Lec 19/20 - Peds I and 2

Question 1

define anemia

Answer 1

• reduction in the number of RBC
• reduction in quantity of Hb
• reduction in the volume of RBC

===> result in decreased O2 carrying potential that is needed for metabolism

Question 2

History consistent with iron deficiency anemia

Answer 2

• excessive milk intake
• early milk intake prior to one year
• blood loss

labs: mild to mod anemia; MCV decreased; RDW increased; ferritin,transferritin, serum iron decreased; TIBC inc; retic count normal to inc

Question 3

treatment plan for Diamond blackfan anemia

Answer 3

• prednisone
• transfusion which may lead to iron overlad
• bone marrow transplant may be curative

Question 4

treatment plan for iron deficiency anemia

Answer 4

• encourage breast feeding for >6mo and if only breast feeding after 4 mo need Fe supplementation
• 6mg/kg/day when taken oral!
• use iron fortified formula
• use iron fortified cereals
• avoid whole cows milk in kids <12mo
• balance diet in Fe (greens, veggies, meat, fish, chicken)

Question 5

treatment plan for transient erythroblastopenia of childhood

Answer 5

• supportive only

- transfuse if necessary with cardiovascular instability

Question 6

complications of sickle cell anemia

Answer 6

• vaso-occlusive pain (the sickle cells clog shit up - MAJOR RISK OF STROKE)
• aplastic- acute drop in HCT and Hgb usually due to PARVOVIRUS B19
• hemolytic/splenic sequestration

-renal, pulmonary, and neurologic issues

Question 7

basic prevention and Tx of sickle cell anemia

Answer 7

-Tx = PAIN CONTROL and HYDRATION; O2 if needed

Question 8

key dietary history point when evaluating for anemia in children?

Answer 8

milk intake!

Question 9

what condition is consistent with chloramphenicol drug use?

Answer 9

anemia

Question 10

first screen infants for anemia at what age?

Answer 10

9-10mo, kindergarden entrance and for adolescents

Question 11

Hematocrit number relationship to Hb number?

Answer 11

HCT ~= 3xHb

Question 12

Method to detect Hb levels? HCT?

Answer 12

direct spectrophotometry

HCT is calculated (3 times Hb)

Question 13

What blood sample do you need for Hg check

Answer 13

venous sample

Question 14

After anemia is confirmed via CBC and Hb look at?

Answer 14

RBC indices

Question 15

Most useful RBC indice?

Answer 15

MCV

Question 16

If MCHC is high its a sign of

Answer 16

spherocytosis

Question 17

RBC of varying sizes - most likely?

Answer 17

iron deficiency anemia

Question 18

RBC indices same size but know there is an issue with Hb?

Answer 18

thalassemia trait

Question 19

What type of evaluation done pancytopenia? What diseases to thnik of?

Answer 19

bone marrow exam

aplastic anemias; leukemias…

Question 20

increased WBC and low platelets is sign of…

Answer 20

infection when associated anemia is present (hemolytic uremic syndrome)

Question 21

normal WBC and low platelets and mild anemia sign of?

Answer 21

platelet dysfunction (ITP)

Question 22

Two accepted ways to classify anemia in kids:

Answer 22

1) size of RBC

2) increased destruction vs decreased production

Question 23

Microcytic hypochromic RBC - differential Dx?

Answer 23

iron def
lead tox
thalassemia

Question 24

Macrocytic hyperchromic - differential Dx?

Answer 24

B12
folate def (if fed goat milk)

Question 25

if infant fed goat milk what deficiency?

Answer 25

folate deficiency = macrocytic hyperchromic

Question 26

Diamond blackfan anemia (congenital pure red cell aplasia) classification?

Answer 26

macrocytic normochromic

Question 27

Positive Coombs test posibilities:

Answer 27

immune
ABO compatibility
Rh incompatibility

Question 28

Negative Coombs test posibilities:

Answer 28

Non-immune
membrane defect
hemoglobinopathy
G6PD
pyruvate kinase defect

Question 29

transient erythroblastemia of childhood - etiology, age

Answer 29

• unknown etiology - usually follows a viral illness but not always and causes a transient dec production of RBC in the bone marrow
• affects kids >1yr

Question 30

transient erythroblastemia of childhood - lab characteristics

Answer 30

• MCV normal
• mod to severe anemia down to 2.5
• reticulocyte count decreased

Question 31

Diamond blackfan anemia - age and lab characteristics?

Answer 31

-under 1yr

-mod to severe anemia
-MCV inc or normal
retic count decreased
-Hgb F increased**

Question 32

Diamond blackfan anemia - etiology

Answer 32

• some sporadic inheritance

- defect ribosomal protein synthesis == lack of progenitor cells

Question 33

first sign of successful iron deficiency treatment?

Answer 33

reticulocytes peak at 5-7 days

Question 34

deferoxamine use for? how deos it work?

Answer 34

iron overload

chelation therapy

Question 35

sickle cell - vaso occlusive pain Tx

Answer 35

-If really bad: hydroxyurea drug to inc HgbF and/or bone marrow transplant

Question 36

sickle cell- aplastic crisis Tx

Answer 36

transfusion but avoid volume overload

-give folic acid supplementation

Question 37

sickle cell - hemolytic crisis important test result?

Answer 37

Pos coombstest

Question 38

for kids with sickle cell infection risk the prophylactic drug to use?

Answer 38

penicillin

ALSO USE IMMUNIZATIONS

Question 39

Sickle cell patients predisposed to::

Answer 39

Salmonella infection

osetomyeltis