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Flashcards in Heme Deck (50)
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1

Microcytic anemias

(<80) → iron deficiency,thalassemia, lead tox, neoplastic

2

Normocytic anemias

(80-100) → acute blood loss, anemia of chronic dz, hemolyic, renal dz

3

Macrocytic anemias

(>100) → hemolytic, alcohol, liver dz, aplastic anemia, hypothyroidism, drug effect, myseldysplasia

4

Megaloblastic anemias

(>110) → folate deficiency, B12 deficiency

5

When should you screen for lead poisoning

Screen at 10-14 mo and 2 yo

6

Tx for lead poisoning

Enviro control, education

10-19 → deu
20-45→ enviro eval +
45-69 → med and enviro intervention including chelation (EDTA or DMSA)
>70 → medical emergency Dimercaprol followed b EDTA x 5 days

7

Presentation of lead poisoning

Acute (>60) → HA, abd pain, loss of appetite, constipation, acute encephalopathy

Chronic → cognitive impairment, ADHD

8

Hemophilia presentation

Easy bruising, intramuscular hematomas, hemarthroses → joint destruction, spontaneous hemorrhaging

9

Hemophilia A

factor VIII deficiency
MC than B and is more likely to be severe

10

Hemophilia B

factor IX deficiency

11

Hemophilia tx

Early diagnosis, prevent trauma

Prompt mgmt of bleeding, recombinant factors, cryoprecipitate

AVOID anticoag, aspirin and NSAIDs

12

ALL presentation

Fatigue, anorexia, lethargy, pallor, bone pain, fever, bleeding, bruising, petechiae, lymphadenopathy, hepatosplenomegaly, bone tenderness,testicular swelling, septicemia

13

What leukemia is mc

ALL 5x mc than AML

14

Leukemia tx

Remission induction: 1 wk anthracycline and cytosine arabinoside

Postremission therapy: several more courses of high dose cytrabine chemo, allogenic stem cell transplant or autologous stem cell transplant

Infection prevention→ isolation and abx

Platelet transfusion for bleeding

RBC trans for anemia

15

Juvenile Chronic Myelogenous Leukemia (JCML) presentation

<2 yo

Skin lesions (eczema, xanthoma, café au lait spots), lymphadenopathy, splenomegaly

16

Juvenile Chronic Myelogenous Leukemia (JCML) tx

Complete remission w/ stem cell transplant

Majority relapse with overallsurvival of 25%

17

Lymphoma presentation

MC childhood cancer in 15-19 yo

Fever, night sweats, weight loss, loss of appetite, cough, dysphagia, dyspnea, lymphadenopathy (lower cervical and supraclavicular), hepatosplenomegaly, mediastinal mass

18

reed-sternberg cells (owl eyes)

Hodgkin lymphoma

19

Lymphoma tx

Radiation for stage I or II dz

Chemo for stage III or IV

20

Neutropenia w/u

ANC < 1500

Mild: 1000-1500

Moderate: 500-1000

Severe: <500

Agranulocytosis: <200

21

Neutropenia presentation

suspectibility ot bacterial infection

Stomatitis, gingivitis, recurrent OM, cellulitis, pneumonia and septicemia

Skin and oral cavity mc affected

22

Juvenile pernicious anemia, red beefy tongue

vit B12 def anemia

23

tx for vit B12 def anemia

Vit B12 IM monthly

Oral therapy is CI

24

tx for iron def anemia

Ferrous sulfate 3-6 mg/kg/day x 8 wks after a nrml Jgb level is obtained

25

tx for folate def anemia

Parenteral folic acid (CI if co-existing vit B12 deficiency anemia)

Eat more green veggies, fruits

26

Appears after 6 mo (when HbF↓)

Anemia, vaso-occlusive (leg ulcers, stroke,priapism, pain crises), hand foot syndrome (swollen), splenomegaly, infection, cardiac enlargement, short stature, delayed puberty, gallstones/jaundice

Sickle Cell Disease

27

Sickle Cell Disease tx

Infection prevention → pneumococcal vaccine, meningococcus, pphx Pcn by 4 m until 5 yo

Hydration and analgesics for painful crisis

Priapism → exchange transmusion, hydroxyurea

28

Hemolytic Disease of the Newborn presentation

Hemolytic anemia

Fetal hydrops→ large placenta, ↑ unconjugated hyperbilirubinemia, abd distension,scalp or skin edema, purpura, cyanosis

29

Hemolytic Disease of the Newborn etiology

Maternal blood comes in contact w/ fetal blood cells → maternal Ab produced against Rh Ag → subsequent preg w/ Rh + → hemolysis

30

Thalassemia tx

Monthly transfusion of packed RBC to maintain Hgb >10

Splenectomy if requiring >240 mL/k of pRBC/yr