Hem/Onc Flashcards
At how many weeks of life does physiologic anemia occur?
6-9 weeks of life
*Hgb will naturally drop at this time
Premature infants are more prone to the development of anemia because their RBCs have a?
shorter life span
What anemia is associated with jaundice and hyperbilirubinemia in an infant?
hemolytic anemia
At what age does anemia associated with hemoglobinopathies develop?
3-6 months of age
Low MCV =
microcytic anemia
Examples of microcytic anemias include ____ and _____
IDA and Thalessemia
What etiologies will show anemia with a normal MCV?
*H___ ___
*B___ ____
*i_____
*m_____
hemolytic anemia
blood loss
infection
medication
high MCV =
macrocytic anemias
Etiologies for macrocytic anemias include?
*___ deficiency
*____ deficiency
*h______
B12 deficiency
folate deficiency
hyperthyroidism
A high reticulocyte count is indicative of
*H____
*B____
*H_______
hemolysis
bleeding
hemoglobinopathies
A low reticulocyte count indicates the bone marrow is?
A low reticulocyte count may also be due to ____ poisoning.
No working well
Lead poisoning
Evidence of hemolysis include
*J____
*U____ ____ changes
*S___ I______
jaundice
urine color changes
scleral icterus
High retic + Low MCV =
H____
hemoglobinopathy
high retic + normal MCV =
D
I
B___ ____
DIC, Infection, Blood loss
Low MCV =
I___
L____
T_____
IDA
Lead toxicity
thalessemia
High MCV =
A_____ ____
I___ ____
aplastic anemia/crisis
immune disorder
In what type of anemia is there hematopoiesis failure secondary to immune-mediated destruction?
Aplastic anemia
Aplastic anemia occurs in what age groups?
10-20 YOA
Aplastic anemia CBC findings will show?
pancytopenia without blasts
+
low or absent retic
Blood products for children with aplastic anemia should be?
CMV -, irradiated, and leukocyte reduced
Is BMT a possibility for children with aplastic anemia?
Yes
What anemia presents with decreased or absent Hb beta-globin and increased alpha?
Beta thalassemia
beta thalassemia is characterized as a _____ ____ anemia
chronic hemolytic anemia
Children with beta thalassemia are at increased risk for?
iron overload
Beta thalassemia has what type of inheritance pattern?
Often seen in what cultural groups?
autosomal recessive
mediterranean, asian, african
Beta thalassemia is often diagnosed by what year of age?
1 year of age
What beta-thalassemia has a severe presentation?
thalassemia major
*inherited from both parents
This Hgb electrophoresis is diagnostic for what?
elevated Hgb A2 and F
beta thalassemia
Beta thalassemia presentation includes
*F___
*H____
*J_____
*B___ D_____
FTT
Hepatosplenomegaly
Jaundice
Bone Deformities
Beta thalassemia will cause a
m____ h_____ anemia, in which RBC’s will be ____ and MCV/MCH will be _____
microcytic hypochromic
elevated
low
Children with beta thalassemia will require supplementation with what?
folate
At what age are children with beta-thalassemia at most risk for iron overload?
children older than 10 YOA
What type of inheritance pattern is G6PD?
X-linked recessive
Newborns with G6PD may present with J____ and K_____
jaundice and kernicterus
G6PD can be triggered by
F___ B____
I_____
The following medications may also trigger G6PD
S____
Q_____
C______
N_____
Anti-______
fava beans
infection
sulfa’s
quinolones
cipro
nitroglycerin
antimalarials
Sickle cell is inherited from ___ parents
both
In sickle cell, the RBC lifespan is how many days?
10-20
The 3 most common clinical manifestations of sickle cell anemia include H____, p____, and i_____.
hemolysis
pain
infection
What is the gold standard diagnostic test for sickle cell anemia?
Hgb electropheresis
Vaso-occlusive management includes
h____
p_____
hydration and pain management
Encourage ventilation of sickle cell patients via?
incentive spirometry
When a child with sickle cell has a fever, ensure to cover for _____ organisms.
encapsulated
The most common organism in a child with sickle cell anemia is?
