BLOOD DISORDERS 1.1 (AB) Flashcards
What should be considered in the family history of a patient with suspected hematologic disorder?
History of blood disorders such as hemophilia (which may not show symptoms)
What medications are relevant in evaluating a patient with suspected hematologic disorder?
Warfarin, NSAIDs, antibiotics
What recent illnesses may be relevant when evaluating immune thrombocytopenia (ITP)?
Viral infection within the past 2 weeks
How is anemia defined?
A decrease in red cell mass or hemoglobin concentration at 2 standard deviations below normal
What is the most common cause of microcytic anemia?
Iron deficiency
What are less common causes of microcytic anemia?
Thalassemias and lead poisoning
What is the usual cause of macrocytic anemia in children?
Folic acid and vitamin B12 deficiencies (though not frequent in children)
Why is normocytic anemia difficult to diagnose?
Because it has many causes
What are common causes of anemia in newborns?
Hemolysis, sepsis, blood loss, leukemia, TORCH infections
What are common causes of anemia in 16-18 months old children?
Iron deficiency anemia, congenital hemolytic anemia, sepsis, aplastic anemia, lead poisoning, acute anemia
What are common causes of anemia from 18 months to adolescence?
Leukemia, childhood malignancies, infections, parasitism, chronic inflammatory conditions
What symptom might indicate severe anemia?
Shortness of breath and palpitations
What symptom suggests hemolysis?
Jaundice
What symptoms suggest blood loss?
Dark stools, heavy menstruation
What viral infections can trigger ITP or worsen anemia?
EBV, CMV, HIV
What medications may cause GI bleeding?
NSAIDs, aspirin
What antibiotics may lead to hemolysis or bone marrow suppression?
Trimethoprim, sulfamethoxazole, cotrimoxazole
What chronic diseases are associated with anemia?
Autoimmune diseases, kidney disease, liver disease
What dietary deficiency is common in iron deficiency anemia?
Lack of iron from red meat, green leafy vegetables, iron-fortified foods
What nutrient deficiencies may lead to macrocytic anemia?
Vitamin B12 and folate
What dietary habit in toddlers may cause iron deficiency?
Excessive cow’s milk consumption
What blood disorder is common in Africans?
Sickle cell disease
Why are adolescent females at higher risk of IDA?
Due to menstrual blood loss
Why is G6PD deficiency more common in males?
It is an X-linked disorder
What early onset anemia may be seen in children less than 2 years old?
Diamond Blackfan anemia
What condition may cause neonatal jaundice?
G6PD deficiency
What does ictericia (jaundice) suggest in anemia?
Hemolysis
What conditions may present with organomegaly and lymphadenopathy?
Malignancies and hemolytic anemias
What oral lesions are seen in iron deficiency anemia?
Cheilosis, angular stomatitis, smooth tongue
What physical sign may suggest Fanconi’s anemia?
Hyperpigmentation and skeletal abnormalities
What skull abnormality may be seen in thalassemia?
Bossing of the skull
What are key RBC parameters in CBC?
Hemoglobin, Hematocrit, RBC count, MCV, MCH, MCHC, RDW
What are the main WBC parameters in CBC?
Total WBC count, Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils
What platelet parameters are assessed in CBC?
Platelet Count, Mean Platelet Volume
What are additional labs used to evaluate anemia?
Peripheral blood smear, reticulocyte count, bilirubin, fecalysis, urinalysis, iron studies, bone marrow aspirate
What is the most common and widespread nutritional disorder globally?
Iron deficiency
What parasitic infestation is the leading cause of IDA worldwide?
Hookworms (Necator americanus and Ankylostoma duodenale)
How many people are affected by parasitic infestation causing IDA?
1 billion people
When are breastfed infants at risk for iron deficiency?
If they do not receive iron-fortified foods by 6 months
How long do iron stores typically last in term infants?
6–9 months
What groups of infants have smaller iron stores?
Premature, low birthweight, or those with perinatal blood loss
How does delayed umbilical cord clamping affect iron status?
Improves iron status and reduces iron deficiency risk
What is the age of onset for dietary iron deficiency anemia?
Typically between 9–24 months
What dietary pattern in toddlers can lead to IDA?
Excessive cow’s milk consumption
What global cause is primarily responsible for iron deficiency?
Undernutrition
What are common causes of blood loss leading to IDA in adolescents?
Menstrual losses, nosebleeds, hemoglobinuria
What GI lesions can lead to chronic occult blood loss in children?
Peptic ulcers, Meckel diverticulum, polyps, hemangiomas, IBD
How does cow’s milk affect anemia in infants?
Can cause chronic intestinal blood loss
How can chronic blood loss in infants be prevented?
Breastfeeding, delaying cow’s milk until after 1 year, and limiting to <24 oz/day
What infections contribute to IDA in developing countries?
Trichuris trichiura and Plasmodium spp.
What is the hallmark of the pre-latent stage of IDA?
Depletion of tissue iron stores or ferritin
What lab results are seen in the latent stage of IDA?
Low serum iron, increased iron binding capacity
What are features of frank iron deficiency?
Hypochromic and microcytic anemia, pallor, easy fatigability, tachycardia, anorexia
What physical findings suggest pallor in IDA?
Pale oral mucosa, conjunctiva, nails, and palmar creases
What nail change is seen in severe IDA?
Koilonychia (spoon-shaped nails)
What is pica?
Unusual craving and ingestion of nonnutritive substances like starch, clay, or soil
What are mental effects of iron deficiency?
Cognitive decline and poor concentration
What are psychomotor effects of iron deficiency in children?
Delayed motor milestones
What are immune effects of iron deficiency?
Increased susceptibility to infections
What are neurological effects of iron deficiency?
Breath-holding spells, cranial nerve palsies, pseudotumor cerebri, developmental delay
What is the earliest lab indicator of iron deficiency?
Low serum ferritin
What are the late lab findings in IDA?
Decreased hemoglobin, hypochromia, and microcytosis
How is oral iron therapy given for IDA?
Ferrous sulfate 6 mg/kg/day for 3 weeks to 3–4 months
What is the proper way to take ferrous sulfate?
Before meals with water, not mixed with milk
What is a more palatable oral iron option than ferrous sulfate?
Ferrous fumarate
When is parenteral iron used?
For patients who cannot tolerate oral iron
What type of disorder is G6PD deficiency?
X-linked hereditary disorder
What are the typical symptoms of G6PD deficiency?
Sudden onset of pallor, jaundice, and hemoglobinuria
What should be suspected if a baby has prolonged but non-deep jaundice?
Possible G6PD deficiency
What common drugs can cause hemolysis in G6PD deficiency?
Analgesics, antipyretics, anti-malarials, cardiovascular drugs, cytotoxic antibacterial PAS
Is G6PD deficiency treatable?
No, it is persistent but manageable
What is the mainstay of G6PD deficiency management?
Avoidance of prohibited drugs
What supplements and treatments may be used in severe G6PD deficiency?
Folic acid and packed RBC transfusion
