
3) Retic count
4) G6PD possibly

Question 9

how do you treat bilirubin excess in newborn

Answer 9

phototherapy
hydration
IVIG
exchange transfusion

Question 10

what is the definition of anemia

Answer 10

Reduction of red cell mass as evidenced by a decrease in hemoglobin or hematocrit

Question 11

what are 2 basic ways to classify anemia

Answer 11

Physiologic
Decreased production with lower than expected retic count and
Increased destruction

Morphologically
Microcytic
Normocytic
Macrocytic/megaloblastic

Question 12

differential for MCV <78 (microcytic)

Answer 12

iron deficiency anemia
lead intoxication
chronic disease
thalassemias
hemoglobinopathies
sideroblastic anemia

Question 13

MCV greater than 100 (macrocytic) differential

Answer 13

Megalobastic bone marrow

• B12 deficiency
• Folate deficiency

Non-megaloblastic bone marrow
-liver disease
-myelodysplastic 
aplastic anemia
-hypothyroidism