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Hematology and Oncology > Newman, VG > Flashcards

Flashcards in Newman, VG Deck (29):
1

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).

2

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

3

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)

4

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)

5

Three most common causes of microcytic anemias in kids:

IDA, Lead poisoning, thalassemia

6

Physical findings for fanconi anemia

Microcornea, hyperpigementation of the skin

7

Physical findings for Vit B12 deficiency

glossitis, mouth sores

8

Physical findings for Diamond-Blackfan Syndrome

Shield chest

9

Physiologic nadir of Hct/Hb occurs when?

6-8 weeks

10

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

11

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)
-MICROcytic

12

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

13

Sickle cell inheritance pattern and lab findings.

AR
basophilic stippling, reticulocytosis, hemolysis, HgbS on electrophoresis

14

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)

15

Mentzer Index

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#)

16

Normocytic anemia in older child with a low retic count = ?

Marrow hypofunction --> ddx: leukemia

17

Most common cause of thrombocytopenia in kids - ISOLATED THROMBOCP in the absence of any obvious initiating or underlying cause

Acute ITP

18

Clinical manifestations of ITP

petechiae, purpura, ecchymoses, gingival bleed, epitaxis, menorrhagia, GI bleed, hematuria, CNS hemorrhage

19

Platelet:
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

20

Four main causes of thrombocytopenia

Decreased platelet production, decreased platelet survival, sequestration, dilution

21

Anemia and leukopenia, then consider what?

Marrow failure/infiltration

22

Most common viral infection caused by marrow suppression

Parvo, CMV, HIV, EBV, varicella

23

Causes of decreased platelet production (5)

1. Marrow failure or infiltration
2. Infection
3. Cyanotic heart disease
4. nutritional deficiencies
5. genetic defects

24

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)

25

What labs in Acute ITP

ONLY ISOLATED THROMBOCYTOPENIA

26

Tx of Acute ITP

None that alter natural history, but use IVIG/prednisone/anti-D Ig to temporarily increase platelets

27

Plt range ofr chronic ITP. QOF? Tx?

30,000-80,000
Normal, just no contact sports
Tx - splenectomy

28

Worry about what?
1. All cell lines decreased + LAD + constitutional symptoms
2. All cell lines decreased only

1. leukemia
2. aplastic anemia

29

Plt low, H/H low, WBC normal, child presents with rash, fatigue, bloody diarrhea, bleeding gums.

microangiopathic process