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Flashcards in Pediatric hematology Deck (30):
1

MCV definition and values

expression of the average volume and size of individual erythrocytes
80 macrocytic (not for peds!)

2

MCHC definition and values

expression of the average hemoglobin (Hgb) concentration or proportion of each RBCs occupied by Hgb as a %, "color"
32%-36% normochromic
36% hyperchromic

3

Red cell distribution width definition and abnormal indications

Red call size variation (anisocytosis). Differentiates between iron deficiency anemia, thalassemia, and anemia of chronic disease
IDA-Increased RCDW
Thalassemia- normal or slightly increased
ACD- Normal RCDW

4

Reticulocyte count definition and indications for what type of anemia

Number of new, young RBCs in circulation, normal is 1-2%
Index of bone marrow health and response to anemia
Anemia due to bone marrow failure, hemorrhage or hemolysis

5

What kind of anemia is seen in pediatric population and what conditions causes it?

MIcrocytic/hypochromic anemias caused by IDA, lead poisoning that leads to IDA, thalassemia, G6PD deficiency

6

What causes normocytic, normochromic anemias

ACD, acute blood loss, early IDA

7

What kinds of anemias are primarily for adults and what causes it?

Macrocytic/ normochromic anemia caused by vitamin b12 deficiency, folate deficiency, pernicious anemia

8

causes of iron deficiency anemia in the infant, toddler, and adolescent

In general, caused by decreased iron intake, increased needs, or slow GI blood loss
Infancy: inadequate intake of iron (breast fed, low iron formula)
Toddlers: whole milk at the expense of solid foods
Adolescence: inadequate iron intake, menarche

9

Lab findings with IDA

H&H low
Low MCV (microcytic)
Low MCHC
Low RBCs
Increased RDW
Increased TIBC (differentiates from thalasemia)
Serum ferritin

10

Management of IDA

tx underlying cause
Elemental iron 3-6mg/kg/day 1-3x daily until Hgb normalizes
Replace iron stores 2-3 mg/kg/day for 4 months

11

s/sx of thalassemia

some states do newborn screening
Varies from symptomatic to severe
Pale or bronze
tachycardia
tachypnea
hepatosplenomegaly
frontal bossing
Infancy- FTT, irritability, splenomegaly, pallor
Older child- Bony changes, splenomegaly, iron overload due to multiple transfusions

12

risks of iron overload

cirrhosis of the liver, cardiomyopathy

13

Lab findings with thamassemia

decrease Hgb
decreased MCV (microcytic)
hypochromic RBCs
increased reticulocyte count
Hemoglobin electropharesis, beta globin gene mapping

14

What is a common reticulocyte count look like for sickle cell anemia>

10-25% of immature red cells without nuclei (normal is 1-2%)

15

What are Howell-Jolly bodies?

cells seen in a splenic conditions (sickle cell)

16

What makes sickle cell diagnosis?

Hemoglobin electrophoresis

17

What does hydroxyurea do

stimulates fetal hemoglobin (Hgb F) which does not sickle

18

What factor is deficient in hemophilia A

factor VIII

19

What level does the CDC consider lead poisoning?

>10

20

s/sx of lead poisoning

Vague/ Gi symptoms
Severe: lethargy, difficult walking, neuropathies
Headaches
Burtonian lines: blueish discoloration of gingival border
Ataxia
Papilledema

21

What year of residence is known for lead poisoning?

22

What blood level of lead and class is chelation therapy recommended?

class IV 45-69

23

What should you observe for in lead poisoning?

IDA, hemoglobinopathies, impaired renal function, vitmain D deficiencies

24

Leukemia definition

A group of malignant hematological diseases in which normal bone marrow elements are replaced by abnormal, poorly differentiated lymphocytes known as blast cells

25

ALL- % of cases and peak age, cure rate

Acute lymphocytic leukemia- 75% of all cases, peak around 4 years old, has 95% cure rate

26

AML- % of cases, age range

Acute myelogenous leukemia- 20% of all leukemia, primarily in infants and older children

27

S/SX leukemia

anemia, pale, listless, irritable chronically tired, history of repeated infections, bleeding such as epistaxis, petechia, and hematomas, lymphadenopathy and hepatosplenomegaly, bone and joint pains are a late sign

28

What will show up on a blood count in 85% of leukemia

thrombocytopenia and anemia

29

What is the hallmark trait of bone marrow for leukemia

Bone marrow will show the poorly differentiated blast cells that have been replacing the healthy bone marrow tissue

30

what is the best prognostic test for a childs sickle cell anemia

a cellulose acetate and citrate apgar gel electropharesis to confirm the hemoglobin genotype