CIS: Pediatric Anemia Flashcards
Anemia, what is it
reduction of the hbg concentration or RBC volume below the range of values occurring in healthy persons
-varies with age
What does anemia do to your heart?
speeds it up to compensate
What change do we see in the O2 saturation curve in anemia?
the affinity of Hbg for O2 gets lower
-blood O2 content goes down from normal
Does EPO go up or down?
up
-we need to make more
What do we need to ask someone who has anemia?
if they are bleeding!
What region is important for thalassemia?
mediterranean
-Thala means sea
What does thalassemia protect against?
malaria falciparium
- so does G6PD
- and sickle cell
What does Chloramphenicol do in the realm of anemia?
it can cause aplastic anemia!
-so watch out
What kind of anemia is anemia of chronic disease?
microcytic hypochromic
What kind of anemia does Pb cause
Microcytic hypochromic
What kind of Anemia does Parvovirus cause?
aplastic anemia
What clinical finding will always be there in extravascular hemolysis?
splenomegaly!
-remember, the action happens in the macs
What do some kids have in their gall bladder?
stones,
-so don’t freak out when you see them
What happens to cardiac output in anemia?
it increases
- look for a flow murmur
- again, don’t freak out
- it just means that more blood is running through
what do kids who drink cows milk get?
iron deficiency anemia
-there’s no bioavailable iron in milk
If you order H and H, what is that?
hemoglobin and hematocrit… that’s it
What do we order for someone who has anemia?
a CBC
RDW, what is it and why is it important
the range of RBC sizes
-higher means some kind of iron defiency or something like that
poikilocytosis
different shapes
what do we use to determine the kind of anemia… micro or macrocytic
MCV
-mean corpuscular volume
2 ways to divide anemia
are the RBCs being destroyed or is the bone marrow not working?
What test will tell us if the bone marrow is working?
the reticulocyte count
how can we tell a lead toxicity from an iron deficiency?
they both have microcytic hypochromic anemia associated with them
-but Pb will give us a higher RDW
what do we think of if all of the cells are lower than normal?
the bone marrow has something wrong with it
daimond black fan
it’s an anemia that affects your RBC’s
Hereditary spherocytosis
- most common in men….
- anything that affects the RBC membrane… the spleen eats it
- so the spleen gets bigger
What happens to the spleen in sickle cell anemia?
it shrivels up
-the HbS is like spikes and kill it
Type O moms
-what test will we do on the mom and baby
direct coomb’s test
indirect coomb’s
-if baby and mom’s RBC’s mix unmatched… it will be bad
-baby will be jaundiced (unconjugated bilirubinemia)
Fanconi’s anemia
- this is on EVERY standardized test
- there will be skin hyperpigmentation
- Macrocytic with a low retic count
if their Hgb is low, what would you order next?
MCV
-then reticulocytes
What does parvovirus B19 cause again?
aplastic anemia
all we need to know about diamond black fan
- red cell aplasia
- in the neonatal period
- normocytic with low reticulocyte count
inheritance of sickle cell disease
auto recessive
why does the rbc in sickle cell anemia sickle
- deoxygenated hbg in this disease polymerized
- the spleen tries to chew it up and loses.. autosplenectomy
Heinz body
denatured hbg
- bite cells
- G6PD deficiency
Spherocytosis, Autosomal or x-linked?
auto
-dominant
direct Coombs test
antibodies ON the RBC
-indirect means it’s somewhere in the serum
if a building has been there since WHAT year, it will have lead in the paint?
1970’s
what will the reticulocyte count look like in iron deficiency anemia?
it will be low
-confirmation of diagnosis can come from reticulocytes coming back after iron supplementation
Mentzer index
MCV/RBC
- <13 suggests thalassemia
- > 13 suggests iron deficiency
what do we do if the MCV doesn’t help us? (like, it’s exactly 13 which is bullshit)
Hemoglobin electrophoresis
-that’ll be $572 please…
what is the first step in evaluating a normocytic anemia?
get a reticulocyte count
What does low reticulocyte count suggest?
bone marrow hypofunction
What confirms a diagnosis of leukemia?
peripheral smear
G6PD genetics
-X-linked
What are Heinz bodies?
cross-linked sulfhydryl groups on globin chains
-they become denatured and form membrane-bound precipitates
-can lead to intravascular hemolysis
-
What happens to G6PD cells as they pass through the spleen?
the Heinz bodies get eaten by macs
- give us those bite cells
- can also be spherocytes
inheritance of sickle cell disease?
auto recessive
What will we see with sickle cells
target cells and howel jolly bodies
what is affected by pernicious anemia
parietal cells
-they make intrinsic factor
If we see a normocytic anemia, what should we do next?
a reticulocyte count
