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Peds clerkship > hematology > Flashcards

hematology Flashcards

1
Q

things to ask on Hx for anemia

A
  1. HPI
  2. effect - pallor, tired etc
  3. diet - cow milk, goat milk, pica
  4. ROS
  5. PMHx - birth, jaundice
  6. Meds - septra, pens, phenytoin
  7. allergies
    8 Fam Hx
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2
Q

things to look for on Phx

A
  • epistaxis
  • rings or blue hue
  • nodes
  • thyroid
  • tachy
  • murmurs
  • HSM
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3
Q

3 most important investigations

A
  1. CBC - WBC, Hb, MVC, Plts
  2. Retic count
  3. smear
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4
Q

what are two outcomes for retics

A

high - RBC loss- hemolysis

low - poor production

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5
Q

2 problems for high retics

A
  1. intrinsic to RBC
    - membranopathy
    - Hbopathys
    - enzymopathy
  2. extrinsic to RBC
    - non-immune hemolysis - coombs neg
    - immmune hemolysis - coombs pos
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6
Q

3 problems with low retics

A
  1. microcytic - TAILS
  2. normocytic
    - chronic disease
    - renal failure
    - malignant
    - trnasient
  3. macrocytic
    - folate or B12 def
    - marrow failure
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7
Q

4 causes of Fe def. anemia

A
  1. poor stores at birth
  2. poor diet
  3. blood loss
  4. malabsorption
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8
Q

workup for FE def.

A
  1. CBC
  2. smear
  3. retics
  4. ferrtin, transferritin, serum Fe
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9
Q

mgmt of Fe def. anemia

A

give Fe

- follow up CBC in 2 weeks

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10
Q

2 types of hemolysis and what is seen on tests

A
  1. intravasc.
    - high LDH, bili, low haptoglobin
    - film show shistocytes and frags
  2. extravasc.
    - spherocytes
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11
Q

3 causes of intravasc.

A
  1. membrane defects
    - hereditary spherocytosis
    - need splenectomy
  2. enxyme defects
    - G6PD
    - x-linked recessive
    - triggered by drugs, fava beans, infections
  3. hemoglobinopathies
    - sickle and thal
    -
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12
Q

2 main types of extrinsic defects and how to tell apart

A
  1. immune related
  2. non-immune related

coombs test - identify antibodies/complement on surface of RBC or in serum

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13
Q

3 main types of immune

A
  1. drug related
  2. alloimmune
    - hemolytic transfusion
    - hemolytic disease of newborn
  3. autoimmune
    - Warm- IgG/complement
    - Cold IgM - keep the blood warm
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14
Q

3 main causes of non-immune

A
  1. TTP
    - emergency
    - hyaline microthrombi
    - supportive and plasmaphersis
  2. hemolytic uermic syndrome
    - like TTP but restricted to kidneys
    - mainly in children
    - may need dyalisis
  3. DIC
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15
Q

3 main types of sickle cell

A
  1. SS disease
  2. SC disease
  3. S-Bthal
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16
Q

what is special about infections in sickle

A

functionally asplenic, so at risk from encapsulated organisms

17
Q

invest for SC

A
  • part of new born screen
  • sickledex
  • protein electrophoresis for def. Dx
  • high retics
18
Q

SCD infection prophylaxis

A
  • antimicrobials between 2mos-5yrs
  • Pen V, or amox
  • regular immunizations, PLUS S.pneumo and n. meningiditis
19
Q

stroke prophylaxis for SCD

A

screen with transcranial doppler

  • abnormal results indicate art. narrowing and increased stroke risk
  • from 2-16 years for average and until 18 for high
20
Q

4 main SCD prophylaxis

A
  1. infection
  2. stroke
  3. hydroxyurea
  4. transfusions
21
Q

what is use of hydroxyurea

A
  • reduces crises by increasing HbF
  • for all HbSS or thal >9mos or more than 3 crises per year
  • expect drop in WBC and platelets and increase in MCV
  • not for preg or breastfeeding
22
Q

2 main types of transfusions in SCD

A
  1. top up to Hb 100

2. exchange - HbS of 30%

23
Q

4 indications for transfusions

A
  1. anemia exacerbation
  2. peri-op
  3. SCD complications
  4. prevention of complications
24
Q

complicaitons of transfusions

A
  1. delayed hemolytic
  2. hyperhemolysis
  3. hyperviscosity
  4. iron overload
25
Q

general approach to SCD crises

A
  1. pain
    - avoid extreme temp
    - hydroxyurea
    - good analgesics
    - rehydration
26
Q

8 crises of SCD and their Tx - see P142 for their casues

A
  1. vaso-occlusive - most common
    - analgesics
  2. aplastic
    - RBCs
    - isolation
  3. splenic sequestration
    - IV resus
    - splenectomy
  4. acute chest
    - IV cephalosporin, macrolide
    - O2
    - possible RBC
  5. fever/sepsis
    - empiric Abx
  6. stroke
    - urgent CT head
    - exchange transfusion
  7. priapsim
    - hydration and analgesia
  8. gallstones
    - watchful waiting
27
Q

what is def. of thrombocytopenia

A

platelets of less than 150

28
Q

3 broad differential for thrombopenia

A
  1. decreased production
  2. increased destruction
    - immune - ITP, SLE, evans
    - non-immune - DIC, HUS, thrombosis
  3. sequestration
29
Q

def. of ITP

A

autoimmune dis. char. by immune destruction of normal platelets
- peak age 2-6

30
Q

Tx of ITP

A 
observe if >10 platelets
if under 10
- pred
- IVIG
- anti-D

Peds clerkship (22 decks)

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