Lec 19/20 - Peds I and 2 Flashcards

1
Q

define anemia

A
  • reduction in the number of RBC
  • reduction in quantity of Hb
  • reduction in the volume of RBC

===> result in decreased O2 carrying potential that is needed for metabolism

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2
Q

History consistent with iron deficiency anemia

A
  • excessive milk intake
  • early milk intake prior to one year
  • blood loss

labs: mild to mod anemia; MCV decreased; RDW increased; ferritin,transferritin, serum iron decreased; TIBC inc; retic count normal to inc

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3
Q

treatment plan for Diamond blackfan anemia

A
  • prednisone
  • transfusion which may lead to iron overlad
  • bone marrow transplant may be curative
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4
Q

treatment plan for iron deficiency anemia

A
  • encourage breast feeding for >6mo and if only breast feeding after 4 mo need Fe supplementation
  • 6mg/kg/day when taken oral!
  • use iron fortified formula
  • use iron fortified cereals
  • avoid whole cows milk in kids <12mo
  • balance diet in Fe (greens, veggies, meat, fish, chicken)
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5
Q

treatment plan for transient erythroblastopenia of childhood

A
  • supportive only

- transfuse if necessary with cardiovascular instability

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6
Q

complications of sickle cell anemia

A
  • vaso-occlusive pain (the sickle cells clog shit up - MAJOR RISK OF STROKE)
  • aplastic- acute drop in HCT and Hgb usually due to PARVOVIRUS B19
  • hemolytic/splenic sequestration

-renal, pulmonary, and neurologic issues

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7
Q

basic prevention and Tx of sickle cell anemia

A

-Tx = PAIN CONTROL and HYDRATION; O2 if needed

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8
Q

key dietary history point when evaluating for anemia in children?

A

milk intake!

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9
Q

what condition is consistent with chloramphenicol drug use?

A

anemia

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10
Q

first screen infants for anemia at what age?

A

9-10mo, kindergarden entrance and for adolescents

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11
Q

Hematocrit number relationship to Hb number?

A

HCT ~= 3xHb

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12
Q

Method to detect Hb levels? HCT?

A

direct spectrophotometry

HCT is calculated (3 times Hb)

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13
Q

What blood sample do you need for Hg check

A

venous sample

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14
Q

After anemia is confirmed via CBC and Hb look at?

A

RBC indices

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15
Q

Most useful RBC indice?

A

MCV

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16
Q

If MCHC is high its a sign of

A

spherocytosis

17
Q

RBC of varying sizes - most likely?

A

iron deficiency anemia

18
Q

RBC indices same size but know there is an issue with Hb?

A

thalassemia trait

19
Q

What type of evaluation done pancytopenia? What diseases to thnik of?

A

bone marrow exam

aplastic anemias; leukemias…

20
Q

increased WBC and low platelets is sign of…

A

infection when associated anemia is present (hemolytic uremic syndrome)

21
Q

normal WBC and low platelets and mild anemia sign of?

A

platelet dysfunction (ITP)

22
Q

Two accepted ways to classify anemia in kids:

A

1) size of RBC

2) increased destruction vs decreased production

23
Q

Microcytic hypochromic RBC - differential Dx?

A

iron def
lead tox
thalassemia

24
Q

Macrocytic hyperchromic - differential Dx?

A
B12
folate def (if fed goat milk)
25
if infant fed goat milk what deficiency?
folate deficiency = macrocytic hyperchromic
26
Diamond blackfan anemia (congenital pure red cell aplasia) classification?
macrocytic normochromic
27
Positive Coombs test posibilities:
immune ABO compatibility Rh incompatibility
28
Negative Coombs test posibilities:
``` Non-immune membrane defect hemoglobinopathy G6PD pyruvate kinase defect ```
29
transient erythroblastemia of childhood - etiology, age
- unknown etiology - usually follows a viral illness but not always and causes a transient dec production of RBC in the bone marrow - affects kids >1yr
30
transient erythroblastemia of childhood - lab characteristics
- MCV normal - mod to severe anemia down to 2.5 - reticulocyte count decreased
31
Diamond blackfan anemia - age and lab characteristics?
-under 1yr -mod to severe anemia -MCV inc or normal retic count decreased -Hgb F increased**
32
Diamond blackfan anemia - etiology
- some sporadic inheritance | - defect ribosomal protein synthesis == lack of progenitor cells
33
first sign of successful iron deficiency treatment?
reticulocytes peak at 5-7 days
34
deferoxamine use for? how deos it work?
iron overload | chelation therapy
35
sickle cell - vaso occlusive pain Tx
-If really bad: hydroxyurea drug to inc HgbF and/or bone marrow transplant
36
sickle cell- aplastic crisis Tx
transfusion but avoid volume overload | -give folic acid supplementation
37
sickle cell - hemolytic crisis important test result?
Pos coombstest
38
for kids with sickle cell infection risk the prophylactic drug to use?
penicillin ALSO USE IMMUNIZATIONS
39
Sickle cell patients predisposed to::
Salmonella infection | osetomyeltis