Term
| why do RBC look like they do on a peripherial smear |
|
Definition
| RBC have more Hb on the edges due to the biconcave disck so are lighter in the middle |
|
|
Term
| why do we do a peripherial smear (5) |
|
Definition
confirm coulter printout values
RBC morphology
WBC differential and morphology
platelet morphology
immature precursor identification (have nuclei) |
|
|
Term
| RBC: primary function, what is the functional component |
|
Definition
mediate exchange of respiratory gasses between lungs and tissues
intracellular Hb picks up oxygen |
|
|
Term
| what can affect binding of RBC to oxygen (3) |
|
Definition
| fever, acidosis, and 2,3-BPG decrease binding |
|
|
Term
| what stimulates release of erythropoetin |
|
Definition
|
|
Term
| how much oxygen on a RBC is normally released to the tissues |
|
Definition
|
|
Term
| what is a reticulocyte, where do you see them |
|
Definition
| RBC that is still loosing its nucleus, there a little bit in the circulation. when it raises it is a concern |
|
|
Term
| what changes Hb levels other than anemia (3) |
|
Definition
age, sex, and race
make sure to check appropirate levels for the age |
|
|
Term
| what is the official diagnosis criteria |
|
Definition
| two standard deviations below the standard Hb level for the child - it is really a lab diagnosis |
|
|
Term
| describe the trends of Hb levels through out life |
|
Definition
| higher in the first two weeks then comes down to 11.5 then in the teens it jumps to 13.5-14 |
|
|
Term
| what is the cause of aplastic / hypoplastic anemia, what is a good sign of this |
|
Definition
decrease in marrow production of RBC
reticulocyte site would be lower than normal |
|
|
Term
| what is the cause of hemolytic anemia, what is a good sign of this |
|
Definition
increased destruction of RBC peripherially
a sign is immature precursors in marrow (ineffective erythropoiesis) |
|
|
Term
| what is the cause of hemorrhagic anemia |
|
Definition
| nose bleed, GI bleed, trauma, etc |
|
|
Term
| what is the causes of hypochromic / microcytic anemia (4) |
|
Definition
| iron deficiency, thalassemia minor, lead poisoning, chronic infection |
|
|
Term
| what are some common general clinical signs of anemia (4) |
|
Definition
| fatigue, looks pale, pale conjunctiva, pale palmer creases |
|
|
Term
| other than Hb and reticulocites what are other signs on anemia (2) |
|
Definition
|
|
Term
| what is the standard range of MCV for all kids |
|
Definition
|
|
Term
| what is it called when the MCV is below the normal range |
|
Definition
|
|
Term
| what is it called when the MCV is above the normal range |
|
Definition
|
|
Term
| what is it called when the MCV is normal but a kid still has anemia |
|
Definition
|
|
Term
| how can you tell if anemia is caused by marrow hypoplasia |
|
Definition
|
|
Term
| what does chromicity mean in RBC |
|
Definition
|
|
Term
| how do you determine the MCV |
|
Definition
| (hematocrit x 10) / RBCmm^3 |
|
|
Term
| how do you determine the MCHC |
|
Definition
|
|
Term
|
Definition
|
|
Term
| what is it called if you have low Hb in anemia |
|
Definition
|
|
Term
| what is it called if you have normal Hb but still have anemia |
|
Definition
|
|
Term
| what is the most common anemia |
|
Definition
| hypochromic microcific anemia (iron deficiency anemia usually) |
|
|
Term
| what are the three causes of iron deficiency anemia, how can ou figure out which |
|
Definition
poor nutrition, hemorrhage, poor absorption
ask if the kid is getting milk fed, see if they have lots of diarrhea (poor absorption Fe causes diarrhea) |
|
|
Term
| when does iron deficiency anemia normally show up, why (2) |
|
Definition
after 6 mo, usually 10-18 mo
milk decreases the Fe absorption so if mom feeds milk and not Fe fortified forumla you can bet a happy chubby anemia baby.
