Peds. Heme Flashcards
The two reasons why physiologic jaundice occurs:
- Increased destruction of RBC - lifespan of RBC is 70-90 d
2. Hepatic uptake is lower (decreased glucuronyl transferase) - this conjugates bilirubin
When does physiologic jaundice appear and pattern?
Days 3-5; cephalopods –> caudal
Breastfeeding jaundice is when:
The mom is not producing enough milk - their jaundice is MORE EXAGGERATED because they are dehydrated and nutrient deprived
Breast Milk jaundice is when:
There is a LATER onset of physiologic jaundice with peak bilirubin levels 2-3 weeks after birth (slower progression)
What is the normal level of diapers for elimination?
- 6 wet
- 3-4 dirty
Bilirubin levels and regions of the body:
Safe (II): Head and to the nipple line = 12 Dangerous (III): Lower abdomen and legs = 8-16 More dangerous (IV): Arms and lower legs: 11-18 BAD (V): Palms and soles (15)
What do you order and treatment level for bilirubin assessment?
TSB; treat after 12
What is Kernicterus:
Acute bilirubin encephalopathy - stains the basal ganglia, pons or cerebellum
Bilirubin >20
Symptoms when bilirubin >25
Major risk factors for hyperbilirubinemia
Jaundice within 24 hours of birth A sibling with jaundice as a neonate Unrecognized hemolysis Nonoptimal sucking/nursing Def. in glucose-6-phosphate Infection Cephalohematoma (extra blood) East Asian or mediterranean
When do you treat a baby with phototherapy? Day 3 and day 5 levels:
Day 3: At 16/17
Day 5: Over 20
Kernicterus has not been documented to show:
A relationship with Breast milk jaundice
What are the therapies for breast milk jaundice (2)?
- 1-2 days of formula (keep pumping) and breast feed later
- Phototherapy
What is the therapy for breastfeeding failure jaundice?
- 1-2 days of formula and then re-begin breast feeding 5 days later (jaundice usually does not return)
If you see jaundice in the first 24 hours of life, think of:
Hemolytic anemia
What are the two causes of hemolytic anemia?
- Mom is rh - and baby is rh +
- Mom is O and baby is A or B
Hemolytic disease of the newborn is from:
Mom is Rh- and formed AB against previous Rh + baby - now her Ab are attacking baby #2 RBC = lysis
To prevent AB formation to an Rh+ baby, mom is given shots when?
28 weeks and within 72 hours of birth
To test if the baby is a different blood type than mom, you can perform the:
Direct Coomb’s test - Looking for AB on the baby RBC
If the direct coomb’s test is positive, you should:
Switch the infant to formula
What do you do for a baby with Hemolytic anemia of the newborn?
- hospitalize
- exchange transfusion
Anemia is diagnosed when:
It is two SD below the normal
Pattern of H and H in newborns:
Newborn: HIGH: 18.5 and 56%
1 mo - 2 yr: Decreases to 13 and 36%
12: Adult levels
What is the most common cause of anemia in kids?
Iron def. during times of rapid growth - toddlers and adolescents
When does a normal term and a premature infant run out of its iron stores?
Normal: 4-6 months
Premature: 3-4 months
What three things would make a child vulnerable to anemia?
- Low SES (mex. Americans)
- Lead exposure
- Exclusively breast feeding beyond 4 months
IDA is more common where?
Inner city (8%)
When is routine Fe screening and when should it be done early?
Routine: at 12 months
Early:
- 9-12: Low SES, immigrated to USA
- 6 months: Pre-term/low birth weight
How should you treat IDA? Recovery?
- 3-6 mg of iron/kg/day TID or BID
Response: 1g/dL/week
Recovery: 6-8 weeks
What are two PE findings of sickle cell?
- Maxillary hyperplasia
- Dactylysis
What is the most common reason for early mortality in sickle cell patients?
Acute Chest Syndrome
What are the three symptoms of pediatric acute chest syndrome?
- Fever
- Cough
- Upper lobe
What are the three symptoms of adult acute chest syndrome?
- Afebrile
- Pain
- Lower lobe
What are lab findings for Sickle cell?
Increased: MCV, WBC, Platelets
Decreased: H & H
An aplastic crisis can result from:
A parvovirus infection - slapped cheek rash
What is hereditary spherocytosis and treatment?
The RBC membrane is rigid and gets clogged in the spleen - treatment is to remove the spleen
When should you perform a splenectomy on someone with hereditary spherocytosis?
Age 5/6 or unless they are being hospitalized for crisis before then
You are susceptible to parvovirus causing problems with what two illnesses?
- Hereditary spherocytosis
- Sickle cell
Primary hemostasis involes what two things:
Platelets and endothelial cells
What does secondary hemostasis involve?
Coagulation factors
ITP only affects the ___ in the body and is most common in ____ YO (time of year?)