Pneumococcas
Children with sickle cell anemia, require infection prophylaxis with?
penicillin
The chest x-ray of a child with acute chest syndrome will show new _____ and possible lung _____
infiltrates
infarct
Treatment for a child with acute chest syndrome includes
A____
P____
and
R____ support
antibiotics
PRBC’s
respiratory support
Children with sickle cell anemia should have annual screening for what?
stroke
Stroke screening for a child with sickle cell anemia should begin at what age?
2 YOA
Prevention of sickling crisis and its complications is achieved with
* _____ ______ and
* keeping HgbS levels less than ___%
exchange transfusions
30%
Once a child with sickle cell anemia has had a stroke, they are at increased risk for needing a?
transplant
What sickle cell complication occurs when there is pooling of blood into the spleen?
splenic sequestration?
Splenic sequestration can lead to h____ s___ and d_____
hypovolemic shock and death
What age groups are at the highest risk for splenic sequestration?
____ months- ____ YOA
3 months - 5 YOA
Management of splenic sequestration includes slow?
PRBC retransfusion
DIC is described as a coagulation disturbance leading to both t___ and h____
thrombosis and hemorrhage
In DIC
* plts will be _____
* PT/INR will be _____
*D. Dimer will be ____
low
high
high
The key to managing DIC begins with treating the?
underlying cause
What syndrome is considered a thrombotic microangiopathy?
hemolytic uremic syndrome
Hemolytic uremic syndrome is characterized by
*T_____
*h____ a____
and
*r____ organ damage
thrombocytopenia
hemolytic anemia
renal organ damage
Hemolytic uremic syndrome is often induced by what infection?
E. Coli, shiga toxin
Hemolytic uremic syndrome is more common in children less than ___ YOA
4
Hemolytic uremic syndrome clinical manifestations include
*a___ pain
*w____/b___ d____
*f_____
abdominal pain
watery/bloody diarrhea
fever
Hemolytic uremic syndrome physical examination findings include
*p___
*p____
*h____
*o____ and
*H______
pallor
petechiae
hematuria
oliguria
hypertension
The initial treatment for hemolytic uremic syndrome is to correct _____ and _____.
hypovolemia
rehydrate
*early fluid resuscitation reduces the risk for dialysis need
If the child with hemolytic uremic syndrome presents with volume overload and oliguria, initial treatment should begin with correction of ___ ____ via the administration of intravenous ______
volume overload
furosemide
Dialysis in a child with hemolytic uremic syndrome is indicated in patients with
*_____/_____ abnormalities
*h____ not resolved by medical therapies
electrolytes/acid-base abnormalities
hypertension
Strep pneumoniae-associated HUS should be treated with?
amoxicillin
atypical HUS is ____ mediated
complement
*treated with MAB
Children with ITP include a history of a recent?
viral illness
ITP is immune-mediated, plts counts will often below?
1000
ITP treatment includes the administration of ___ and _____
IVIG and steroids
What medication is indicated for ITP patients with severe bleeds?
WinRHo
Children with ITP are at the greatest risk for a ____ bleed
brain
What immune-mediated condition is described as a vasculitis of small vessels?
HSP
HSP often develops s/p?
respiratory tract infection
HSP is most often caused by what organism?
Group A strep
S/S of HSP include
P____
R____
S_____
R____ dysfunction
H_____
P_____
H______
pain
rash
swelling
renal dysfuction
hematuria
proteinuria
hypertension
HSP can progress to ____ failure
renal failure
Children with HSP will often have ____ purpura, acute ____, and ___ pain
palpable purpura
acute athralgias
abdominal pain
HSP diagnostic criteria include the findings of ___ deposition
IgA
What is the hereditary pattern for hemophilia?
x-linked recessive
The key to managing hemophilia is through the replacement of ____
factor
Along with factor replacement, what other medication can be used as an adjunct to treat mild-moderate bleeds in a hemophiliac?
DDAVP
What condition presents with a defect or decrease in Von Willibrand protein?
Von Willebrand disease
Von Willibrand Disease is often diagnosed in what age group?
later in life, teens
S/S of Von Willibrand Diseases include
e___
m_____
easy _____
excessive _____ s/p surgical and/or dental procedures
epistaxis
menorrhagia
easy bruising
excessive bleeding
Bleeds for patients with Von Willibrand disease are treated with what two medications?
amicar and DDAVP
What is the gold standard diagnostic test to r/o a DVT, P.E, renal thrombosis, and cerebral sinus thrombosis?
