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Pediatrics (Past Year) > Blood > Flashcards

Blood Flashcards

1
Q

Daily requirement and causes of iron deficiency anemia

A

Daily requirement: 10mg/day

Causes

  1. Inadequate supply of iron
    - premature, twin pregnancy
    - fetal blood loss at delivery
    - prolonged BF without iron supplement
    - food poor with iron
    - chronic diarrhea,
    - malabsorption syndrome
  2. Excessive demand of iron
    - acute, chronic hemorrhage
    - parasitic infection
  3. Failure to meet increase demand of growth
    - premature
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2
Q

Clinical picture of iron deficiency anemia

A
  • common 9-24 month
  • screening at 12 month by laboratory
  • anorexia, fatigue
  • pallor
  • pica
  • impair intellectual activities
  • cardio: tachycardia, murmur
  • spleen enlarge
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3
Q

Investigate of iron deficiency anemia

A
  • decrease serum ferratin
  • decrease serum iron
  • decrease MCV, MCH, MCHC
  • variation size of RBC
  • increase reticulocyte
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4
Q

Treatment of iron therapy

A
  1. Iron therapy
    a) oral
    - ferrous sulphate
    - ferrous gluconate
    - 6mg/kg/ day for 4-6 weeks

b) parenteral
- if GIT irritation
- iron dextran mixture , IM
- 50mg ( infant), 100mg (child) for 3-5 days

  1. Blood transfusion
    - if severe anemia
    - 10ml/kg
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5
Q

Type of aplastic anemia

A
  1. Acquired aplastic anemia
  2. Congenital
    - fanconi anemia
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6
Q

Definition and clinical picture of fanconi test

A

Definition
- inherited as autosomal recessive character

Clinical picture 
- 3- 14 years
- abscence radii and thumb
- pallor, fatigue
- bleeding mucous membrane
- short stature
- pigment of skin
- FA facies: 
> micrpencephaly
> small eyes
> epicantus fold
  • horseshoe kidney
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7
Q

Investigation and treatment of Fanconi Anemia.

A

Investigation (lab)

  • thrombocytopenia, granulocytopenia
  • macrocytic anemia
  • scanty reticulocyte
  • test of skin fibroblast
  • test amnion fluid cell for abnormal chromosome breakage.

Treatment

  • hemopoitic stem cell transplant
  • granulocyte colony stimulating factor (for increas platelet)
  • GCSF + erytropoietin ( increase neotrophill)
  • oral oxymetholone
  • low dose prednisone
  • supportive: blood transfusion + Ab
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8
Q

Cause and clinical picture of acquired aplastic anemia

A

Causes

  • chemotheraphy
  • drug: chloramphenicol, antiepileptic
  • virus: cytomegalovirus, HIV, Hep. B, C
  • leukemia
  • pregnancy

CP

  • fatigue
  • heart failure
  • infection: throat, skin
  • bleeding, purpura
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9
Q

Investigation and treatment of acuired aplastic anemia

A

Investigate as FA

Treatment
1. Bone marrow transplant

  1. Immunosuppression
    - antithymocyte globulin
    - cyclosporine
  2. High dose cyclophosphamide
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10
Q

DD of acquired aplastic anemia

A
  • acute leukemia ( pancytopenia without leukemic cell)
  • hypersplenism ( has splenomegally)
  • bone marrow replacement
  • autoimmune pancytopenia
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11
Q

Type of chronic hemolytic anemia

A
  • B-thalessemia
  • sickle cell anemia
  • hereditary spherocytosis
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12
Q

Definition and clinical picture of B- thalessemia

A

Definition

Hereditery chronic hemolytic anemia due to impair production of B- chain

CP
- mangoloid face
> big head
> depress nasal bridge
> frontal bosing
> protusion of maxilla
  • jaundice
  • pallor
  • cardiomegaly
  • hepatosplenomegally
  • short stature
  • delay puberty
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13
Q

Complication of B-thalessemia

A
  • infection
  • iron overload
  • anemic HF
  • hepatitis C
  • hypersplenism
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14
Q

Investigation of B-thalessemia

A
  • microcytic hypochromic anemia
  • increase reticulocytic count
  • increase serum iron
  • BM exam
  • xray bone skull ( hair appearance)
  • PCR : detact mutation
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15
Q

Treatment of B-thalessemia

A
  • packed RBC transfusion ( 10-15ml/kg/dose every 4-6 weeks)
  • irom chelation: desferroxamime
  • folate 1mg/ day
  • decrease iron diet
  • splenectomy
  • BM transplant
  • gene therapy
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16
Q

Definition and clinical picture of hereditary spherocytosis

A

Definition

Chronic hemolytic anemia due dysfunction of cell membrane protein ( spectrin)

