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MCV is 1 of 3 RBC indices that define the __ & __ content of RBC
size & hemoglobin
Low MCV (small cell) = ____
microcytic
High MCV (large cell) =
macrocytic
Retic count is essential in determining whether pt has ____ anemia
hemolytic
Normal response to a drop in erythrocytes in inc production of ____
reticulocytes
Reduction in RBCs, or in their hgb concentration, to a level >2 SDs below the mean
anemia
The sole fxn of RBC:
carry & release O2 to tissues
T/F: determination of appropriate hgb levels is dependent on age of the pt
TRUE
Most frequent sign of iron deficiency
pallor
Iron def anemia: common from __-__ months of age
9-24 months
T/F: iron def anemia is a microcytic hypochromic anemia
TRUE
T/F: iron def anemia
Modify diet (iron rich foods), supplement w/iron ferrous salts
Tx iron def anemia lasts __ months. 1m to correct the __, 2m to replace ___
lasts 3 months. 1m to correct anemia, 2m to replace iron stores
Take iron supplement with vitamin __ source
vit C
__ will inhibit the absorption of iron
Milk
Iron def anemia: blood transfusions only nneded if pt ____
symptomatic (tachycardic, hyoxic, hypovolemic)
S/Sx: vaso-occlusive crisis-->dactylitis painful swelling of hand, feet, fingers & toes, splenic sequestration, aplastic crisis, infxn, maxillary hyperplasia
Sickle cell Dz
SC: why start PCN in infancy & continue into adolescence?
Prophylaxis of fxnal asplenia very important
Tx: sickle crisis
admit hosp if sev. If F-->IV abx. Fluid hydration, O2, pain mgmt, bone marrow transplant, hydroxyurea & butyrate
Sickle trait: RCs contain only __-__% sickle hgb; is this sufficient to cause sickling?
30-40%; no sickling (unless in hypoxic setting)
T/F: life expectancy is not altered by sickle trait
TRUE
MC acquired platelet disorder of childhood
immune thrombocytopenia purpura (ITP)
ITP often preceded by ____
viral infxn
ITP: most feared complication
CNS bleed
ITP: assoc w/___ & ____ hemorrhage
GI & renal hemorrhage
ITP: tx only when platelets < ______K
20,000K
Tx: ITP
spontaneous remission high, steroids (ONLY if Dx confirmed and not early leukemia), IV gamma globulin, splenectomy for chronic ITP
X-link Dz, 1:5000 males, 85% have factor 8 deficiency
Hemophilia A
X-link, abnormal factor 9
Christmas Dz (hemophilia B)
Tx: hemophilia
transfusion with specific clotting factors, avoid aspirin & anti-inflamm, vaccinate against hep B early, mild cases - desmopressin acetate
S/Sx: inc exercise intolerance & tiredness, heavy period, frequent nose bleeds
von Willebrand Dz
MC hereditary coagulopathy (autosomal dominant, type I MC)
von Willebrand Dz
Tx: VWD
Desmopressin acetate for type I & II. Replacement therapy
S/Sx: vasculitis triggered by winter viruses, lumpy papules only from waist down-->buttocks & legs; purpura is palpable
Henoch Schonlein purpura
Tx: HSP
Tx only for severe GI, neuro, or renal findings
MC malignancy Dx\\\'d in children (30%)
acute leukemia
S/Sx: fever, pallor, purpura & pain; onset acute or insidious over few d,wks, mths
Acute lymphoblastic leukemia
Dx: ALL
abnormal CBC w/ confirmation bone marrow
Tx: ALL
1. remission induction 2. presymptomatic CNS therapy 3. maintenance 4. elective d/c therapy & long-term, late effects f/u
ALL: about __% of children w/newly Dx\\\'d ALL survive in remission & Dz free for >5yrs
65%
Most serious complications of AALL Tx is:
bone marrow relapse
T/F: extramedullary relapse found in the CNS & testes
TRUE
Presentation similar to ALL, but Tx not as successful
Acute myeloid leukemia
S/Sx: H/A in morining not relieved by tylenol/motrin, vomint in AM upon rising, vision changes, inc intracranial pressure
Malignant brain tumors
MC brain tumor type
Infratentorial (45-60%)
Tx: brain tumor
surgical, radiation, chemo (hard to Tx, not much progress in this field)
S/Sx: inc bulging of bilateral eyes & bruising of eyelids (racoon eyes), Hx of F off & on, abdominal mass
Neuroblastoma
2nd MC solid tumor in childhood
neuroblastoma
Dx: neuroblastoma
bone marrow, urine eval - catecholamine, VMA, HVA; MRI, US of liver
Tx: neuroblastoma
related to stagin. Mainstay - radiation + chemo. Poor prognosis
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