Peds Heme I

Question 1

What are the components of the CBC?

Answer 1

RBCs
WBCs
Platelets

Question 2

What is the normal RR for a neonate?

Answer 2

40-60 breaths per minute

Question 3

What is the normal range of PMNs?

Answer 3

50-75%

Question 4

What is the normal range of lymphocytes?

Answer 4

30%

Question 5

What is the normal range of monocytes?

Question 6

What is the normal range of bands?

Question 7

What is the normal range of WBCs for a newborn?

Answer 7

9-30 thousand

Question 8

What happens to the WBC after birth?

Answer 8

Increases

Question 9

What is the age at which the WBCs ranges are standard?

Answer 9

after 12 years

Question 10

When does PMN count start to decrease?

Answer 10

between 1 month and 1 year

Question 11

What is the value of ANC?

Answer 11

Takes into account actual WBCs

Question 12

What are the three immature PMNs that you might see?

Answer 12

Myelocytes
Metamyelocytes
Band cells

Question 13

What are bands?

Answer 13

Immature or unsegmented PMN

Question 14

When is the percent of bands the highest?

Answer 14

Within first two days of life

Question 15

What is the I:T ratio?

Answer 15

take the percentage number of immature cells / total percent of PMNs

Question 16

What is the range of normal I:T?

Answer 16

Less than 0.20

Question 17

What happens to lymphocytes as PMNs go down?

Answer 17

Go up

Question 18

What is the normal range of Hb for neonates?

Answer 18

14-22

Question 19

What happens to the HB dissociation curve at birth? Why?

Answer 19

shift left d/t HbF

Question 20

True or false: Hb levels are highest just after birth

Answer 20

True

Question 21

What is the normal Hg:HCT ratio?

Answer 21

3:1

Question 22

How do you diagnose polycythemia in neonates?

Answer 22

HCT >65%

Question 23

Polycythemia is based on an arterial or venous sample?

Answer 23

venous

Question 24

Why is it that capillary samples tend to run higher in terms of HCT than venous samples?

Answer 24

Capillary usually involve some squeezing of the sample area, causing an increased proportion of cells to be obtained

Question 25

What are the three major causes of newborn polycythemia?

Answer 25

Placental insufficiency secondary to preeclampsia Endocrine abnormalities Trisomies

Question 26

Why is polycythemia concerning in the newborn?

Answer 26

Hyperviscosity can cause a decrease in blood flow to the heart, brain, lungs, and intestines

Question 27

What percent of pts with polycythemia exhibit polycythemia?

Answer 27

50%

Question 28

What are the signs/symptoms of polycythemia in the neonate?

Answer 28

Red Irritability Feeding difficulties Lethargy

Question 29

What is the treatment for asymptomatic polycythemia?

Answer 29

Observe and support

Question 30

What is the treatment for symptomatic polycythemia?

Answer 30

Exchange transfusion

Question 31

What is exchange transfusion?

Answer 31

Draw off blood and replace with saline

Question 32

After the neonatal period, the term polycythemia refers to the HGB or the HCT when it is what level?

Answer 32

2 stds above the mean

Question 33

The RBCs life span in newborns is about how long?

Answer 33

80 days

Question 34

True or false: shortly after birth, erythropoiesis ceases b/c of oxygen rich environment

Answer 34

True

Question 35

What happens to Hb as it matures?

Answer 35

Declines over 10-12 weeks

Question 36

True or false: a Hb of 9 in the term infant, or 6 in a preterm infant is normal 10-12 week postpartum

Answer 36

True

Question 37

When does Hb climb to reach normal adult levels?

Answer 37

2 yo

Question 38

What is the best lab to get for red cell indices?

Answer 38

MCV

Question 39

What is the lower limit of the MCV in children less than 10 yo?

Answer 39

70 fL + age in years

Question 40

After 6 months of age, the upper limit of MCV is calculated how?

Answer 40

84 + (0.6*age)

Question 41

True or false: retic count is separate from the CBC

Answer 41

True

Question 42

What is polychromatophilia?

Answer 42

the ability of the bone marrow to produce retic in response to RBC loss

Question 43

What is the normal range of platelets for newborns?

Answer 43

150-450 thousand

Question 44

What is the range of platelets that spontaneous bleeding is a concern?

Answer 44

5000 ish

Question 45

What is alloimmune thrombocytopenia?

Answer 45

Transfer of maternal antibody that crosses the placenta causing destruction of platelets

Question 46

True or false: alloimmune thrombocytopenia is usually a benign issue

Answer 46

True

Question 47

What is the major concern with alloimmune thrombocytopenia?

Answer 47

Intracranial bleeding

Question 48

What are the symptoms of alloimmune thrombocytopenia?

Answer 48

Limited petechia

Question 49

If severe bleeding occurs in neonates from alloimmune thrombocytopenia? Why?

Answer 49

Give mother's platelets Will not react with the baby's

Question 50

When does nadir occur in alloimmune thrombocytopenia?

Answer 50

3-4 days

Question 51

What is maternal ITP?

Answer 51

Low platelets in the infant when the mother has immune thrombocytopenia, since the IgG of mother will cross placenta, and decrease the platelets

Question 52

What is the treatment for maternal ITP?

Answer 52

IVIG

Question 53

True or false: maternal ITP is usually a severe phenomenon

Answer 53

False--usually self resolved in 1-2 weeks

Question 54

What is the usual cause of thrombocytopenia in infants? Why?

Answer 54

Bacterial or viral infection Platelet aggregation from bacterial products

Question 55

What happens to neonatal platelet count as an infection is treated?

Answer 55

Increases