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Hematology and Oncology > EXAM #2: PEDIATRIC CBC > Flashcards

EXAM #2: PEDIATRIC CBC Flashcards

1
Q

What is a CBC?

A

Complete Blood Count

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2
Q

What are the components of a CBC?

A
  • WBC count
  • WBC diff.
  • RBC count
  • Hbg
  • Hct
  • MCV
  • MCH
  • MCHC
  • RDW
  • Platelet count
  • Mean platelet volume
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3
Q

In the newborn, what is the normal WBC count?

A

9,000 - 30,000

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4
Q

When in life do you have your highest WBC count?

A

At birth

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5
Q

When do you stop worrying about differences in WBC counts between children and adults?

A

12 years old

Remember, at 12, greater than 12,000 is abnormal.

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6
Q

What is more useful in evaluating the neutrophil count: absolute numbers or percentage?

A

Absolute count

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7
Q

What is the normal absolute neutrophil count? How do you calculate it?

A

10,000 is roughly normal

Take percentage of neutrophils and multiply by the WBC count

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8
Q

What is the normal percentage of neutrophils at birth? How does this compare to the adult?

A

50-60%

- This is less than the adult value of ~60%

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9
Q

How do you know if the number of bands cells is worrisome?

A

I:T ratio

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10
Q

How do you determine an I:T ratio?

A

Immature: Total neutrophils

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11
Q

What are the three types of immature neutrophils?

A
  • Bands
  • Metamyelocytes
  • Myelocytes
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12
Q

How do you interpret an I:T ratio?

A

1) 0-0.15= low suspicion for sepsis
2) 0.15-0.20= intermediate
3) Greater than 0.20= HIGH suspicion for sepsis

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13
Q

What is the normal percentage of lymphocytes in the newborn?

A

30%

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14
Q

How are lymphocytes and neutrophils related?

A

Inversely i.e. one goes up the other goes down

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15
Q

How does the newborn Hb compare to adult normal Hb concentrations?

A

Newborns have much HIGHER concentrations of Hb

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16
Q

What are the normal values for Hb in newborns?

A

14 - 22 g/dL

17
Q

What is the definition of polycythemia in a neonate?

A

HCT greater than 65 in a VENOUS sample

Note that capillary samples generally run HIGHER than venous*

18
Q

What is the relationship between HCT and Hb?

A

3:1 ratio

I.e. a Hb of 15 has a HCT of roughly 45

19
Q

What causes polycythemia?

A

1) Increased fetal EPO
2) Smoking
3) Alcohol
4) Maternal DM
5) Trisomy
6) Erythrocyte transfusion

20
Q

Why is polycythemia concerning?

A

Hyperviscosity decreases blood flow to the:

  • Heart
  • Brain
  • Lungs
  • Intestines
21
Q

What are the clinical features of polycythemia?

A

1) Poor feeding
2) Ruddy complexion
3) Irritability
4) Tremors
5) Lethargy
6) Respiratory distress

22
Q

How do you treat an asymptomatic neonate with polycythemia? Symptomatic?

A

Asymptomatic= hydration and observation

Symptomatic= EXCHANGE TRANSFUSION

23
Q

What is an exchange transfusion?

A

Draw off blood and replace with saline/LR

Note that this is dangerous and done in an ICU

24
Q

What is the normal RBC lifespan in newborns?

A

80 days

Vs. 120 days in adults*

25
Q

What is the physiologic anemia of infancy?

A

B/c of the shorter lifespan of the RBC, there is a NORMAL anemia in a 10-12 week old

**9 g/dL in the term baby and 6 g/dL in the premature baby is NORMAL*

26
Q

When do babies get near adult normal values of Hb?

A

2 years old

27
Q

How do you calculate the normal lower limit of the MCV in children?

A

70 fL + age in YEARS

E.g. 4 y/o= 70 + 4= 74 fL

28
Q

What is the normal upper limit of an MCV in children?

A

84fL + (0.6 x age in years)

29
Q

What is Polychromatophilia?

A

Ability of bone marrow to produce reticulocytes in response to RBC loss

30
Q

Is a RC count part of a normal CBC?

A

NO, you have to order this separate

31
Q

How do the normal platelet counts compare between children and adults?

A

SAME i.e. 150,000 - 450,000

32
Q

What is Alloimmune Thrombocytopenia?

A

Transfer of maternal antibody across the placenta can cause maternal “attack” of paternal antigens on the fetal platelets

33
Q

What is the treatment for Alloimmune Thrombocytopenia?

A

Transfusion of the MOTHERS platelets

The platelets transfused will contain the MATERNAL antigens

34
Q

When does Alloimmune Thrombocytopenia typically present?

A

3-4 days

35
Q

What is Maternal ITP?

A
  • Maternal ITP i.e. IgG to platelets

- Crosses placenta and causes same in infant

36
Q

How do you tell the difference between Alloimmune Thrombocytopenia and Maternal ITP?

A

Maternal platelet count

  • Mom low in ITP
  • Mom NOT low in Alloimmune
37
Q

How is Maternal ITP treated in the mother and newborn?

A

IVIG

38
Q

What is a third cause of thrombocytopenia in the neonate?

A

Sepsis

Hematology and Oncology (38 decks)

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