Hematologic Disorders Flashcards
1
Q
Clinical Findings of Iron Deficiency Anemia
A
- irritability, PICA
- anorexia with Hgb less than 8
- developmental delays
- pallor
- tachycardia, murmurs, CHF signs
- stool guaiac testing in severe anemia
2
Q
Diagnostic Studies for Iron Deficiency Anemia
A
- Hgb/Hct
- RDW earliest marker of IDA
- serum ferritin will be low
-comorbidity with lead poisoning
3
Q
Management of Megaloblastic Anemias
A
- refer to pediatric hematologist
- dietary supplementation
- correction of underlying disorder
3
Q
Management of IDA
A
- iron supplementation: ferrous sulfate
- reassess Hgb/Hct in 4 weeks
- response to iron is diagnostic and therapeutic
- peripheral reticulocytosis in 4 days
- continue iron supplements for 2-3 months
3
Q
Typical Blood Profile for Iron Deficiency Anemia
A
- microcytic hypochromic RBCs
- low/normal MCV; low/normal RBC number
- High RDW
- Low ferritin
- High TIBC
-Mentzer index greater than 13
3
Q
Patient and Family Education for IDA
A
- increase iron rich foods
- iron supplementation for exclusively breastfed infants at 4 months
- avoid cows milk until 12 months
- no goats milk
- dont give iron with milk; give with vitamin C
4
Q
Megaloblastic Anemias
A
- may lack folic acid or B12
- weakness, pallor, beefy-red, smooth, sore mouth and tongue
- elevated MCV, nucleated RBCs, normal WBC, PLT
5
Q
Clinical Findings of Sickle Cell Anemia
A
- symptoms emerge in first 6 months of life
- painful, vaso-occlusive crises
- splenomegaly disappears after 5 years from auto-infarction of organ
- height/weight slow after 7 years
- puberty delayed by 3-4 years
6
Q
Diagnostic Studies of Sickle Cell Anemia
A
- Hct 20%
- Hbg 6-10
- Reticulocyte count elevated 5-15%
- normal to increased WBC
- MCV > 80; MCHC > 37
- Hgb electrophoresis - predominance of Hgb S
- irreversible sickled cells
7
Q
Emergency Admission for Sickle Cell Anemia
A
- fever greater than 101
- penumonia, chest pain, pulm symptoms
- sequestration crisis
- aplastic crisis
- severe pain crisis
- unusual HA, visual disturbances
- priapism
8
Q
What is Immune or Idiopathic Thrombocytopenic Purpura
A
- autoimmune response, destroys circulating platelets
- usually occurs after viral illness
- most resolve within 6 months with or without treatment
- Chronic ITP if longer than 12 months; requires evaluation for other disorders
9
Q
Clinical Findings for ITP
A
- diagnosis based on symptoms
- PLT less than 20,000
- acute onset of petechiae, purpura, bleeding
- recent viral illness
- hemorrhage of mucous membranes
- nosebleeds
- menorrhagia
10
Q
Diagnostic Studies for ITP
A
- low PLT
- normal PT and aPTT
- megathrombocytes on peripheral smear
- normal WBC, RBC
- Hbg may decrease with severe bleeding
11
Q
Management of ITP
A
- prognosis excellent
- if PLT greater than 20,000 and no hemorrhage: avoid contact sports, ASA, NSAIDs
- If PLT less than 20,000 a short course of corticosteroids or IVIG if bleeding severe
- splenectomy, immunosuppressives for refractory or chronic ITP
12
Q
Leukemia
A
- normal bone marrow elements replaced by abnormal, poorly differentiated blast cells
- classified by cell type involvement, cellular differentiation
ALL 80%
AML 15%
13
Q
Clinical Findings for Leukemia
A
- repeated infection, fever, weight loss
- bleeding episodes
- lymphadenopathy, hepatosplenomegaly
- bone/joint pain
14
Q
Diagnostic Studies for Leukemia
A
- CBC with diff, PLT, reticulocyte counts
- peripheral smear
- bone marrow aspirate
- chromosomal/genetic abnormalities
15
Q
Management of Leukemia
A
- 90% have 5 yr survival rate
- 4-6 wk induction chemo followed by consolidation phase of several months, then 2-3 years of maintenance therapy
- stem cell transplant after 2nd remission
- philadelphia chromosome: may be considered for stem cell transplant sooner
16
Q
Non-Hodgkins Lymphoma
A
- solid tumors of lymphatic tissues: malignant proliferation of T cells, B cells, or indeterminate lymphocyte cells
- most frequently occurs in 2nd decade of life
17
Q
Clinical Findings of Non-Hodgkins Lymphoma
A
- acute abdomen
- nontender lymph node enlargement
18
Q
Diagnostic Studies for Non-Hodgkins Lymphoma
A
- CBC
- LDH
- uric acid
- electrolytes
- radiography, CT, MRI, PET
19
Q
Hodgkins Disease
A
Malignancy of reticuloendothelial and lymphatic systems = involves B cells
** Originates in cervical lymph node
20
Q
Clinical Findings for Hodgkins Lymphoma
A
- painless enlargement of lymph nodes
- chronic cough
- fever, decreased appetite, weight loss, drenching night sweats
21
Q
Diagnostic Studies for Hodgkins Lymphoma
A
- anemia
- elevated or depressed WBC, PLT
- ESR, CRP
- elevated copper, ferritin
- abnormal LFTs
- proteinuria
- radiography, US, CT, MRI, PET
22
Q
Management of Hodgkins Lymphoma
A
- treatment at comprehensive pediatric oncology center
- lifelong monitoring for side effects
