Peds - Hematologic

Question 1

What can early ingestion of cow’s milk cause?

prior to 9 months

Answer 1

micro-hemorrhage from the gut, leading to anemia

Question 2

What can lead to iron deficiency anemia in toddler’s?

Answer 2

Reliance on whole milk at the expense of solid food.

Question 3

What nail changes may be associated with anemia?

Answer 3

flat, brittle, or spoon-shaped nails

Question 4

Laboratory findings in IRON DEFICIENCY ANEMIA

Answer 4

MCV - low (microcytic)
MCHC - low (hypochromic)
RDW - increased
TIBC - increased (available slots)
Serum ferritin - low (stores)
Serum iron - low
Reticulocyte count - low if low Fe is cause, hi if bleeding, or in thalassemia

Question 5

Which anemias tend to be found in children?

Answer 5

MICROcytic - HYPOchromic (small cell, less color)

Iron deficiency anemia (IDA)
Thalassemia
Lead poisoning
G6PD deficiency

NORMOcytic, NORMOchromic can too

acute blood loss
early IDA

Question 6

Which anemias tend to be found in adults?

Answer 6

MACROcytic, NORMOchromic

B12 deficiency
folate deficiency
pernicious anemia

Question 7

Treatment for iron deficiency anemia

Answer 7

Elemental iron until HEMOGLOBIN normalizes
AND
Replace iron stores with supplementation x 4 months

Question 8

IRON OVERLOAD can cause what two serious conditions?

Answer 8

cirrhosis

cardiomyopathy

Question 9

What can giving iron to a person with Thalassemia cause?

Answer 9

Iron overload

they don’t have the binding sites to use the extra iron

Question 10

Laboratory findings in Thalassemia that differ from IDA.

Answer 10

Reticulocyte count is increased

TIBC is low (no open slots, hence risk for iron overload)

Question 11

Thalassemia is typically seen in what populations?

Answer 11

Mediterranean

Asian

Question 12

Treatment for thalassemia

Answer 12

Refer to hematology

Question 13

Genetics variations of sickle cell -

which is carrier which is symptomatic?

Answer 13

HOMOzygous - Hgb SS - symptomatic

HETEROzygous - Hgb AS - carrier, usually no clinical symptoms

Question 14

Features of blood work findings in sickle cell? (4)

Answer 14

o nucleated RBCs
o reticulocytosis (10-25%)
o Howell-Jolly bodies
o WBCs elevated

Question 15

Support for sickle cell crisis (5)

Answer 15

o  hydration
o  oxygen
o  analgesics
o  antibiotics
o  transfusion

Question 16

What medication can be given to stimulate fetal hemoglobin (which doesn’t sickle)?

Answer 16

Hydroxyurea

Question 17

What supplement is important for those with sickle cell?

Answer 17

folic acid

Question 18

Which anemia can lead poisoning lead to?

Answer 18

iron deficiency anemia

Question 19

Where does the body store lead?

Answer 19

bone marrow

Question 20

At what point is chelation therapy used for lead poisoning?

Answer 20

Class IV: 45-69 mcg/dL

Question 21

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

Answer 21

Leukemias

Question 22

Is bone and joint pain an early or a late sign in leukemia?

Answer 22

late sign

Question 23

What are red flags for leukemia?

Answer 23

Lympadenopathy and hepatosplenomegaly

especially with recent fatigue, bleeding, and frequent infection

Question 24

Which is the most common leukemia in children?

Answer 24

ALL - Acute Lymphocytic Leukemia = 70%

Question 25

Epidemiology of pediatric ALL?

Answer 25

peak age 4 years white more boys than girls

Question 26

Acute myelogenous leukemia occurs more commonly at which ages?

Answer 26

Infant and older children