EXAM #2: ANEMIA IN CHILDHOOD Flashcards

1
Q

What is the definition of anemia as it relates to childhood?

A

Decreased RBC mass

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2
Q

What is the consequence of anemia?

A

Decreased oxygen carrying capacity

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3
Q

What labs help to make the diagnosis of anemia in children?

A
  • CBC and PBS
  • Hb
  • Hct
  • Red cell indices
  • Reticulocyte count
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4
Q

What symptoms are characteristic of anemia in children?

A
  • Fatigue
  • Irritability
  • Inappropriate behavior

*****Other sx of anemia i.e. decreased exercise tolerance, dyspnea, palpitations…etc. are seen in severe anemia in children.

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5
Q

What is the dietary history that is important when evaluating anemia in children?

A

Milk intake– children often over consume cow’s milk

* 16-20 ounces is recommended in the toddler*

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6
Q

When is screening for anemia recommended in children?

A

1) 12 months
2) Kindergarten entrance
3) Adolescents

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7
Q

How is the lower limit of MCV calculated in children less than 10?

A

Age in years + 70

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8
Q

How is the upper limit of MCV calculated in children?

A

84 + 0.6x age in years

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9
Q

What is a MCHC greater than 35 g/dL characteristic of?

A

Spherocytosis

Mean Corpuscular Hemoglobin Concentration*

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10
Q

When is a low MCHC found?

A

Iron deficiency anemia

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11
Q

What is increased WBC/ low platelets and anemia a sign of?

A

HUS

Hemolytic Uremic Syndrome

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12
Q

What can a normal WBC/ low platelet count and mild anemia be a sign of?

A

ITP

Idiopathic Thrombocytopenic Purpura

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13
Q

What are the causes of microcytic/ hypochromic anemia in children?

A

1) Iron deficiency
2) Pb toxicity
3) Thalassemia

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14
Q

What are the causes of macrocytic/ hyperchromic anemia?

A

1) B12 deficiency
2) Folate deficiency

Note that a PE exam finding with B12 deficiency that is commonly overlooked is a positive Rhomberg.*

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15
Q

What is a common cause of Folate Deficiency in infants?

A

Infants that are fed goat milk

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16
Q

What are the characteristics of Diamond Blackfan anemia?

A

Normocytic anemia with decreased RC

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17
Q

If you see a normocytic anemia and decreased RC count, what should your differential include?

A
  • Diamond Blackfan anemia
  • Transient Erythroblastopenia of Childhood
  • Parvovirus B19
18
Q

What is a normocytic anemia with increased reticulocytes a sign of?

A

Blood loss

19
Q

What is a normocytic anemia/ increased RC count with a positive coombs’ test indicate of?

A

Autoimmunity:

1) ABO incompatibility
2) Rh incompatibility

20
Q

What is a normocytic anemia/ increased RC count with a negative coombs’ test indicate of?

A
  • Non-immune mediated destruction
  • Membrane defect
  • Hemoglobinopathy
  • G6PD
  • Pyruvate Kinase Deficiency
21
Q

When is iron deficiency anemia common in children?

A

9-24 months

22
Q

What is the common cause of iron deficiency anemia in children?

A
  • Excessive milk intake
  • Early milk intake
  • Blood loss
23
Q

What are the labs that are indicative of iron deficiency anemia?

A
  • Mild to moderate anemia i.e. Hb (7-10)
  • Decreased MCV i.e microcytic
  • RDW increased
  • Ferretin low
  • Transferrin low
  • Serum iron low
  • TIBC HIGH
  • RC normal to increased
24
Q

How is iron deficiency anemia prevented?

A
  • Encourage breast-feeding for more than 6 months
  • Iron fortified cereal
  • Avoid cow milk under 12 months
  • High Fe diet
25
Q

What are the characteristics of TEC?

A
  • Unknown etiology causing transient decrease in RBC production
  • Age is greater than 1 year
  • Moderate to severe anemia
  • MCV is normal i.e. normocytic
  • Reticulocyte count is decreased
26
Q

What are the characteristics of Diamond Blackfan anemia?

A
  • Under 1 year of age
  • Moderate to severe anemia
  • RC decreased
  • HgB F increased
  • 25% have physical abnormalities
27
Q

What causes of Diamond Blackfan anemia?

A

Abnormal ribosomal protein synthesis

Don’t make precursor cells*

28
Q

What is the treatment of TEC?

A
  • Supportive
  • Transfuse if unstable

Spontaneous recovery usually happens within a year

29
Q

What is the treatment for DBA?

A
  • Prednisone
  • Transfusion
  • Bone marrow transplant IF resistant to steroids
30
Q

How is iron deficiency treated?

A

6mg/kg/day of oral elemental iron until Hb is normal + 2 more months

31
Q

How is iron overload treated?

A

Chelation therapy

The drug used for this procedure is “Deferoxamine”

32
Q

What are the three types of crises that are seen in Sickle Cell Disease?

A

1) Vaso-occlusive crisis/ pain
2) Aplastic crisis
3) Hemolytic/ Splenic Sequestration

33
Q

What is the role of hydroxyurea in Sickle Cell Disease?

A

Increase in Hb-F

34
Q

What is a common cause of aplastic crisis in Sickle Cell Disease?

A

Parvovirus B19

This viral infection leads to an acute drop in Hb/Hct and RCs

35
Q

How do you tell the difference between aplastic crisis and hemolytic crisis?

A

Both will cause an acute drop in Hb and Hct. The difference:

  • Aplastic= drop RC
  • Hemolysis= increase in RC and +DAT
36
Q

What infections are children at risk with that are functionally asplenic because of Sickle Cell Disease?

A

Encapsulated bacteria

  • S. pneumonia
  • H. influenza
  • N. meningitidis
37
Q

What is a common cause of osteomyelitis in children with Sickle Cell Disease?

A

Salmonella

38
Q

What should you be concerned about if a child’s house is over 60 years old?

A

Pb toxicity

39
Q

When should infants be Fe supplemented?

A

After 4 months

40
Q

How is aplastic crisis treated in children with Sickle Cell Disease?

A

Blood transfusion

This can be a truly lifesaving procedure in these children.