Module 4 - Neonatal Hematologic Manangement

Front 1

Megaloblastic phase

Back 1

Yolk sac is principal site of RBC production

Front 2

Most primative RBCs

Back 2

Megaloblasts

Front 3

Begins by the 5-6th week gestation

Back 3

Hepatic phase

Front 4

RBCs are still produced by the liver until _____ after birth

Back 4

1 week

Front 5

Begins @ 4-5th month and is the principal site of RBC production during the 3rd trimester

Back 5

Myeloid phase

Front 6

Initially produced by the fetal _________ but during the 3rd trimester the _________ become the major source of this growth factor called ___________

Back 6

liver
kidneys
Erythropoietin

Front 7

in the term infant, Hgb begins to rise by _______ and reaches a plateau by _______ of age.

Back 7

2hrs
8-12 hrs

Front 8

Hgb reaches it's nadir by _________ of age in the term infant.

Back 8

8 weeks

Front 9

In the preterm infant, Hgb reaches a nadir by ________ with an average level of _______

Back 9

4-8 weeks
8g/dL

Front 10

In states of hyperviscosity/polycythemia, the MCV (mean cell volume) will be __________.

a. Increased
b. decreased

Back 10

Increased

Front 11

Seen in hemoglobinopathies, RBC enzyme deficiencies, or after a splenectomy

Back 11

Heinz bodies

Front 12

Intracellular inclusions, usually attached to RBCs, compsed fo denatured hemoglobin.

Back 12

Heinz bodies

Front 13

Nuclear remnants seen in RBCs after Wright's staining

Back 13

Howell-Jolly bodies

Front 14

Seen in types of anemia, asplenia/hyposplenia and severe iron deficiencies.

Back 14

Howell-Jolly bodies

Front 15

Decreased production of RBC's by the bone marrow

Back 15

Hypoplastic anemia

Front 16

Immature RBC containing a nucleus

Back 16

Erythroblast

Front 17

Represents an estimate of the amt of Hgb in an average RBC.

Back 17

MCH

Front 18

Calculated from the ratio between the amt of Hgb and the number or RBCs in a specimen

Back 18

MCH

Front 19

Calculated from the ratio of Hgb to Hct, expressed as a percentage

Back 19

MCHC (mean copuscular hemoglobin concentration

Front 20

RBCs have variable and abnormal sizes on a peripheral smear

Back 20

Anisocytosis

Front 21

Indicates variation in RBC size and is used to detect anisocytosis

Back 21

Red cell distribution width (RDW)

Front 22

Can be a sensitive and specific early indicator of iron deficiency anemia in infants with cyanotic heart disease

Back 22

RDW

Front 23

Type of transfusion used for symptomatic anemia and improvement of tissue oxygenation

Back 23

PRBC

Front 24

PRBCs have a final Hct of _____________%

Back 24

55-60

Front 25

A solution of 10 ml/kg of additive RBCs would raise the Hct by __________%

Back 25

7-8

Front 26

Transfusion used when there is a need for concurrent volume and coag factor replacement

Back 26

whole blood

Front 27

PRBC transfusion volume should be _______ml/kg

Back 27

20

Front 28

Rate of infusion shoud be less than _________ in the absence of cardiac failure

Back 28

10ml/kg/hr

Front 29

In the presence of cardiac failure, rate of PRBC infusion should be no more than ___________

Back 29

2ml/kg/hr

Front 30

Each transfusion of 9ml/kg should increase the Hgb by ______g/dl

Back 30

3

Front 31

Thrombocytopenia occurring at less than 72 hours of age is caused most commonly by:

Back 31

Placental insuficiency
maternal PIH
early onset sepsis
perinatal asphyxia

Front 32

Thrombocytopenia occurring behond 72 hours of age is most commonly caused by

Back 32

Sepsis
necrotising enterocolitis
intrauterine infections
metabolic errors
congenital platelet production deficiencies

Front 33

Indications for platelet infusions

Back 33

plt ct less than 30,000 regardless of condition

plt 30-50000 in:
sick or bleeding infants
<1000gms or <1wk of age
IVH gr 3-4
concurrent coagulopathy
requiring surgery or exchange transfusion
Plt ct >50000 only if actively bleeding

Front 34

Should platelets be filtered?

Back 34

NO, it will decrease the number of plts

Front 35

What is the usual recommended dose of platelets for neonates?

Back 35

5mL/kg

Front 36

What are the three valid indicaitons for transfusion of FFP in a neonate?

Back 36

DIC
Vit K deficiency bleeding
Inherited deficiencies of coagulation factors

Front 37

Contains about 87% of factor VIII

Back 37

FFP

Front 38

Contains 80-100U of factor VIII/10-25ml, and 300mg of fibrinogen

Back 38

Cryoprecipitate

Front 39

Indications for use of cryoprecipitate

Back 39

Congential factor VIII deficiency
Congenital factor XIII deficiency
Afibrinogenimia and dysfibrinogenemia
VonWillebrands disease

Front 40

Volume fo FFP to be transfused is usually:

Back 40

1-=20ml/kg

Front 41

Volume of cryoprecipitate to be infused is usually

Back 41

5ml/kg

Front 42

Most important indicator of blood viscosity

Back 42

Hematocrit

Front 43

Hyperviscosity is defined as:

Back 43

Hct >65%

Front 44

In small diameter vessels, blood viscosity __________ with decreasing diameter of RBCs

a. decreases
b.increases

Back 44

a.decreases

Front 45

Major causes of neonatal polycythemia:

Back 45

Increased intrauterine erythropoiesis due to chronic hypoxia, or placental-fetal transfusion, as in late cord clamping.

Front 46

Placental transfusion to the fetus resulting in polycythemia can be caused by __________and ___________

Back 46

late cord clamping
oxytocin treatment (enhanced uterine contractions)

Front 47

Maternal conditions associated with polycythemia due to epo stimulation

Back 47

toxiemia
smoking
placental insufficiency
Maternal diabetes

Front 48

Most common clinical manifestations of polycythemia include:

Back 48

peripheral or systemic cyanosis and plethroa

Front 49

Polycythemia is treated by:

Back 49

hemodilution with albumen, NS, or LR - usually with NS

Front 50

Polycythemia volume exchange:

Back 50

100ml/kg x (observed - desired Hct)