Hematologic Flashcards
Anemia
is characterized by small (microcytic), pale (hypochromic), RBCs, and depletion of iron (Fe) stores
Who is at risk for anemia
Low socioeconomic status – especially Mexican Americans
History of prematurity or low birth weight
Exposure to environmental lead
Exclusive breast feeding beyond 4 months of age without supplemental iron
Weaning to whole milk or supplementary foods that are not iron-fortified
What is the earlieast lab change that makes conclusive evidence of iron deficiency anemia
Serum Ferriting below 20mcg/ L
but also if a Hgb <11 mg/dL at the 12 month visit should warrant further evaluation
Iron supplementation
Poly-vi- sol WITH IRON – 3mg/kg/day in one or two divided doses
who is at risk for lead poisoning
A child that lives in or visits regularly a house with chipping paint built before 1960
A child that lives in or visits regularly a house with on going renovations built before 1960
A child with a sibling or playmate being treated for lead poisoning
A child that lives with an adult whose job or hobby involves lead
A child that lives near a factory likely to release lead
what is lead poisoning level
Elevated blood lead level of 10 mcg/dL is considered elevated/toxic – however, a blood lead level at ANY level is considered abnormal
A decrease in IQ of 2-3 points for every point above 10 has been proven in many different meta-analyses
who is at risk for sickle cell
Ethnicity:
Occurs primarily in African-Americans
Occurs 1 in 375 infants born in United States
1 in 12 has sickle cell trait
Occasionally also in persons of Mediterranean descent
Also seen in South American, Arabian, and East Indian descent
most common cause of isolated thrombocytopenia in otherwise well children
Idiopathic Thrombocytopenia Purpura
ITP presentation
Abnormal physical findings, other than petechiae and bruising are usually absent
Laboratory findings:
Platelet count < 20x10^3 and sometimes below 5x10^3
*Hgb and MCV are NORMAL
*Total differential WBC counts NORMAL
Most common form of childhood cancer
Leukemia
Leukemia is an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body
Liver, spleen and lymph nodes are the most severely affected organs
Although leukemia is an overproduction of WBCs, often acute form causes low leukocyte count
Cellular destruction takes place by infiltration and subsequent competition for metabolic elements
Leukemia clinical presentation
25% of children present with severe to moderate bone pain – may present with a limp or refusal to walk
Pallor, fatigue, decreased appetite, fever, petechiae, ecchymosis, mucosal and other bleeding, weight loss
Hemophilia A
deficiency in Factor VIII
much more common 1:5,000 male births
The most common serious congenital coagulation factor deficiencies
Only hereditary clotting diseases inherited in a sex linked recessive pattern
Hemophilia B
deficiency in Factor VIX
less common 1:30,000 male births
The most common serious congenital coagulation factor deficiencies
Only hereditary clotting diseases inherited in a sex linked recessive pattern
Hemophilia A & B presentation
Prenatal diagnosis is available via chromosomal analysis of cells obtained by amniocentesis or chorionic villus sampling
Prolongation of PTT is found in Hemophilia, whereas the PT and thrombin time will be normal, as well as a normal platelet count
Bleeding tendencies range from mild to severe
Symptoms may not occur until 6 months of age:
Mobility leads to injuries from falls and accidents
Hemarthrosis:
Bleeding into joint spaces of knee, ankle, elbow, leading to impaired mobility
Ecchymosis
Epistaxis
Bleeding after procedures:
Minor trauma, tooth extraction, minor surgeries
Large subcutaneous and intramuscular hemorrhages may occur
Bleeding into neck, chest, mouth may compromise airway