CP

  • anemia
  • aplastic crisis
  • splenomegally
  • jaundice
  • gall stone formation
17
Q

Investigate of hereditary spherocytosis

A
  • anemia: normocytic normochromic
  • increas reticulocyte
  • unconjugated bilirubinemia
  • spherocyte
  • increase osmotic fragility
18
Q

Treatment of hereditary spherocytosis

A
  • blood transfusion
  • folic acid supplement
  • splenectomy
  • vaccines: pneumococci, h. Influenza
  • penicillin
19
Q

Etiology and clinical picture of idiopathic thrombocytopenic purpura

A

Etiology
- virus particle attach to platelet to provoke immunologic response

CP
- history of viral infection 1-4 weeks before
- hemorrhagic rash: petechial, ecchymosis
- bleeding
> oozing gums
> epistaxis
> hematuria, melena

  • anemia ( if blood loss)
  • Spleen and liver NOT ENLARGE
20
Q

Management of idiopathic thrombocytopenic purpura

A
  • whole fresh blood transfusion
  • IV immunoglobulin 0.8-1g/kg/day
  • prednisone 1-4mg/kg
  • IV anti-D
  • splenectomy
21
Q

What is hemophilias A and its Clinical picture

A

Deficiency of factor VIII

CP

  1. Predisposing factor
    - male
    - +ve family history
  2. Present
    - recurrent hge after minor trauma
    - prolonged bleeding after circumcision
  3. Frequency and severity of bleeding
  4. Site of bleeding
    - large intramuscular hematoma
    - ecchymosis
    - mucous membrane
22
Q

Investigation and ttt of hemophilis A

A

Investigate

  • prolonge clotting time and PTT
  • factor VIII assay: reduce
  • normal prothrombin level

Ttt

  1. Prevent of bleeding
    - avoid trauma & surgery
    - dental hygiene
    - pad on knee
  2. Replacement therapy
    - fresh frozen plasma
    - cryoprecipitate
    - factor VIII Concentration 25-75unit/ kg
23
Q

Type of leukemia

A

Malignant neoplasm

  • Acute Lymphoblastic leukemia
  • acute myeloid leukemia
  • chronic lymphoblastic leukemia
  • Chronic myeloid leukemia
24
Q

Definition of ALL

A

Group of malignant disease,
genetic abnormalities in hematopoietic cell rise
unregulated clonal proliferation of cell

25
Q

Cp of ALL

A
  1. Bone marrow failure : anemia, bleeding
  2. Specific tissue infiltration
  3. Present:
    - fever
    - pallor
    - bleeding
    - anorexia
    - joint pain
    - increase ICP
  4. Lympadenopathy + hepatosplenomegally
26
Q

CP of AML

A
  1. Bone marrow failure: anemia, bleeding
  2. Lymphadenopathy + hepatosplenomegally
  3. Bone pain
  4. Chloroma ( mata berdarah)
27
Q

Diagnosis of Leukemia

A
  1. Cp
  2. CBC
    - WBC: variety
    - RBC: decrease
    - platelet: decrease
    - blood smear: lymphoblast cells
  3. Bome marrow aspirate: leukemic blast cell
28
Q

Treatment of ALL

A
  1. Induction ( 4 weeks)
    - vincristine
    - prednisone
    - aspraginase
    - irradiation mediastinal mass
    - hydration
    - bone marrow transplant
  2. Remission (2-5 years)
    - vincristine
    - prednisone
    - methotrexate
    - CNS prophylaxis
    > intra thecal methotrexate
    > hydrocortisone
    > cytarabine
29
Q

Treatment of AML

A
  1. Anthra cycline + cytarabine
  2. CNS prophylaxis (mcm ALL)
  3. Bone marrow transplant
30
Q

Diagnosis of Hemorrhagic diathesis

A
  1. Present history
    - fever
    - rash
    - abdominal pain
    - joint pain
    - duration, onset
  2. Family history
  3. Past history
    - prolonged bleeding after sugery
  4. Physical exam
    - distribute rash
    - fever
    - organ enlargement
  5. Lab test
    - hemostasis at small vessel: hess test, platelet count
    - blood coagulation
    - thromboplastin generation test
    - specific factor assey
31
Q

Causes of thrombocytopenia

A
  1. Decrease platelet production
    a) congenital
    - fanconi a
    - congenital leukemia
    - thrombopoiten deficiency

b) acquired
- drug
- toxin
- nutritional deficiency
- renal failure

  1. Increase platelet destruction
    a) congenital
    - ITP
    - SLE

b) acquired
- DIC
- infection
- drug

Pediatrics (Past Year) (10 decks)

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