Hematology and Oncology Flashcards
Anemia
Hemoglobin concentration too low to deliver adequate oxygen to meet demands. Hgb concentration < 2 standard deviations below the mean for age, gender, and race.
Causes: Many!
- Acute: Viral illness, oncologic diagnosis, inflammation.
S/S: Common in young children. Pallor, tachycardia, fatigue, lethargy, shortness of breath.
Dx: CBC, Reticulocyte count, Ferritin, Fe, TIBC, FEP, Hemoglobin electrophoresis, Peripheral smear, Additional screens for hemolytic anemia.
Tx: Treatment is based on underlying cause. Extremely low hgb with significant side effects requires transfusion.
Thalassemia - Alpha
Sx
Immune Thrombocytopenia Purpura
Idiopathic low platelet count.
- Cause is unknown, but may be immune. May occur as a result of disease such as oncologic or infection.
- Platelet count < 50, 000 or < 10, 000
- Acute or chronic.
Dx: CBC, may need bone marrow smear.
Tx: Based on acute or chronic presentation. If no bleeding, usually no treatment. If moderate bleeding, IVIG or anti-D or platelet infusion, especially associated with another acute illness.
Neutropenia
Decreased neutrophils with normal hemoglobin and platelet count, May be associated with viral or oncologic illness.
Dx: ANC
Tx: G-CSF, or if chronic, no treatment.
Pancytopenia
Low hgb, platelets, and WBC.
Leukocytosis
WBC higher than normal, often associated with leukemia, infection, or significant inflammation.
Dx: WBC
Sickle Cell Anemia
Deoxygenated hemoglobin S polymerizes and distorts the shape of the red blood cells. Sickled blood cells are more prone to hemolysis. Vaso-occlusive pain crisis and intrapulmonary thrombosis are two clinical manifestations. Acute crises and infection occur with pain.
Dx: Hemoglobin electrophoresis.
- Can identify hemoglobin S and hemoglobin A SSD on newborn screen.
- Splenomegaly is a common feature early in life.
Complications: Jaundice, cholestasis, pallor, fatigue, chronic pain, decreased exercise tolerance, cardiomegaly, stroke, aplastic, hypoplastic, hyperhemolytic crisis. Acute splenic sequestration, Chest Syndrome, Stroke, Acute Vascular Compromise.
Serious S/S: Fever, unusual fatigue, lethargy, pallor, acute splenic enlargement, shortness of breath, hypoxia, protracted vomiting, sudden loss of speech, weakness in an arm or leg.
Tx: Prophylaxis is usually with PCN.
Stroke
Ischemic or hemorrhagic. Dysfunction of brain activity due to interruption of blood flow in brain.
- Ischemic strokes occur with cardiac disease, hematologic disorders (SSD), primary vasculitis, lipid abnormalities, metabolic abnormalities, dehydration, shock.
- Hemorrhagic strokes occur with vascular malformation, cavernous malformation, aneurysm, brain tumor, thrombocytopenia or other hematologic problems, coagulopathies, spontaneous dissection.
PE: Neurologic evaluation, skin assessment, abdominal exam, cardiac evaluation, rash or petechiae.
S/S: Acute neurologic symptoms, headache, confusion and lethargy.
Dx: History, neurologic exam, head CT or MRI/MRA, labs (CBC, coags, LFTs, CMP, ESR).
- Acute and chronic monitoring.
Tx: Focused on underlying cause, anticoagulation therapy may or may not be warranted.
- Evaluation of CBC, maintain low hgb/hct, exchange transfusion, urea
Disseminated Intravascular Coagulation
Acquired, life-threatening complication resulting from a variety of disease processes including sepsis, trauma, malignancy, vascular irregularities, liver failure and pregnancy. Results when excessive fibrinogen and platelets are deposited in the microvascular system.
S/S: Diffuse bleeding and thrombosis with coagulation abnormalities by laboratory analysis.
Tx: Treat underlying condition, blood products, vit K.
Hemolytic Uremic Syndrome
Bacterial verotoxins cause damage to microvessels in circulation, resulting in inflammation and thrombosis leading to decrease in glomerular filtration rate, hematuria, proteinuria, and oliguria.
- HUS is MOST common cause of renal failure.
- Typical causative factor is E. coli 0157
S/S: Incubation period 3-5 days, abdominal pain, nonbloody diarrhea, fever, then progresses to bloody diarrhea. Other symptoms are pallor, fever, weakness, petechiae, hematuria, and hematemesis.
Dx: Based on clinical findings and labs - electrolytes with increased BUN and creatinine. Stool culture positive for E. coli 0157.
Tx: Preventing renal failure with diuretics, fluid management and assessment.
- May need dialysis!
Most Common Types of Pediatric Cancers
- Leukemia
- Brain and other nervous system tumors
- Neuroblastoma
- Wilm’s Tumor
- Lymphoma
- Rhabdomyosarcoma
- Retinoblastoma
- Bone Cancer (osteosarcoma, Ewings)
Dx: CBC, electrolytes, ESR, CT, MRI, plain xray
Tx: Per specific cancer presentation
Acute Lymphoblastic Leukemia (ALL)
Blood cell cancer.
- Most common malignancy.
- Usually affects ages 2-5 years, but can occur in older children.
S/S: Clinical presentation includes fever, bone pain, anorexia, weight loss, pallor and mucosal bleeding, lymphadenopathy, splenomegaly, hepatosplenomegaly.
Dx: CBC, peripheral blood smear, bone marrow smear, electrolytes, uric acid, LDH.
Tx: Based on oncology group.
- Includes induction and maintenance chemotherapy
Acute Myelocytic Leukemia (AML)
Blood cell cancer.
- 20% of all leukemias.
- Presents with coagulopathies and chloromas.
S/S: Clinical presentation includes fever, bone pain, anorexia, weight loss, pallor and mucosal bleeding, lymphadenopathy, splenomegaly, hepatosplenomegaly.
Dx: CBC, peripheral blood smear, bone marrow smear, electrolytes, uric acid, LDH.
Tx: Based on oncology group.
- Includes induction and maintenance chemotherapy
- Bone marrow transplant.
Neuroblastoma
Extracranial solid tumor.
- MOST common in children < 1 year of age.
S/S: Palpable mass, 60% in abdomen. Bruising, pallor, fatigue, bone pain, fever, hepatosplenomegaly, lymphadenopathy, periorbital bruising.
Dx: CBC, liver and renal function, coags, VMA/HVA (urine), CXR, abdominal film, CT and MRI.
Tx: Tumor staging, surgical resection and chemotherapy, BMT for high risk tumors.
Wilm’s Tumor
Unilateral or bilateral solid tumor of the kidney.
- MOST common renal neoplasm in children.
- Median age is 2-3 years old.
S/S: Often idenitifed by parent or family member. Some have pain, microscopic or gross hematuria, malaise, fever, HTN.
Tx: Nephrectomy or partial resection, chemotherapy.
