Heme/Onc Flashcards
If a CBC shows a microcytic anemia with a concomitant low retic count what ddx should you consider?
-iron deficiency anemia, anemia of chronic disease, lead poisoning
If a CBC shows a macrocytic anemia with a concomitant low retic count what ddx should you consider?
-bone marrow failure
If a CBC shows a normocytic anemia with a concomitant normal retic count what ddx should you consider?
-anemia of chrnonic disease
What would be seen on the diff smear for G6PD or microangiopathic hemolytic anemia?
- Microangiopathic hemolytic anemia-schistocytes
- G6PD-ghost cells, helmet cells, blister cells, bite cells
When should you suspect milk related iron deficiency and what is the treatment?
- Any child drink >24oz cow’s milk formula
- Tx w/ iron deficiency
What is the presentation of and treatment of lead poisoning?
- presents with anorexia, vomiting, constipation, abdominal pain, neurobehavioral changes, peripheral neuropathy, bradycardia, HTN
- Labwork: microcytic anemia with low retics, basophilic stipling seen on diff smear
- Remove the pb source and consider iron chelation
- What PE findings of G6PD?
- lab findings?
- management?
- PE-jaundice, gallstones, splenomegally
- lab-elevated indirect bilirubin, decreased haptoglobin, bite cells, helmet cells
- mgmt-avoid antimalarials, sulfonylureas, floroquinolones, nitrofurantoin, pyridium, fava beans
- What is the presentation of and treatment of transient erythroblastopenia of childhood?
- What will lab work show?
- sxs-fatigue, pallor, nonspecific viral symptoms in a 2yo
- labs-hgb 5-7, normocytic anemia with decreased retics
- tx-self resolves in 1-2 months
What is the presentation of and management of immune thrombocytopenic purpura (ITP)?
- sxs-a 1-4yo w/onset of petechiae, mouth bleeding, bruising w/out systemic sxs
- If the patient is a teen consider workup for lupus and HIV, otherwise this requires a rheumatology consult for consideration of steroids and IVIG
What is the presentation of and treatment of hemophilia?
- bleeding in weird areas, this is an abuse mimic
- labs will show increased PTT and a normal PT
- rule out head bleeds, intraabdominal bleeds, and intraarticular bleeds
- Tx with factor repletion, consult H/O for consideration of DDAVP
What are potential complications to be on the alert for in patients who have received chemotherapy?
-neutropenia, typhlitis, tumor lysis syndrome, hyperleukocytosis, spinal cord compressions, SVC syndrome, anemia, thrombocytopenia, line infections
Give specific complications to be alert for in patients who have received the following chemotherapy agents:
- daunorubicin/doxorubicin
- L-asparaginase
- methotrexate
- vincristine
- daunorubicin/doxorubicin-cardiomyopathy
- L-asparaginase-pancreatitis
- methotrexate-renal dysfunction, hepatitis, neurotoxicity, bone marrow suppression
- vincristine-constipation, neuropathy, SIADH, lower extremity pain
- How common is nephroblastoma/Wilms tumor?
- Describe a typical presentation of a Wilms tumor
- Affects 1 in 10k children, accounts for 5% of all childhood cancers and 80% of all pediatric renal tumors
- Patient <10yo whose parent noticed an abdominal mass with bathing, usually painless. Patient has elevated BP. Mass is nontender to palpation but Udip shows hematuria. Presence of complications below should also increase your suspicion
- What complications can occur with nephroblastoma/Wilms tumor?
- If you suspect Wilms tumor, what should you do next?
- Complications: acute abdomen, anemia, fever (tumor rupture), CHF, ascites, hepatomegaly (tumor extension to nearby vasculature), varicocele, acquired paraneoplastic syndrome (hypercalcemia, erythrocytosis, acquired von Willebrand disease)
- If Wilms tumor is suspected obtain an abdominal US to characterize the mass and if positive, get a CT or MRI with h/o consultation. Also obtain chest xray to rule out mediastinal metastasis
