Pediatric Anemia - Newman

Question 1

A reduction of Hb concentration or RBC volume below the range of values occurring in healthy persons

Answer 1

anemia

Question 2

concentration of 2,3-DPG increases within the RBC

• oxygen dissociation curve shifts to the RIGHT
• affinity of Hb for O2 is reduced in tissues needing to oxygenated

Answer 2

physiologic response to anemia

• increases cardiac output
• enhanced oxygen extraction
• blood flow shunts to vital organs

Question 3

what family hx should you ask about in peds anemia pt?

Answer 3

• anemia
• splenomegaly
• jaundice
• early-age onset of gallstones

Question 4

what clinical features would you see once anemia becomes more severe?

Answer 4

• weakness
• tachypnea
• SOA
• cardiomyopathy

Question 5

what lab tests do you order for anemia pt?

Answer 5

• Hb/Hct

- CBC: MCV, MCH, MCHC

Question 6

what is MCV?

Answer 6

mean corpuscular volume

- mean value of volume of RBC’s in sample

Question 7

what is MCHC?

Answer 7

mean corpuscular hemoglobin concentration

- Hb/Hct

Question 8

what is MCH?

Answer 8

mean corpuscular hemoglobin

- average content (mass, weight) of Hb per RBC

Question 9

what is RDW?

Answer 9

red cell distribution width

• measure of variability of RBC sizes in sample
• is a percent (if all RBC’s were exactly same size, would be 0%)

Question 10

what is a peripheral smear?

Answer 10

provides information about RBC and WBC morphology, platelet clumping and hemolysis

Question 11

anysocytosis

Answer 11

different SIZE

Question 12

poikilocytosis

Answer 12

different SHAPES

Question 13

schistocytosis

Answer 13

fragments of RBC’s

Question 14

anemia with MCV <2.5 percentile for age,race, sex

Answer 14

microcytic

Question 15

anemia with MCV between 2.5 and 97.5 percentile for age, race, sex

Answer 15

normocytic

Question 16

anemia with MCV >97.5 percentile for age, race, sex

Answer 16

macrocytic

Question 17

MCHC <32 g/dL

Answer 17

hypochromic

Question 18

MCHC 33-34

Answer 18

normochromic

Question 19

MCHC >35

Answer 19

hyperchromic

Question 20

what causes decreased RBC production?

Answer 20

ineffective erythropoieses

Question 21

what causes increased destruction of RBC’s?

Answer 21

• intravascular: mechanical injury, complement fixation, parasites, toxins
• extravascular: macrophages in reticuloendothelial system

Question 22

low or low-normal number of reticulocytes in a pt with anemia is indicative of what?

Answer 22

inadequate bone marrow response KNOW this

Question 23

increased number of reticulocytes is normal response to what?

Answer 23

anemia (bone marrow trying to keep up)

Question 24

when do you see Howell-Jolly bodies?

Answer 24

in asplenic pt (post-spelenctomy)

Question 25

when do you see the lowest point of Hb/Hct in healthy term infants?

Answer 25

* *2 months** KNOW this | - lowest point called the nadir

Question 26

what is the age-specific cause of anemia in neonates?

Answer 26

immune hemolytic anemia

Question 27

what lab values would see for autoimmune hemolytic anemia?

Answer 27

- positive direct Coombs test - elevated indirect bilirubin - normocytic anemia - elevated reticulocyte count

Question 28

what is the most likely cause of congenital infection causing anemia in neonates?

Answer 28

parvovirus B19

Question 29

macrocytic anemia with low reticulocyte count

Answer 29

Diamond-Black syndrome | - aka congenital pure red cell aplasia, resulting from increased apoptosis in erythroid precursors

Question 30

macrocytic anemia and reticulocytopenia, thrombocytopenia, leukopenia - most common inherited form of aplastic anemia

Answer 30

Fanconi anemia | - progresses to pancytopenia

Question 31

what is the most common cause of anemia in infancy to toddlerhood?

Answer 31

iron deficiency anemia | - pay attention to cows milk consumption (not enough iron)

Question 32

what would peripheral smear show in iron deficiency anemia?

Answer 32

- hypochromic microcytes | - target cells

Question 33

what is the mentzer index?

Answer 33

used to differentiate iron def anemia from beta thalassemia | - MCV/RBC count

Question 34

what does a mentzer index >13 indicate?

Answer 34

iron deficiency anemia

Question 35

what does a mentzer index <13 indicate?

Answer 35

beta thalassemia

Question 36

what two deficiencies cause anemia?

Answer 36

- G6PD (Heinz and bite cells!) | - pyruvate kinase (spur cells)

Question 37

toxicity of what would lead to microcytic, hypochromic anemia? - peripheral smear may show **basophilic stippling**

Answer 37

lead poisoning