the iron stores that came from mom last until around this time |
|
|
Term
|
Definition
| meat, spinach, apples, rasins, |
|
|
Term
| what are 4 signs specific to Fe deficient anemia |
|
Definition
| low IQ, asymptomatic, irritability if severe, spooning of finger nails |
|
|
Term
| what is the AAP recommendation for time to check Hb level in a healthy child |
|
Definition
|
|
Term
| what is the cause of thalassemia |
|
Definition
| abnormal Hb gene affects the a or B globin chain synthesis causing a or B thalassemia |
|
|
Term
| how is thalassemia minor diagnosed (7) |
|
Definition
Hb <9g/dl
hypochromic very severe
mentzer index
serum ferritin
theraputic trial of Fe
TIBC
serum Fe |
|
|
Term
| thalassemia major treatment |
|
Definition
| transfusion every 6-8 weeks (severe anemia) |
|
|
Term
| mentzer index: how is it calculated, what does the number mean |
|
Definition
MCV/(RBC/10^6)
>13.5 suggests Fe deficiency anemia
<11.5 suggests thallasemia minor |
|
|
Term
| how does a theraputic trial of Fe help diagnose anemia |
|
Definition
| if Fe deficient anemia they will get better. make sure to see the child back in 3 mo (it takes a while for the Hb to return to normal) or check the reticulocyte count it should go up |
|
|
Term
| how do you diagnose a vs B thalassemia |
|
Definition
electrophoresis
FHb should go down around 3 mo so if they have it after that they have thalassemia |
|
|
Term
| signs of thalassemia major (6) |
|
Definition
severe anemia
expansion of marrow - maxillary hyperplasa (flat bones try to help)
signs of chronic hypoxia
basophillic stippling
hepatosplenomeagly - spleen and liver try to help make RBC |
|
|
Term
| lead poisioning: 4 neurological complications |
|
Definition
| psychomotor slowing, seizures, encephalopathy, lower IQ |
|
|
Term
| what are the 3 GI symptoms of lead poisoning |
|
Definition
| abdominal pain, vomiting, constipation |
|
|
Term
| what is a late finding of lead poisoning, why |
|
Definition
| papilledema, due to increased ICP |
|
|
Term
| what is the cause of lead poisoning (5) |
|
Definition
| leaded gasoline, old paint, aersolized paint, PICA |
|
|
Term
| how is lead poisoning confirmed (3) |
|
Definition
serum lead
lead lines on x-rays
some states mandate that all kids at 1 yo they need lead check |
|
|
Term
| what is the cut off for concern in serum lead levels |
|
Definition
|
|
Term
| macrocytic anemia: aka, two qualifiers |
|
Definition
megaloblastic anemia
MCV > 100
Hb is low |
|
|
Term
| macrocytic anemia causes (5) |
|
Definition
B12 deficienciey
folate deficiency: goat milk fed
medication: phenytoin (anticonvulsant)
congenital hypoplastic anemia
transient erythroblastopenia of childhood |
|
|
Term
| what are some microscopic signs of megaloblastic |
|
Definition
hypersegmented polymorphic neutrophils
low Hb
MCV > 100 |
|
|
Term
| what is the difference in the Hb, cellular antigens, reticulocytes, MCV, and RBC enzymes in congenital hypoplastic anemia and transient erythroblastopenia |
|
Definition
CHA: increased FHb, low reticulocytes, antigen i, increased MCV, normal or high RBC enzymes
TEC: notmal FHb, normal reticulocytes, antigen I, normal MCV, low RBC enzymes |
|
|
Term
| what is the cause of congenital hypoplastic anemia, what is the treatment |
|
Definition
switch from FHb to adult is broken. marrow aplasia
need marow transplant |
|
|
Term
| what is the cause of transient erythroblastopenia of childhood, what is the treatment |
|
Definition
switch from FHb to adult is fine but the marrow becomes supressed by virus
might need a few bridge transfusions but dont need marrow transplant |
|
|
Term
| hereditary spherocytosis: inheritance, caue |
|
Definition
| autosomal dominant disease with abnormal RBC membrane due to deficiency of contractile spectrums making spherical RBC so the cells cannot squeeze through the sinusoids of the spleen and the RBC get lysed so they only liv 30-40 days |
|
|
Term
| what are some signs of spherocytosis (5) |
|
Definition
| hemolytic signs: marrow overdrive expands marrow sites, increased reticulocytes, RBC lysed in the spleen cause splenomeagly, jaundice due to hemolysis, urobillinogen in urine |
|
|
Term
|
Definition
|
|
Term
| why does hemolysis cause jaundice |
|
Definition
| bilirubin is released during lysis |
|
|
Term
| what are 5 causes of hemolytic anemia |
|
Definition
sickle cell hemoglobinopathies
hereditary spherocytosis
G6PD deficiency
autoimmune hemolytic anemia
hemolytic disease caused by microangiopathy |
