Pediatric Disorders Flashcards
Normal values for hemoglobin and hematocrit _____ in the pediatric population
VARY with AGE
When is the physiologic nadir (low) for hemoglobin in children?
2 months of age
At 2 months of age, what is at a physiologic low?
Hemoglobin
Due to Anemia, what will increase in the RBC?
2,3-DPG
Due to Anemia, which way will the hemoglobin-oxygen dissociation curve shift?
To the RIGHT
Due to Anemia, why does the hemoglobin-oxygen dissociation curve shift to the right?
Affinity of hemoglobin for oxygen DECREASES in tissues needing oxygen
What cardiac effects can Anemia have on children?
Increased cardiac output
- Increased heart rate
- Flow murmur may be possible
If Anemia develops rapidly the symptoms will be more ____
Dramatic
If Anemia develops slowly the body will?
Compensate better so the symptoms will be less dramatic
Anemia can also be due to ____ blood loss
Chronic blood loss
If Anemia is due to intravascular RBC destruction, what will the symptoms be more associated with and what can cause this?
Hemoglobinuria, Hemoglobinemia
- Toxins, mechanical, autoimmune
If Anemia is due to extravascular RBC destruction, what will the symptoms be more associated with?
Jaundice, splenomegaly
A LOW number of reticulocytes with anemia =
INADEQUATE bone marrow response
A HIGH number of reticulocytes with anemia =
The problem is NOT in the bone marrow
ex. hemolysis, sequestration, blood loss
Iron Deficient Anemia is microcytic, hypochromic and has an increased RDW. What is it usually caused by?
Dietary deficiency in iron
With Iron Deficient Anemia, what are the levels of:
Iron, Ferritin and Transferrin
Iron = LOW Ferritin = LOW Transferrin = HIGH
With a pale child that drinks a lot of cow’s milk you should suspect?
Iron deficient anemia
You should suspect iron deficient anemia in a?
Pale child who drinks lots of cow’s milk
What can the Mentzer Index do?
Distinguish between iron deficient anemia and beta-thalassemia trait
What distinguishes between iron deficient anemia and beta-thalassemia trait?
Mentzer Index
How do you calculate the Mentzer index and what are its levels?
MCV/RBC
- Less than 13 = beta-thalassemia trait
- Equal to 13 = Indeterminate
- More than 13 = iron deficient anemia
How do you calculate ANC?
(%Neutrophils + %Bands) X WBC/100
What is the most common class of drugs that causes Neutropenia?
Chemotherapeutics
Neutropenia ANC level
ANC < 1500
Mild Neutropenia ANC level
ANC between 1000-1500
Moderate Neutropenia ANC level
ANC between 500-1000
Severe Neutropenia ANC level
ANC < 500
Red cheeks followed by a diffuse, erythematous rash with anemia/neutropenia/thrombocytopenia could indicate?
Parvovirus B19 infection (Fifth Disease)
What is absent in DiGeorge Syndrome?
NO thymus
What immunodeficiency is seen with DiGeorge Syndrome and why?
T cell immunodeficiency because of an absent thymus
What is the #1 cause of death due to ILLNESS in the U.S for children?
Brain cancer
What is the #2 cause of death due to ILLNESS in the U.S for children?
ACUTE Leukemias
What is the #1 malignancy that affects children in the U.S?
Acute Leukemias
What is the #1 cause of death due to ILLNESS in the U.S for children?
Brain cancer
What is the #1 cause of death in the U.S for children?
Accidental injuries
What is the most common lymphoma in children?
B-cell NON-Hodgkin lymphoma
What is the most common malignancy in 15-19 year olds?
Hodgkin Lymphoma
Hodgkin Lymphoma is most common in what age group and associated with what 3 virus infections?
15-19 year olds
- HHV-6
- EBV
- Cytomegalovirus
What do Reed Sternberg cells look like?
- Seen with Hodgkin Lymphoma
- - Owl Eyes
What symptoms are often seen with Hodgkin Lymphoma?
B symptoms:
- Fever of 39/102.2
- Night Sweats
- Weight loss of more than 10% body weight in 6 months
Any patient with unexplained and persistent lymphadenopathy and/or respiratory symptoms should get?
Chest X-ray
- Rule out a mediastinal mass
Trisomy 21 (Down Syndrome) is associated with what malignancies?
ALL
AML
2 Thrombocytopenia categories
- Decreased platelet production
2. Increased platelet degradation
Possible reasons for decreased platelet production?
Genetic disorders, nutritional deficiencies, bone marrow infiltration/failure
How do kids feel if they have ITP and when does it usually occur?
They feel fine
- Occurs 1-3 weeks after a viral infection
What are the levels of platelets and PT/PTT with ITP?
Platelets < 20K
PT/PTT = NORMAL
ITP involves what against platelets?
Antibodies against platelets
With ITP the other cell lines are usually?
Normal
With ITP if the other cell lines are NOT normal, what should you get?
Bone marrow aspirate
What is the treatment for ITP in children?
Usually self-resolves with supportive care
If the ITP is severe with children, what is the treatment?
Prednisone
What is Kasabach-Merritt phenomenon?
- Thrombocytopenia
- Hypo-fibrinogenemia (low fibrinogen)
- GIANT HEMANGIOMA
- Intravascular coagulation
What is Kasabach-Merritt phenomenon?
- Thrombocytopenia
- Hypofibrinogenemia (low fibrinogen)
- GIANT HEMANGIOMA
- Intravascular coagulation
What are 3 red flag signs in patients with Thrombocytopenia?
- Pancytopenia
- LDH
- Renal impairment
What are 3 red flag signs in patients with Thrombocytopenia?
- Pancytopenia
- LDH
- Renal impairment