CT angiography
Management for heparin-induced thrombocytopenia includes discontinuing ____ and administration of ______
heparin
vitamin k
Methemoglobinemia s/s include
c____ and
_____ appearing blood
cyanosis
chocolate
Methemoglobinemia can occur after the administration of what drugs?
D____
n______
b______
p_____
Dapsone
Nitropusside
benzocaine
prirlocaine
What is the treatment for Methemoglobinemia?
methylene blue IV
What time of stroke occurs s/p clot or obstruction?
ischemic stroke
What time of stroke occurs s/p bleed?
hemorrhagic stroke
S/S of a pediatric stroke includes the development of acute h___ and s____
headaches and seizures
What is the gold standard diagnostic test to detect a pediatric stroke?
brain MRI
What is the pediatric dosing for blood, platelet, and FFP transfusion?
10-15 ml/kg
What blood product replaces coagulation factors?
FFP
1 unit of cryoprecipitate is indicated for children weight __-__ kg
5-10
The administration of cryoprecipitate is indicated when fibrinogen levels fall below.
100
During a blood transfusion, what causes an acute hemolytic reaction?
ABO incompatability
What is your child experiencing when he c/o back pain, hypotension, and hemoglobinuria during or s/p blood transfusion?
An acute hemolytic reaction
During a blood transfusion, nonhemolytic reactions present with?
allergy like s/s
Nonhemolytic reactions during or s/p blood transfusion are the result of an ____ reaction to l___ or p____
antibody reaction to leukocytes or plasma
TACO, during or s/p blood transfusion is characterized by c____ collapse and p____ e_____
circulatory collapse
pulmonary edema
TRALI will occur within ___ hours of a blood transfusion
6
TRALI presents with acute ____
hypoxemia
The administration of cryoprecipitate is indicated when fibrinogen levels fall below.
100
Leukemic cell tumors are known as what?
chloromas
What is the gold standard diagnostic test for ALL?
a bone marrow aspiration
Upon initial workup and once confirmed, a patient with ALL will get periodic LP’s to rule out?
CNS disease
The clinical presentation of a child with non-hodgkin’s lymphoma is rapid. What two oncologic emergencies are patient’s with Non-hodgkin’s lymphoma most at risk for?
Acute tumor lysis syndrome and
superior vena cava syndrome
A child with non-Hodgkins lymphoma presenting with SVCS and chest pain, should be worked up for the presence of a?
mediastinal mass
In an emergency situation, what is the initial diagnostic tests for the presence of a mediastinal mass?
a chest x-ray
What other radiologic exams can assess for the presence of a mediastinal mass?
PET and CT
Superior vena cava s/s include c___ and s___
cough and shortness of breath
Children with hodgkin’s lymphoma often present with c/o l______, f_____, and a______
lymphadenopathy
fatigue
anorexia
In Hodgkin’s lymphoma, B s/s are correlated with?
poor outcomes
B symptoms include
f____
w_____ _____
n____ ______
fever
weight loss
drenching night sweats
What are the characteristics of lymph nodes associated with malignancy?
p_____
e_______
f_______
r_______
painless
enlarged
firm
rubery
Wilm’s tumor is a ____ tumor which most often presents in children ___-___ years of age
renal
2-3
Wilm’s tumor s/s include
abdominal ____
and _____
abdominal distension
hypertension
Initial Wilms tumor treatment includes
a?
nephrectomy
A young child with leukocoria (white eye) and strabismus most likely has?
retinoblastoma
Retinoblastoma is often a _____ condition
genetic
What is a sympathetic nervous system neoplasm, that is often an extracranial solid tumor?
neuroblastoma
The most common finding in a child with neuroblastoma is?
opsoclonus myoclonus
Neuroblastoma tumors most often occur in the c_____, a____, and p_____
chest, abdomen, and pelvis
At diagnosis, children with neuroblastoma will often present with ______ because initial disease s/s are vague
metastasis
What diagnostic tests are good to obtain in a child being worked up for neuroblastoma?
CT, MRI, MIBG
What urine diagnostic tests are good to obtain in a child being worked up for neuroblastoma?
Urine HMA + Urine VMA
-assess for catecholamines
Second to ALL, what is the most common pediatric cancer diagnosis?