|
|
Term
| G6PD deficiency: cause, who gets it, what can trigger it |
|
Definition
enzyme that prevents oxidation of RBC membrane is deficient
more in males
if exposed to medicies (anti-malarial, fava beans) can trigger hemolysis |
|
|
Term
| hemolytic disease caused by microangiopathy: cause |
|
Definition
| when cells go through the narrow capillaries they are destoried |
|
|
Term
| what are three chrisis that people with sickle cell get |
|
Definition
| sequesteration chrisis, vasoocclusive chrisis, aplastic chrisis |
|
|
Term
| what causes sequesteration chrisis |
|
Definition
| when RBC are exposed to hypoxia or acidosis the Hb crystalizes and causes sickling. the RBC get trapped in the capillaries (especially in liver and spleen) and cause hypovolemia because this trapped blood is not available for use |
|
|
Term
| what is vasoocclusive chrisis |
|
Definition
| active child gets hypoxia in phalanges or tores |
|
|
Term
| what is a aplastic chrisis |
|
Definition
| kid with sickle cell gets 5th disease and marrow is supressed due to virus on top of anemia making anemia worse |
|
|
Term
| what is part of a sickle cell that is characteristic and seen on a peripherial smear (3) |
|
Definition
| howell-jolly body, bluster cells (when Hb condenses), sickle cells |
|
|
Term
|
Definition
| maxillary hyperplasia, dactylitis (hand foot syndrome, more common in toddlers), priapism (12h erectionin adolescent) |
|
|
Term
| what substances can cause hemolysis in someone with G6PD deficiency (4) |
|
Definition
| antimalarials, sulfa drugs, fava beans, antipyretics/analgesics |
|
|
Term
| malaria: cause, pathology, 3 symptoms |
|
Definition
Plasmodia vivax lives intracellilarly and can be seen on smear
RBC are more fragile causing hemolysis, fever, chills, anemia |
|
|
Term
| what does it mean when band cells are seen |
|
Definition
neutrophilia (shift left). mobilization of neutrophils to fight bacterial infection allows immature neutrophils into the blood.
if there is lots think sepsis |
|
|
Term
| what does lymphocyte elevation indicate |
|
Definition
|
|
Term
| what does monocyte elevation indicate |
|
Definition
|
|
Term
| what does eosinophilia indicate |
|
Definition
| parasite infection, allergies (allergic rhinitis, bronchial asthma) |
|
|
Term
| what are the causes of thrombocytopenia (2) |
|
Definition
destruction: ITP
consumption: DIC, massive hemangioma
production: TAR syndrome |
|
|
Term
| what is a coagulation disorder |
|
Definition
|
|
Term
| what is a normal platelet count, if it gets low what happens |
|
Definition
1500,000 - 450, 000 mm^3
<50,000 get petechiae
<20,000 get purpura purple spots |
|
|
Term
| what is a petechiae and purpura |
|
Definition
patechi are small
purpura are many patechiae and are larger |
|
|
Term
|
Definition
| purpura on the oral mucosa or retinah |
|
|
Term
| how does hemangomia cause low platelets, what disease |
|
Definition
kasabach-merritt syndrome
lyming sticking platelets on walls of hemangioma causes low platelet in circulation |
|
|
Term
| what is the CC of someone with ITP |
|
Definition
| low grade fever that began a week ago, bluish rash |
|
|
Term
|
Definition
| viral particles attach to surface of platelets and are not recognized as ours in the spleen so it destories them |
|
|
Term
| what are some lab values of ITP (2) |
|
Definition
| WBC norma, platelets <20,000 |
|
|
Term
| what is the treatment of ITP |
|
Definition
not platelet transfusion unless life is iin danger because they get destoried too
corticosteroids supress immune reaction, gamma globulins coat sites in spleen and saturate them so it cannot grab platelets, give rh positive and coat the spots in the spleen with anti-b immunoglobulin |
|
|
Term
| what do you do if the ITP treatments dont work |
|
Definition
| suspect leukemia, get marrow aspirate |
|
|
Term
| how does a marrow aspirate distinguish between ITP and leukemia |
|
Definition
ITP: overdrive like in hemolytic anemia
megakaryocytes are hypoplastic
leukemia: megakaryocytes decrease because lukemia cells take up all the room |
|
|
Term
|
Definition
| abnormalities of the radius due to hypoplastic anemia |
|
|
Term
| vitamin K deficiency complications |
|
Definition
needed for production of clotting factors
increases bleeding
seen in chronic liver disease in adults |
|
|
Term
| vitamin K deficiency prophylaxis |
|
Definition
| within 24 hours kids get injection to avoid hemorrhagic disease of the newborn |
|
|
