Ped Hem/Onc/Allergies Flashcards
Low MCV
Normal RDW
High serum iron
Thalassemia
MCV of microcytic, normocytic, and macrocytic
microcytic: MCV < 80
normocytic: MCV 80-100
macrocytic: MCV > 100
Microcytic anemias
iron deficiency
thalassemia
Lead toxicity
Normocytic anemias
Sickle cell
ITP
signs/sx’s of iron deficiency
weakness, tachycardic, palpitations, angular cheilosis, koilonychias (nail spooning), pica, Plummer-Vinson (esophageal webs)
Peripheral blood smears with basophilic stippling
Lead toxicity
How are types of thalassemias differentiated?
Ethnicity: Asian (alpha); Mediterranean (beta)
Hgb electrophoresis: normal (alpha); increased Hb A2 and F (beta)
What lab values can differentiate iron def anemia from thalassemia?
serum iron (high in thalassemia and low in IDA) Mentzer index (< 13 in thalassemia and > 13 in IDA)
Iron deficiency management in pediatric patients?
iron supplement x 3-6 mon and f/u
if no response then get Hgb electrophoresis
Diagnostic labs of Sickle cell
peripheral smear with “sickled” cells
Hgb S on electrophoresis
When should routine lead screen be done?
at 12 months
Blood smear results of thalassemia
microcytic, hypochromic
targets
acanthocytes
What labs should be ordered for anyone with unexplained petechial rash?
CBC
What are four variants of alpha thalassemia and how do they present?
3 = silent carrier; asx 2 = Alpha trait; mild anemia 1 = Hb H; pallor, splenomegaly 0 = Hydrops fetalis: stillborn
How can mild thalassemia be treated?
folate
NO iron
Anemia common in African Americans
Sickle Cell
How do sickle cell carriers present?
symptomatic only under severe hypoxia
Onset of Sickle Cell by age _____ and loss of spleen by age _____.
1 yo
2 yo
Treatment of Sickle Cell
- Daily folate
- Hydroxyurea (Hb F)
- Abx if immunocomp’d to prevent infxtn
- Vaccinate prior to spleen loss
- Regular eye exams (prevent retinopathy)
3 yo female with petechial rash but otherwise normal PE. Recent URI that has resolved. Only finding on CBC was thrombocytopenia. What do you suspect?
ITP
ITP treatment
Based on platelet count; self-limiting
> 50: no tx; close monitoring
10-20 or bleeding signs: IV IG
< 10: platelet transfusion
What meds should be avoided as supportive care for ITP?
aspirin or ibuprofen
DDX of petechial rash
meningits (fever)
HUS (E. coli infxtn)
TTP (older, HA)
ITP (young, asx)
Pathophysiology of ITP
immune mediated destruction of platelets
IgG or IgM mediated antibodies cross-react
5 yo child with bone pain, fever, bruising, and pancytopenia on blood smear. Likely dx?
ALL
Likely leukemia in 65 yo
CLL
Philadelphia chromosome hallmark of _______.
CML
Auer rods hallmark of ______.
AML
Signs of intracranial tumors
change in mentation, HA, vomiting, gait change, papilledema, torticollis, increased head circumference
How to differentiate neuroblastoma and Wilms tumor?
Both have solid abd mass, but neuroblastoma is painful and Wilms is painless
Child comes to clinic saying he feels fine, but mother is concerned with hemihypertrophy and abdominal mass. Next best step? Likely dx?
abd U/S to eval kidneys
suspect Wilms tumor
What is a Type 1 hypersensitivity reaction?
IgE mediated; binds to mast cells which release histamines, cytokines, interleukins
How can allergies get worse over time?
with repeated exposures for allergen, body produces more memory cells until a threshold is reached
Signs of allergic rhinitis in children on PE
allergic shiners
Dennie-Morgan lines (fold under lower eyelid)
Nasal salute or crease
Nasal mucosa pale and boggy
Lab findings of allergic rhinitis
eosinophils on nasal smear
elevated IgE serology markers
+/- skin testing (gold std)
Treatment of allergic rhinitis in children
intranasal steroids
anti-histamines prn
decongestants if over 6 yo (Afrin)
avoid triggers
What are common allergies in infants and children?
milk protein (most common) eggs nuts seafood legumes bees
Which food allergies are outgrown? When?
milk protein at 3
eggs at 6
nuts are lifelong!
How are lifelong allergies managed?
epi pen
Sx’s of milk protein allergy
vomiting, bloody diarrhea, colic, failure to thrive
How should milk protein allergy be managed by parent?
Initially, no dairy for mom and baby given hypoallergenic milk (Alimentum)
Reintroduce whole milk at 15 mon old
Should outgrow by 3 yo
What is oral allergy syndrome?
local IgE reaction when eating fruit and raw veggies that causes tingling around mouth
What should be suspected if 1 month old baby’s umbilical cord still has not fallen off?
leukocyte adhesion deficiency
Immunodeficiency with face abnormalities, seizures, cardiac defect, and low serum calcium.
DiGeorge syndrome
Sickle Cell symptoms
anemia, episodes of pain (crises), delayed growth, swelling of hands and feet, vision changes
