Lec 19/20 - Peds I and 2 Flashcards
define anemia
- 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
History consistent with iron deficiency anemia
- 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
treatment plan for Diamond blackfan anemia
- prednisone
- transfusion which may lead to iron overlad
- bone marrow transplant may be curative
treatment plan for iron deficiency anemia
- 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)
treatment plan for transient erythroblastopenia of childhood
- supportive only
- transfuse if necessary with cardiovascular instability
complications of sickle cell anemia
- 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
basic prevention and Tx of sickle cell anemia
-Tx = PAIN CONTROL and HYDRATION; O2 if needed
key dietary history point when evaluating for anemia in children?
milk intake!
what condition is consistent with chloramphenicol drug use?
anemia
first screen infants for anemia at what age?
9-10mo, kindergarden entrance and for adolescents
Hematocrit number relationship to Hb number?
HCT ~= 3xHb
Method to detect Hb levels? HCT?
direct spectrophotometry
HCT is calculated (3 times Hb)
What blood sample do you need for Hg check
venous sample
After anemia is confirmed via CBC and Hb look at?
RBC indices
Most useful RBC indice?
MCV
If MCHC is high its a sign of
spherocytosis
RBC of varying sizes - most likely?
iron deficiency anemia
RBC indices same size but know there is an issue with Hb?
thalassemia trait
What type of evaluation done pancytopenia? What diseases to thnik of?
bone marrow exam
aplastic anemias; leukemias…
increased WBC and low platelets is sign of…
infection when associated anemia is present (hemolytic uremic syndrome)
normal WBC and low platelets and mild anemia sign of?
platelet dysfunction (ITP)
Two accepted ways to classify anemia in kids:
1) size of RBC
2) increased destruction vs decreased production
Microcytic hypochromic RBC - differential Dx?
iron def
lead tox
thalassemia
Macrocytic hyperchromic - differential Dx?
B12 folate def (if fed goat milk)
if infant fed goat milk what deficiency?
folate deficiency = macrocytic hyperchromic
Diamond blackfan anemia (congenital pure red cell aplasia) classification?
macrocytic normochromic
Positive Coombs test posibilities:
immune
ABO compatibility
Rh incompatibility
Negative Coombs test posibilities:
Non-immune membrane defect hemoglobinopathy G6PD pyruvate kinase defect
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
transient erythroblastemia of childhood - lab characteristics
- MCV normal
- mod to severe anemia down to 2.5
- reticulocyte count decreased
Diamond blackfan anemia - age and lab characteristics?
-under 1yr
-mod to severe anemia
-MCV inc or normal
retic count decreased
-Hgb F increased**
Diamond blackfan anemia - etiology
- some sporadic inheritance
- defect ribosomal protein synthesis == lack of progenitor cells
first sign of successful iron deficiency treatment?
reticulocytes peak at 5-7 days
deferoxamine use for? how deos it work?
iron overload
chelation therapy
sickle cell - vaso occlusive pain Tx
-If really bad: hydroxyurea drug to inc HgbF and/or bone marrow transplant
sickle cell- aplastic crisis Tx
transfusion but avoid volume overload
-give folic acid supplementation
sickle cell - hemolytic crisis important test result?
Pos coombstest
for kids with sickle cell infection risk the prophylactic drug to use?
penicillin
ALSO USE IMMUNIZATIONS
Sickle cell patients predisposed to::
Salmonella infection
osetomyeltis
