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Flashcards in Hematology and Oncology Deck (23):
1

Anemia

Hemoglobin concentration too low to deliver adequate oxygen to meet demands. Hgb concentration < 2 standard deviations below the mean for age, gender, and race.

Causes: Many!
- Acute: Viral illness, oncologic diagnosis, inflammation.

S/S: Common in young children. Pallor, tachycardia, fatigue, lethargy, shortness of breath.

Dx: CBC, Reticulocyte count, Ferritin, Fe, TIBC, FEP, Hemoglobin electrophoresis, Peripheral smear, Additional screens for hemolytic anemia.

Tx: Treatment is based on underlying cause. Extremely low hgb with significant side effects requires transfusion.

2

Thalassemia - Alpha

Sx

3

Immune Thrombocytopenia Purpura

Idiopathic low platelet count.
- Cause is unknown, but may be immune. May occur as a result of disease such as oncologic or infection.
- Platelet count < 50, 000 or < 10, 000
- Acute or chronic.

Dx: CBC, may need bone marrow smear.

Tx: Based on acute or chronic presentation. If no bleeding, usually no treatment. If moderate bleeding, IVIG or anti-D or platelet infusion, especially associated with another acute illness.

4

Neutropenia

Decreased neutrophils with normal hemoglobin and platelet count, May be associated with viral or oncologic illness.

Dx: ANC

Tx: G-CSF, or if chronic, no treatment.

5

Pancytopenia

Low hgb, platelets, and WBC.

6

Leukocytosis

WBC higher than normal, often associated with leukemia, infection, or significant inflammation.

Dx: WBC

7

Sickle Cell Anemia

Deoxygenated hemoglobin S polymerizes and distorts the shape of the red blood cells. Sickled blood cells are more prone to hemolysis. Vaso-occlusive pain crisis and intrapulmonary thrombosis are two clinical manifestations. Acute crises and infection occur with pain.

Dx: Hemoglobin electrophoresis.
- Can identify hemoglobin S and hemoglobin A SSD on newborn screen.
- Splenomegaly is a common feature early in life.

Complications: Jaundice, cholestasis, pallor, fatigue, chronic pain, decreased exercise tolerance, cardiomegaly, stroke, aplastic, hypoplastic, hyperhemolytic crisis. Acute splenic sequestration, Chest Syndrome, Stroke, Acute Vascular Compromise.

Serious S/S: Fever, unusual fatigue, lethargy, pallor, acute splenic enlargement, shortness of breath, hypoxia, protracted vomiting, sudden loss of speech, weakness in an arm or leg.

Tx: Prophylaxis is usually with PCN.

8

Stroke

Ischemic or hemorrhagic. Dysfunction of brain activity due to interruption of blood flow in brain.
- Ischemic strokes occur with cardiac disease, hematologic disorders (SSD), primary vasculitis, lipid abnormalities, metabolic abnormalities, dehydration, shock.
- Hemorrhagic strokes occur with vascular malformation, cavernous malformation, aneurysm, brain tumor, thrombocytopenia or other hematologic problems, coagulopathies, spontaneous dissection.

PE: Neurologic evaluation, skin assessment, abdominal exam, cardiac evaluation, rash or petechiae.

S/S: Acute neurologic symptoms, headache, confusion and lethargy.

Dx: History, neurologic exam, head CT or MRI/MRA, labs (CBC, coags, LFTs, CMP, ESR).
- Acute and chronic monitoring.

Tx: Focused on underlying cause, anticoagulation therapy may or may not be warranted.
- Evaluation of CBC, maintain low hgb/hct, exchange transfusion, urea

9

Disseminated Intravascular Coagulation

Acquired, life-threatening complication resulting from a variety of disease processes including sepsis, trauma, malignancy, vascular irregularities, liver failure and pregnancy. Results when excessive fibrinogen and platelets are deposited in the microvascular system.

S/S: Diffuse bleeding and thrombosis with coagulation abnormalities by laboratory analysis.

Tx: Treat underlying condition, blood products, vit K.

10

Hemolytic Uremic Syndrome

Bacterial verotoxins cause damage to microvessels in circulation, resulting in inflammation and thrombosis leading to decrease in glomerular filtration rate, hematuria, proteinuria, and oliguria.
- HUS is MOST common cause of renal failure.
- Typical causative factor is E. coli 0157

S/S: Incubation period 3-5 days, abdominal pain, nonbloody diarrhea, fever, then progresses to bloody diarrhea. Other symptoms are pallor, fever, weakness, petechiae, hematuria, and hematemesis.

Dx: Based on clinical findings and labs - electrolytes with increased BUN and creatinine. Stool culture positive for E. coli 0157.

Tx: Preventing renal failure with diuretics, fluid management and assessment.
- May need dialysis!

