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Flashcards in Peds I Deck (68):
1

What are the three characteristics of anemia?

1. reduced RBCs
2. Reduced quantity of Hb
3. Reduced MCV

2

Is an 11.5 Hb level normal for a 6 month old?

Yes

3

True or false: cholecystectomy at an early age is a risk factor for anemia

True

4

what are the concurrent diseases that are associated with anemia?

JIA
SLE
renal disorders
Malignancy
Immunodeficiency disorders

5

Why is the age of a house important in determining anemia?

Pb levels

6

When is screening recommended for anemia?

9-12 mo
kindergarten entrance
Adolescents

7

Which draws are preferred for CBCs: venous or capillary draws?

Venous

8

HCT is approx (__)x the Hb?

3x

9

When should you look at the red cell indices?

After anemia is confirmed

10

What are the two labs for anemia eval?

CBC and PBS

11

What is the most useful RBC index?

MCV

12

In children less than 10 yrs the lower limit of HCT is what?

70+age in years

13

After 6 months of age, the upper limit can be calculated by (___) until the adult limit of 96 fL.

84+(0.6* age in years)

14

What is MCHC?

Mean cell Hb concentration

Measures hydration status

15

What is the normal value of MCHC?

>35 g/dL

16

RDW in Fe deficiency anemia is high, normal, or low?

High

17

RDW in thalassemia trait is high, normal, or low?

Normal

18

Why is it important to look at WBC as well as RBCs when evaluating anemia?

Look for bone marrow suppression
(pancytopenia)

19

Is there is pancytopenia, what lab should you order?

Bone marrow biopsy

20

Increased WBCs/low platelets may be a sign of what?

infection (hemolytic uremic syndrome)

21

Normal WBC/low platelets and mild anemia could be a sign of what?

Platelet dysfunction

(idiopathic thrombocytopenic purpura)

22

What does the reticulocyte count tell you?

The rate of RBC production

23

Is the reticulocyte count a part of the CBC?

No

24

What are the two ways to classify anemia?

1. Size of RBCs
2. Increased destruction vs decreased production

25

What are the four microcytic, hypochromic anemia?

Fe deficiency
Pb toxicity
Thalassemia
sideroblastic anemia

26

What are the two macrocytic, hyperchromic anemia?

B12
Folate deficiency

27

What type of milk has a low amount of folate?

Goat's milk

28

Normocytic with decreased retics = ?

Diamond black anemia

Transient erythroblastopenia of childhood

Parvovirus

29

Normocytic with increased reticulocytes = ?

Blood loss

30

What does a positive coombs test indicate?

**Immune**
ABO incompatibility
Rh incompatibility

31

What is the normal for MCV for under 10 yrs?

(70 + age in year)

32

What is the recommended amount of milk intake for toddlers?

16-20 ozs

33

What is the effect of milk consumption on Fe stores?

Decreases

34

What are the labs like with milk caused Fe deficiency in toddlers? (MCV, RDW, TIBC, retic)

MCV decreased
RDW increased
TIBC increased
Retic normal to increase

35

Under what age should cow's milk be avoided?

12 mo

36

What is TEC?

Idiopathic (after viral) decreased production of RBCs in the bone marrow

37

What are the labs like in TEC? (MCV, Hb, retic)

-MCV normal (normocytic)
-moderate to severely low Hb
-Retic count decreased

38

What is diamond blackfan anemia?

Moderate to severe anemia

Sporadic inheritance pattern of abnormal ribosomal protein synthesis

39

What are the labs like in diamond blackfan anemia? (MCV, retic, HbF)

Retic decrease
MCV normal or increases
Hb F increased

40

What is the treatment for transient erythroblastopenia of childhood (TEC)?

Self-limited: Supportive unless need to transfuse

41

What is the Fe supplement needed for treatment of Fe deficiency in childhood?

6 mg/kg of *Elemental Fe*

42

When should you stop Fe supplementation in Fe deficiency anemia?

Until ferritin returns to normal

43

What is the treatment for diamond blackfan anemia? (3)

Prednisone
Transfusions
Bone marrow transplant

44

What are the three crises of sickle cell disease?

-Vaso-occlusive
-Aplastic
-Hemolytic/splenic sequestration

45

What is the treatment for vaso-occlusive sickle cell disease?

Supportive or transfusion if need to reduce sickling

46

What is the drug that is used to treat sickle cell disease? How does it work?

Hydroxyurea

Somehow increases HbF

47

What is aplastic crises in sickle cell anemia?

acture drop in Hct and Hb accompanied by a fall in retics

48

Aplastic crises in sickle cell pts are usually caused by what?

Parvovirus B19

49

What is the treatment for sickle cell anemia aplastic crisis?

Transfusion

50

What is vaso-occlusive sickle cell crises?

sickled cells block small vessels, causing bone and tissue infarctions

51

Why do you start sickle cells pts on prophylactic PCN?

Encapsulated bacteria are not removed well by a compromised spleen

52

Osteomyelitis in sickle cell is usually caused by what?

Salmonella

53

early on in sickle cell disease, the sickling of cells results in what? What is the consequence of this?

Functional asplenia
Predisposition to infx

54

What is the normal range of Hb at 2 weeks?

13-20

55

What is the normal range of Hb at 3 months?

9.5-14.5

56

What is the normal range of Hb at 6 months to 6 yo?

10.5-14

57

What is the normal range of Hb at 7-12 years old?

11-16

58

What is the mean HCT levels for 2 weeks? 3 months? 6 months-6 yo? 7-12 yrs?

2 weeks = 50
3 mo = 36
6mo-6yo = 37
7-12yr = 38

59

What is the mean MCV for 2 weeks? 3 months? 6 months-6 yo? 7-12 yrs?

2 weeks = 110

6mo-6yr= 70-74
7-12yo = 76-80

60

What is the normal WBC range for 2 weeks? 3 months? 6 months-6 yo? 7-12 yrs?

2 weeks = 5-21
3 mo = 6-18
6mo-6yo = 6-15
7-12yr = 4.5-13

61

What is the PBS results and reticulocyte amounts in diamond blackfan anemia?

Normocytic with decreased reticulocytes

62

What is the PBS results and reticulocyte amounts in transient erythroblastopenia of childhood?

Normocytic, decreased reticulocytes

63

What is the PBS results and reticulocyte amounts in parvovirus infection?

Normocytic, decreased reticulocytes

64

What is the PBS results and reticulocyte amounts in acute blood loss?

Normocytic with increased reticulocytes

65

What are the PE findings in diamond blackfan anemia?

snub nose
Wide eyes
Flattened thenar eminence
hypertelorism

66

What is the drug for Fe chelation?

Deferoxamine

67

What is sickle cell disease aplastic crisis?

An acute drop in Hct and Hb, accompanied by a fall in retics, after infection with parvovirus B19

68

What is the cause of hemolytic crises see in sickle cell disease?

unknown etiology