Peds Heme I Flashcards
What are the components of the CBC?
RBCs
WBCs
Platelets
What is the normal RR for a neonate?
40-60 breaths per minute
What is the normal range of PMNs?
50-75%
What is the normal range of lymphocytes?
30%
What is the normal range of monocytes?
What is the normal range of bands?
What is the normal range of WBCs for a newborn?
9-30 thousand
What happens to the WBC after birth?
Increases
What is the age at which the WBCs ranges are standard?
after 12 years
When does PMN count start to decrease?
between 1 month and 1 year
What is the value of ANC?
Takes into account actual WBCs
What are the three immature PMNs that you might see?
Myelocytes
Metamyelocytes
Band cells
What are bands?
Immature or unsegmented PMN
When is the percent of bands the highest?
Within first two days of life
What is the I:T ratio?
take the percentage number of immature cells / total percent of PMNs
What is the range of normal I:T?
Less than 0.20
What happens to lymphocytes as PMNs go down?
Go up
What is the normal range of Hb for neonates?
14-22
What happens to the HB dissociation curve at birth? Why?
shift left d/t HbF
True or false: Hb levels are highest just after birth
True
What is the normal Hg:HCT ratio?
3:1
How do you diagnose polycythemia in neonates?
HCT >65%
Polycythemia is based on an arterial or venous sample?
venous
Why is it that capillary samples tend to run higher in terms of HCT than venous samples?
Capillary usually involve some squeezing of the sample area, causing an increased proportion of cells to be obtained
What are the three major causes of newborn polycythemia?
Placental insufficiency secondary to preeclampsia
Endocrine abnormalities
Trisomies
Why is polycythemia concerning in the newborn?
Hyperviscosity can cause a decrease in blood flow to the heart, brain, lungs, and intestines
What percent of pts with polycythemia exhibit polycythemia?
50%
What are the signs/symptoms of polycythemia in the neonate?
Red
Irritability
Feeding difficulties
Lethargy
What is the treatment for asymptomatic polycythemia?
Observe and support
What is the treatment for symptomatic polycythemia?
Exchange transfusion
What is exchange transfusion?
Draw off blood and replace with saline
After the neonatal period, the term polycythemia refers to the HGB or the HCT when it is what level?
2 stds above the mean
The RBCs life span in newborns is about how long?
80 days
True or false: shortly after birth, erythropoiesis ceases b/c of oxygen rich environment
True
What happens to Hb as it matures?
Declines over 10-12 weeks
True or false: a Hb of 9 in the term infant, or 6 in a preterm infant is normal 10-12 week postpartum
True
When does Hb climb to reach normal adult levels?
2 yo
What is the best lab to get for red cell indices?
MCV
What is the lower limit of the MCV in children less than 10 yo?
70 fL + age in years
After 6 months of age, the upper limit of MCV is calculated how?
84 + (0.6*age)
True or false: retic count is separate from the CBC
True
What is polychromatophilia?
the ability of the bone marrow to produce retic in response to RBC loss
What is the normal range of platelets for newborns?
150-450 thousand
What is the range of platelets that spontaneous bleeding is a concern?
5000 ish
What is alloimmune thrombocytopenia?
Transfer of maternal antibody that crosses the placenta causing destruction of platelets
True or false: alloimmune thrombocytopenia is usually a benign issue
True
What is the major concern with alloimmune thrombocytopenia?
Intracranial bleeding
What are the symptoms of alloimmune thrombocytopenia?
Limited petechia
If severe bleeding occurs in neonates from alloimmune thrombocytopenia? Why?
Give mother’s platelets
Will not react with the baby’s
When does nadir occur in alloimmune thrombocytopenia?
3-4 days
What is maternal ITP?
Low platelets in the infant when the mother has immune thrombocytopenia, since the IgG of mother will cross placenta, and decrease the platelets
What is the treatment for maternal ITP?
IVIG
True or false: maternal ITP is usually a severe phenomenon
False–usually self resolved in 1-2 weeks
What is the usual cause of thrombocytopenia in infants? Why?
Bacterial or viral infection
Platelet aggregation from bacterial products
What happens to neonatal platelet count as an infection is treated?
Increases
