Pediatric Hematology

Question 1

MCHC

Answer 1

color

normochromic, hypochromic

Question 2

Reticulocyte count

Answer 2

number of new, young RBCs in circulation

percentage (normal is 1-2 percent)

Question 3

Iron deficiency anemia (IDA)

Answer 3

• microcytic, hypochromic
• increased TIBC, low ferritin
• reticulocyte low w/inadequate iron intake, and high w/blood loss
• pica
• treat with elemental iron 3-6 mg/kg/day until Hgb normalizes
• then to replace iron stores, 2-3mg/kg/day for four months

Question 4

MCV

Answer 4

volume/size of RBCs

microcytic, normocytic, macrocytic

Question 5

ferritin

Answer 5

stored iron

Question 6

Thalassemia

Answer 6

• splenomegaly, frontal bossing
• microcyctic hypochromic
• increased reticulocyte count, ferritin and iron normal)
• refer to hematologist

Question 7

Sickle cell anemia

Answer 7

• jaundice, retinopathy, delayed puberty, hepatosplenomegaly, more frequent infections, systolic murmur)
• sickled cells on peripheral blood smear; Howell-Jolly bodies on RCDW
• reticulocytosis (10-25 percent)
• tx: collaborate with hematologist, chronic folic acid supplementation (supports development of new RBCs), hydroxyurea (stimulate fetal Hgb), immunize, genetic counseling

Question 8

Lead poisoning

Answer 8

• Level >10mcg/dL
• Level >45mcg/dL requires chelation therapy
• Contaminated soil, houses older than 1978
• lethargy, neuropathies, ataxia, headache, Burtonian lines, papilledema

Question 9

Leukemia

Answer 9

• normal bone marrow elements replaced by poorly differentiated blast cells
• ALL (most cases), AML
• anemia, pale, fatigue, recurrent URI, bleeding, easy bruising, bone and joint pain, adenopathy, hepatosplenomegaly
• bone marrow biopsy, CBC

Question 10

What types of anemia do children get?

Answer 10

microcytic, hypochromic
iron deficiency anemia
thalassemia
lead poisoning
G6PD deficiency