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