CNS tumors
What are the classic presenting s/s of a child with a CNS tumor?
h____ with ____ _____
and n_____ changes
headaches with morning vomiting
neurological changes
CNS tumors are best diagnosed with an?
MRI
Common s/s of a child presenting with an osteosarcoma or Ewings sarcoma include?
Pain over affected area
and an
elevated ESR
When working up a child with osteosarcoma or Ewings sarcoma, what is the initial diagnostic test?
plain film x-ray
After a plain film x-ray confirms a bone tumor, obtain both a?
CT and MRI
Children with a mediastinal mass will present with
S____
h_____
d______
c_____
d_____
J____ and a
s____ face
SVCS
hypoxemia
dysphagia
cough
dyspnea
JVD
swollen face
Management of a child with a mediastinal mass includes placing them in a ____ position
prone
Children with a mediastinal mass are difficult to ventilate with anesthesia, if ventilation is required what vent settings are needed?
positive pressure vent
What children are at greatest risk for tumor lysis syndrome?
Children with a high ___ ____ or who are ______
tumor burden
dehydrated
What is the only lab that will be low in a child presenting with tumor lysis syndrome?
calcium
In tumor lysis syndrome uric acid, phosphate, potassium, and LDH will be?
elevated
Hyperleukocytosis is characterized by a WBC count > _____
100,000
Hyperleukocytosis increases blood ______
viscosity
The goal in a child with hyperleukocytosis is to _____
hyperhydrate
What treatment is indicated for a child with pulmonary leukostasis?
dexamethasone
Typhlitis is characterized by _____ inflammation, caused by _____ ______
cecum
bacterial translocation
Typhlitis s/s include
f____
m____ and
____ ____
fever
mucositis
RLQ pain
Examples of mass syndromes include ____ or _____ compression
abdominal or spinal compressoin
S/S of mass syndromes include
altered ____ _______
______ and
______ syndrome
mental status
pain
compartment
Mass syndrome treatment includes ______ to decrease mass effect and ____ _____
radiation
surgical debulking
Should febrile neutropenic patients be catheterized for a urine sample?
no
Antibiotics in a febrile neutropenic patient can be discontinued if there is no fever in ____ hours and cultures remain negative for ____ hours
23
48
What type of transplant is indicated for solid tumors?
autologous transplant
In autologous transplants, the patient’s cells are collected when?
in advance, preferably prior to chemotherapy is started
What type of transplant is indicated for patients with bone marrow failures?
allogenic
sinusoidal obstructive syndrome or VOD is characterized by _____ damage and ____ deposition
hepatocyte damage and
fibrin deposition
Clinical manifestations of sinusoidal obstructive syndrome/VOD include
partial ______
hepatocyte ______
impaired ______
hypertension
hepatocyte necrosis
impaired coagulation
Physical examination findings of sinusoidal obstructive syndrome/VOD include
______ overload
elevated ______
w____ _____
tender ______
fluid overload
elevated bilirubin
weight gain
tender hepatomegaly
sinusoidal obstructive syndrome/VOD management includes d____ and ____ restriction
defibrotide
sodium restriction
Graft failure is more common in patients who have had ____ ____ transplants
solid organ
Graft vs. host disease is due to ____ __ cell activation
donor T-cell activation
Graft v.s host disease occurs ____ s/p transplant
early
What three body systems need to be monitored when assessing for and managing graft vs. host?
liver, skin, and gut
What is the best preventative measure for graft vs. host disease?
immunosuppressing host before transplant
Management for graft vs. host includes the addition of _____ at a dose of ____ mg/kg
corticosteroids
2mg/kg
chronic graft v.s host presents ____ s/p transplant. Chronic graft vs. host presents with _____ features
later
autoimmune
What body systems should be assessed in chronic graft vs. host?
skin
liver
GI
oral
occular
In any child with a life-threatening illness, palliative care is recommended when?
early integration
Palliative care is recommended for children with high ___ ___ and ____ care
s/s burden and complex care
What is the cornerstone of palliative care pain management?
opiods
What is recommended for children in palliative care experiencing neuro pain?
gabapentin
What is recommended for children in palliative care experiencing agitation?
benzos or neuroleptics
What is recommended for children in palliative care needing respiratory support?
oxygen