11

Most Common Types of Pediatric Cancers

1. Leukemia
2. Brain and other nervous system tumors
3. Neuroblastoma
4. Wilm's Tumor
5. Lymphoma
6. Rhabdomyosarcoma
7. Retinoblastoma
8. Bone Cancer (osteosarcoma, Ewings)

Dx: CBC, electrolytes, ESR, CT, MRI, plain xray

Tx: Per specific cancer presentation

12

Acute Lymphoblastic Leukemia (ALL)

Blood cell cancer.
- Most common malignancy.
- Usually affects ages 2-5 years, but can occur in older children.

S/S: Clinical presentation includes fever, bone pain, anorexia, weight loss, pallor and mucosal bleeding, lymphadenopathy, splenomegaly, hepatosplenomegaly.

Dx: CBC, peripheral blood smear, bone marrow smear, electrolytes, uric acid, LDH.

Tx: Based on oncology group.
- Includes induction and maintenance chemotherapy

13

Acute Myelocytic Leukemia (AML)

Blood cell cancer.
- 20% of all leukemias.
- Presents with coagulopathies and chloromas.

S/S: Clinical presentation includes fever, bone pain, anorexia, weight loss, pallor and mucosal bleeding, lymphadenopathy, splenomegaly, hepatosplenomegaly.

Dx: CBC, peripheral blood smear, bone marrow smear, electrolytes, uric acid, LDH.

Tx: Based on oncology group.
- Includes induction and maintenance chemotherapy
- Bone marrow transplant.

14

Neuroblastoma

Extracranial solid tumor.
- MOST common in children < 1 year of age.

S/S: Palpable mass, 60% in abdomen. Bruising, pallor, fatigue, bone pain, fever, hepatosplenomegaly, lymphadenopathy, periorbital bruising.

Dx: CBC, liver and renal function, coags, VMA/HVA (urine), CXR, abdominal film, CT and MRI.

Tx: Tumor staging, surgical resection and chemotherapy, BMT for high risk tumors.

15

Wilm's Tumor

Unilateral or bilateral solid tumor of the kidney.
- MOST common renal neoplasm in children.
- Median age is 2-3 years old.

S/S: Often idenitifed by parent or family member. Some have pain, microscopic or gross hematuria, malaise, fever, HTN.

Tx: Nephrectomy or partial resection, chemotherapy.

16

Retinoblastoma

Retinal tumor, unilateral or bilateral, noted with leukocoria and strabismus, often genetic.

S/S: Noted physical exam, ophthalmological evaluation.

Tx: Individualized therapy with surgery, chemotherapy, cryotherapy, and radiation.

17

Brain Tumors

Most common solid tumor.
- 2nd to leukemia in childhood cancers.
- Many different types and placements.

S/S: Typical presentation is headache with morning vomiting, increased ICP, personality changes, poor performance in school, lethargy, irritability.

Dx: CT or MRI

Tx: Depends on severity of symptoms and location of tumor.
- Usually involves surgical resection, radiation, and chemotherapy.

18

Bone Tumors

Solid tumors.
- Average age is 13-17 years old.
- Ewings, Osteogenic Sarcoma
- Most common area of involvement is distal femur or proximal tibia.

S/S: Presents with pain over affected area, fever, weight loss, increased ESR.

Dx: Imaging with plain films first, followed by MRI

Tx: Resection and chemotherapy

19

Fever and Neutropenia

Fever with low WBC and ANC.

S/S: Fever, lethargy, shock.

Dx: BCx, CBC, electrolytes.

Tx: High dose broad spectrum antibiotics, fluids, symptom management.
- ICU, if indicated.

20

Typhlitis/Intra-abdominal Emergency

Necrotizing enterocolitis occurs from infectious source in neutropenic patients.

S/S: Right lower quadrant abdominal pain, +/- fever, mucocitis.

Tx: Surgical consult for emergency bowel perforation, serial xrays or CT.

21

Tumor Lysis Syndrome

Massive tumor cell lysis with the release of large amounts of potassium, phosphate, and nucleic acid. Can affect neurological, pulmonary, and renal function.

S/S: Can be asymptomatic, but with hyperkalemia, hyperphosphatemia, and hyperuricemia. Nausea, vomiting, diarrhea, anorexia, lethargy, hematuria, heart failure, cardiac dysrhythmias, seizures, muscle cramps, tetany, syncope, and possible sudden death.

Tx: Prevention is key to management! Rasburicase and allopurinol are medical therapy. Aggressive IV fluid hydration.

22

Superior Vena Cava Syndrome (SVC)

Compression of the superior mediastinal structures, ultimately compromising flow to heart.

S/S: Distended neck veins, tachypnea, hypoxia, SOB, signs of decreased cardiac output.

Dx: CXR, CT

Tx: Airway management, decrease pressure.

23

Mass Syndromes

Abdominal, spinal compression via tumor mass.

S/S: Altered neurologic condition/status, pain, compartment syndrome.

Tx: Decrease mass effect via radiation or chemotherapy.