Platelets; 2-5 - Summer and spring
Progression of ITP in kids:
Follows a viral illness from 1 month ago and resolves within 6 months
What are some symptoms of a primary bleeding disorder?
- Bleeding from mucous membranes
- Epistaxis
- Eccymosis
- Petechiae
- Prolonged bleeding from wound
What are some symptoms of a secondary bleeding disorder?
- Palpable SC/IM hematomas
- Hemarthroses
What should you avoid with ITP?
IM injections and NSAIDS
Under a platelet count of 30,000 for ITP you should treat with:
- Tranfusion
- Corticosteroids
- IVIG
- Anti-D immune globulin
- Recover in 3-6 months
Grade I - Minor ITP findings:
Few petechiae <100, and <5 bruises <3 cm diameter
Grade II - Mild ITP findings:
Many petechia >100 and or >5 large bruises >3 cm in diameter
Grade III - Moderate ITP findings
Mucosal bleeding
What is Henoch-Schonlein Purpura NOT
a platelet disorder
What are 5 PE findings of Henoch-Schonlein Purpura?
- Nonthrombocytopenic purpura
- Arthritis
- Arthralgias
- GI sx
- Renal findings
What age are people normally with Henoch-Schonlein Purpura?
6-7 (older than ITP)
What are two features of the clinical presentation for Henoch-Schonlein Purpura?
- Previously well child with a history of illness or immunization
- Rashon hands, legs and feet + abdominal pain and arthralgia
Rash is ___% present in cases of Henoch-Schonlein Purpura but:
100% present; but not always the first thing to develop
The rash in Henoch-Schonlein Purpura becomes:
Confluent over time
What two sites are the most common for arthralgia pain in Henoch-Schonlein Purpura?
Knees and ankles
Antibody in Henoch-Schonlein Purpura?
IgA
What are the three problematic systems in someone with Henoch-Schonlein Purpura?
- Renal
- GI
- Arthralgia
What tests should you order in someone with Henoch-Schonlein Purpura?
- CBC - rule out ITP
- Renal function tests **Renal damage is permanent if not treated
When should someone be hospitalized for Henoch-Schonlein Purpura?
- Cannot orally drink
- Significant abdominal pain
- Change in mental status
- Renal insufficiency
- Mental problems
- Self care issues (cannot walk d/t pain)
What are the two issues with von Willebrand disease?
- Platelets cannot adhere
- VWf is a carrier for factor VIII (results in deficiency)
VWf affects:
Men and women - many different levels of severity
Presentation of VWF?
Bleeding from mucous membranes - nose, vaginal, GI
What are the labs for VWF?
Prolonged PT and bleeding time
What is the management for VWF (2)?
- Supportive
- DDAVP - releases VWF from platelets
What is a huge sign for Hemophilia A?
Bleeding in male circumcision
What are the labs for Hemophilia A?
ONLY PROLONGED PTT
What are the two therapies for Hemophilia A?
- Replacement therapy and DDAVP for VIII replacement
When is lymphadenopathy concerning in kids?
Under 12: over 1 cm
Over 12: Over 0.5 cm
What kills kids most under the age of 15?
- Accidents (44%)
- Cancer 10% of kid deaths under 15
75% of all childhood leukemia:
ALL
__ is rare in kids and ____ is very rare
CML is rare
CLL is very rare
What two things are commonly associated with having leukemia?
Down syndrome
Having a sibling with leukemia
What are three odd signs of leukemia?
- Gingival hyperplasia
- Rashes
- CN palsy
What will you see on a CBC for someone with leukemia?
High WBC, low RBC
What confirms a diagnosis of leukemia?
Bone marrow biopsy
Brain tumors are the __ most common cancer in kids
Second
What three things indicate a kid may have a brain tumor?
- Loss of dev. milestones
- Poor performance in school
- Increased head circumference or expanded fontanelles
What are two signs of a BT in kid regarding their eye:
Marcus Gunn pupil, CN 6 palsy
Lymphoma in kids presents like:
2-3 months of painless growing cervical/supraclavicular lymph nodes
How does Non-Hodgkin Lymphoma present?
SOB, cough, SVC, hepatosplenomegaly, mediastinal mass, abdominal mass/tenderness
What is a wilms tumor?
Nephro tymor
Wilm’s tumor is __ most common cancer in kids:
Second
What age is most common for a Wilm’s tumor and what is the peak age?
Most common in 6mo - 10 yr; peak age is 2-3
Most are asymptomatic with a Wilm’s tumor but 30% can have:
Abdominal pain, malaise, gross hematuria, hypertension
To diagnose a Wilm’s tumor…
US and CT
Osteosarcomas are common where and with what sign?
Metaphysic; Sun burst
Ewing sarcoma is common where and with what sign?
Flat bones, diaphysis (hip); Onion peel
What tests do you order if you suspect osteosarcoma or Ewing’s?
Xray then CT or MRI - Chest X-ray to look for mets
