Peds I Flashcards
What are the three characteristics of anemia?
- reduced RBCs
- Reduced quantity of Hb
- Reduced MCV
Is an 11.5 Hb level normal for a 6 month old?
Yes
True or false: cholecystectomy at an early age is a risk factor for anemia
True
what are the concurrent diseases that are associated with anemia?
JIA SLE renal disorders Malignancy Immunodeficiency disorders
Why is the age of a house important in determining anemia?
Pb levels
When is screening recommended for anemia?
9-12 mo
kindergarten entrance
Adolescents
Which draws are preferred for CBCs: venous or capillary draws?
Venous
HCT is approx (__)x the Hb?
3x
When should you look at the red cell indices?
After anemia is confirmed
What are the two labs for anemia eval?
CBC and PBS
What is the most useful RBC index?
MCV
In children less than 10 yrs the lower limit of HCT is what?
70+age in years
After 6 months of age, the upper limit can be calculated by (___) until the adult limit of 96 fL.
84+(0.6* age in years)
What is MCHC?
Mean cell Hb concentration
Measures hydration status
What is the normal value of MCHC?
> 35 g/dL
RDW in Fe deficiency anemia is high, normal, or low?
High
RDW in thalassemia trait is high, normal, or low?
Normal
Why is it important to look at WBC as well as RBCs when evaluating anemia?
Look for bone marrow suppression
pancytopenia
Is there is pancytopenia, what lab should you order?
Bone marrow biopsy
Increased WBCs/low platelets may be a sign of what?
infection (hemolytic uremic syndrome)
Normal WBC/low platelets and mild anemia could be a sign of what?
Platelet dysfunction
idiopathic thrombocytopenic purpura
What does the reticulocyte count tell you?
The rate of RBC production
Is the reticulocyte count a part of the CBC?
No
What are the two ways to classify anemia?
- Size of RBCs
2. Increased destruction vs decreased production
What are the four microcytic, hypochromic anemia?
Fe deficiency
Pb toxicity
Thalassemia
sideroblastic anemia
What are the two macrocytic, hyperchromic anemia?
B12
Folate deficiency
What type of milk has a low amount of folate?
Goat’s milk
Normocytic with decreased retics = ?
Diamond black anemia
Transient erythroblastopenia of childhood
Parvovirus
Normocytic with increased reticulocytes = ?
Blood loss
What does a positive coombs test indicate?
Immune
ABO incompatibility
Rh incompatibility
What is the normal for MCV for under 10 yrs?
(70 + age in year)
What is the recommended amount of milk intake for toddlers?
16-20 ozs
What is the effect of milk consumption on Fe stores?
Decreases
What are the labs like with milk caused Fe deficiency in toddlers? (MCV, RDW, TIBC, retic)
MCV decreased
RDW increased
TIBC increased
Retic normal to increase
Under what age should cow’s milk be avoided?
12 mo
What is TEC?
Idiopathic (after viral) decreased production of RBCs in the bone marrow
What are the labs like in TEC? (MCV, Hb, retic)
- MCV normal (normocytic)
- moderate to severely low Hb
- Retic count decreased
What is diamond blackfan anemia?
Moderate to severe anemia
Sporadic inheritance pattern of abnormal ribosomal protein synthesis
What are the labs like in diamond blackfan anemia? (MCV, retic, HbF)
Retic decrease
MCV normal or increases
Hb F increased
What is the treatment for transient erythroblastopenia of childhood (TEC)?
Self-limited: Supportive unless need to transfuse
What is the Fe supplement needed for treatment of Fe deficiency in childhood?
6 mg/kg of Elemental Fe
When should you stop Fe supplementation in Fe deficiency anemia?
Until ferritin returns to normal
What is the treatment for diamond blackfan anemia? (3)
Prednisone
Transfusions
Bone marrow transplant
What are the three crises of sickle cell disease?
- Vaso-occlusive
- Aplastic
- Hemolytic/splenic sequestration
What is the treatment for vaso-occlusive sickle cell disease?
Supportive or transfusion if need to reduce sickling
What is the drug that is used to treat sickle cell disease? How does it work?
Hydroxyurea
Somehow increases HbF
What is aplastic crises in sickle cell anemia?
acture drop in Hct and Hb accompanied by a fall in retics
Aplastic crises in sickle cell pts are usually caused by what?
Parvovirus B19
What is the treatment for sickle cell anemia aplastic crisis?
Transfusion
What is vaso-occlusive sickle cell crises?
sickled cells block small vessels, causing bone and tissue infarctions
Why do you start sickle cells pts on prophylactic PCN?
Encapsulated bacteria are not removed well by a compromised spleen
Osteomyelitis in sickle cell is usually caused by what?
Salmonella
early on in sickle cell disease, the sickling of cells results in what? What is the consequence of this?
Functional asplenia
Predisposition to infx
What is the normal range of Hb at 2 weeks?
13-20
What is the normal range of Hb at 3 months?
9.5-14.5
What is the normal range of Hb at 6 months to 6 yo?
10.5-14
What is the normal range of Hb at 7-12 years old?
11-16
What is the mean HCT levels for 2 weeks? 3 months? 6 months-6 yo? 7-12 yrs?
2 weeks = 50
3 mo = 36
6mo-6yo = 37
7-12yr = 38
What is the mean MCV for 2 weeks? 3 months? 6 months-6 yo? 7-12 yrs?
2 weeks = 110
6mo-6yr= 70-74 7-12yo = 76-80
What is the normal WBC range for 2 weeks? 3 months? 6 months-6 yo? 7-12 yrs?
2 weeks = 5-21
3 mo = 6-18
6mo-6yo = 6-15
7-12yr = 4.5-13
What is the PBS results and reticulocyte amounts in diamond blackfan anemia?
Normocytic with decreased reticulocytes
What is the PBS results and reticulocyte amounts in transient erythroblastopenia of childhood?
Normocytic, decreased reticulocytes
What is the PBS results and reticulocyte amounts in parvovirus infection?
Normocytic, decreased reticulocytes
What is the PBS results and reticulocyte amounts in acute blood loss?
Normocytic with increased reticulocytes
What are the PE findings in diamond blackfan anemia?
snub nose
Wide eyes
Flattened thenar eminence
hypertelorism
What is the drug for Fe chelation?
Deferoxamine
What is sickle cell disease aplastic crisis?
An acute drop in Hct and Hb, accompanied by a fall in retics, after infection with parvovirus B19
What is the cause of hemolytic crises see in sickle cell disease?
unknown etiology
