Heme 5 Flashcards
Neonates with G6PD can present with what prominent symptom?
Jaundice + anemia in first 2-3 days of life.
When does Breast milk Jaundice start and peak? How long does it last?
What is the pathophysiology of Breast milk jaundice?
Starts –> 3-5 days of life
Peaks –> 2-3 weeks
Lasts –> weeks to several months.
Factors in breast milk inhibit Glucoronyl Transferase (which converts unconjucated Bili –> conjugated Bili) –> Therefore getting increase in unconjugated bilirubinemia.
TRX = Continue breast feeding as long as baby is well appearing.
What causes Breast feeding Jaundice?
TRX?
Inadequate feeding, so baby will appear dehydrated.
TRX = increase feeds and rehydrate.
Physiologic Jaundice occurs to some degree in all infants. What is the cause?
What is the primary risk factor for Physiologic jaundice?
When does it peak and normalize by?
Unconjugated hyperbilirubinemia due to increased RBC production and turnover in neonates, but because liver is immature and can’t effectively conjugate indirect Bilirubin…leads to build up.
RF= Prematurity
Peaks in several days, normalized by several weeks (2-3)
What is the trx of osteomyelitis in Children?
IN Children with Sickle Cell?
Children:
- Clindamycin + Vancomycin (for gram +ve and MRSA coverage)
Sickle Cell:
- Add 3rd Generation cephalosporin (Cefotaxime, Ceftriaxone for additional gram negative coverage.
For patients who need to be on Chronic Anticoagulation, what is the AC of choice during pregnancy?
What AC is contraindicated?
LMW Heparin = AC of choice during pregnancy;
Switch to Unfractionated Heparin few week before delivery because easily reversible with Protamine.
DC Heparin at onset of Labor.
WARFARIN = Teratogenic (bone, cartilage, limb hypoplasia), don’t use in pregnancy, even thought it is more effective.
What is Superior Vena Cava syndrome?
What is the cause in 80% of cases?
What is the classic presentation?
DX?
Obstruction/blockage of drainage of SVC most often due to Bronchogenic Carcinoma.
Presentation:
- Facial fullness/swelling
- Dilation of Upper extremity veins
- dyspnea, CP
DX = CT w contrast.
What is the treatment of choice for Bone mets from prostate cancer?
External beam radiation
What are the 4 most common Cancers that MET to brian in order of frequency?
- Lung
- Breast
- Melanoma
- Colon
Most neonatal jaundice can be resolved with blue light therapy…
What are the two indications for exchange transfusion?
- Tbili > 20
2. Worsening T bili despite phototherapy.
What is PERIODIC BREATHING in infants?
What is the management?
Cycles or alternating between not breathing for (5-10) seconds, followed by rapid breathing .
Benign, reassure parents.
During blood transfusion…What is the difference between a delayed hemolytic reaction vs acute hemolytic reaction.
Acute Hemolytic Reaction = Occurs <1hr of start transfusion, with fever, chills, flank pain, kidney failure, DIC ext….cause by ABO incompatibility, stop transfusion and aggressive IVF.
Delayed Hemolytic Reaction = Mild fever and hemolytic anemia. Occurs 2-10 days after transfusion because of Ab developed during prior transfusion to Rh, well or other blood Ags.
Autoimmune hemotlytic Anemia causes autoimmune destruction of RBC causing normocytic anemia. You can have COLD vs WARM Abs…
What is the difference in their mechanism of RBC destruciton?
What test helps DX?
What is the management of COLD vs WARM?
WARM = IgG –> bind RBC with C3, causing splenic destruction.
COLD - IgM –> binds RBC in cold temperature causing compliment mediated destruction.
DX = Coombs test +ve ( will show IgG vs Igm)
TRX:
COLD –> Avoid cold
WARM –> Steroids, Rituximab, +/- Splenectomy
COLD Autoimmune hemolytic Anemia is associated with what two infections?
WARM Autoimmune Hemolytic Anemia is associated with what two diseases?
WARM Autoimmune Hemolytic Anemia is associated with what medications?
COLD:
MONO and Mycoplasma
WARM:
SLE and Cancer (CLL and Non-hodgkins Lymphoma)
Penicillin, alpha-Methyl Dopa, Quinidine
In blood transfusion…What is the hallmark of febrile non-hemolytic reaction?
Most common reaction, with fever and chills, 1-6 hours of transfusion…due to cytokine accumulation in blood product.
