Flashcards in Newman, VG Deck (29)
Clinical features seen when Hb falls below 7-8
pallor, sleepiness, irritability, decreased exercise tolerance, flow murmur (grade 2-3, systolic ejection, crescendo-decrescendo, between LLSB and apex).
MCV and RDW in IDA vs. Lead-Poisoning
IDA: slight decrease in MCV, slight increases in RDW
Lead: slight decrease in MCV, HUGE INCREASE in RDW
Anemia caused by decreased RBC production caused by ineffective/incomplete or complete failure of erythropiesis results in: ____ # of reticulocytes
low or normal number of reticulocytes (inadequate marrow response to anemia)
Anemia caused by increased destruction or loss of RBC due to hemolysis, sequestration, or bleeding results in _____ # of reticulocytes
normal number (normal marrow response to anemia)
Three most common causes of microcytic anemias in kids:
IDA, Lead poisoning, thalassemia
Physical findings for fanconi anemia
Microcornea, hyperpigementation of the skin
Physical findings for Vit B12 deficiency
glossitis, mouth sores
Physical findings for Diamond-Blackfan Syndrome
Physiologic nadir of Hct/Hb occurs when?
Define Diamond-Blackfan Syndrome, avg age of dx, and lab findings
-Perfect example of a PURE red cell aplasia due to increased apoptosis in erythroid precursors.
-Avg dx is at 3mo (neonatal pallor progressing to sx anemia)
-MACROcytic with low retic count
Define Fanconi Anemia, avg age of dx, and lab findings
A pancytopenia due to increased apoptosis of marrow progenitor cells.
-8yo (cafe-au-lait, low briht wt, thumb/renal/eye abnormalities)
IDA, avg age of dx, and lab findings
Highest risk from 6-36mo
-MICROcytic with elevated RDW, possible target cells
-increased transferritin, low iron/ferritin
Sickle cell inheritance pattern and lab findings.
basophilic stippling, reticulocytosis, hemolysis, HgbS on electrophoresis
What is often associated with birth trauma - can cause mental status changes, jaundice, tachycardia, tachypnea, increased HC, normal retic, low Hgb (~9) in a newborn
subgleal hemorrhage brith trauma (vacuum/forceps)
Used to differentiate between iron deficiency and thalassemia.
MCV/RBC. greater than 13 suggests iron deficiency (decreased RBC#); less than 13 suggests thalassemia (normal RBC#)
Normocytic anemia in older child with a low retic count = ?
Marrow hypofunction --> ddx: leukemia
Most common cause of thrombocytopenia in kids - ISOLATED THROMBOCP in the absence of any obvious initiating or underlying cause
Clinical manifestations of ITP
petechiae, purpura, ecchymoses, gingival bleed, epitaxis, menorrhagia, GI bleed, hematuria, CNS hemorrhage
Normal count, Primary hemostasis impaired when below___, spontaneous bleeding below ___, clinically significant bleeding below___, life threatening hemorrhage below____.
- Normal count - 150,000 to 450,000
- Primary hemostasis impaired when below 75,000
- Spontaneous bleeding below 50,000
- Clinically significant bleeding below 20,000
- Life threatening hemorrhage below 10,000
Four main causes of thrombocytopenia
Decreased platelet production, decreased platelet survival, sequestration, dilution
Anemia and leukopenia, then consider what?
Most common viral infection caused by marrow suppression
Parvo, CMV, HIV, EBV, varicella
Causes of decreased platelet production (5)
1. Marrow failure or infiltration
3. Cyanotic heart disease
4. nutritional deficiencies
5. genetic defects
Sudden onset of bruising/petechiae or mucocutaneous bleeding in an otherwise healthy child (with NO SYSTEMIC SYMPTOMS), think what?
Acute ITP (1/2 follow 1-2wks after viral illness)
What labs in Acute ITP
ONLY ISOLATED THROMBOCYTOPENIA
Tx of Acute ITP
None that alter natural history, but use IVIG/prednisone/anti-D Ig to temporarily increase platelets
Plt range ofr chronic ITP. QOF? Tx?
Normal, just no contact sports
Tx - splenectomy
Worry about what?
1. All cell lines decreased + LAD + constitutional symptoms
2. All cell lines decreased only
2. aplastic anemia