Peds Assessment: Hematology

Front 1

What are the components of blood?

Back 1

-RBC
-WBC
-Plasma

Front 2

Does the color of the plasma change with the conditions of the body?

Back 2

Yes: ex hyperbilirubinemia will have yellowy plasma

Front 3

What line of blood does 5th's disease affect?

Back 3

the RBC line: get erythropenia

Front 4

Plasma is made up primarily of __

Back 4

water

Front 5

What comprises plasma?

Back 5

protein

91% water

nitrogen substances

Front 6

What is a reticulocyte?

Back 6

premature RBC that you can make more of it you have increase need for erythrocytes

Front 7

What increases during a hemolytic process?

Back 7

reticulocytes

Front 8

ToF: when you have sickle cell trait, the reticulocyte goes up?

Back 8

false! You will have increased in actual SCD

Front 9

What can a stem cell become?

Back 9

white cell, red cell, platelets

Front 10

What can a CBC answer?

Back 10

-Is the patient anemic?
-does the total and diff white count support the diagnosis of infection
-is the platelet count in a range that impacts homeostasis

Front 11

Should a CBC be done on every child?

Back 11

NO

Front 12

There is a clear therapuetic yield less than __% of the time from the CBC alone?

Back 12

1

Front 13

ToF: the CBC varies by age

Back 13

true

Front 14

when does the RBC count make a drastic drop?

Back 14

around 2 months

Front 15

is anemia normal at 2 months?

Back 15

YES!

Front 16

What do B cells become?

Back 16

immunoglobulins: important for humeral immunity

Front 17

What are blasts?

Back 17

premature cells that can be myeloblasts, lymphoblasts etc

Front 18

Is it a problem to see one blast in a viral infection

Back 18

no not a big problem

Front 19

If there are excessive blast what should be considered?

Back 19

leukemia

Front 20

Hgb is the

Back 20

ability of the RBC to carry oxygen

Front 21

What is the MCV?

Back 21

the size of the RBC

Front 22

How is the MCV measured?

Back 22

the palter machine

Front 23

How are MCH and MCHC found?

Back 23

they are derived values, not gotten by the palter machine

Front 24

What is the rule of 3

Back 24

Helps screen for artifact changes
-measure Hgb calculation should be 3 times the RBC count
-the calculated Hct is 3 times the Hgb value

Front 25

ToF: RBC are anucleate?

Back 25

true

Front 26

What is the shape of RBCs?

Back 26

flexible biconcave disc

Front 27

what is the normal survival time for a RBC?

Back 27

120 days

Front 28

where are RBCs recycled?

Back 28

in the liver and spleen

Front 29

A decrease in blood oxygen causes descreased O2 tesntion in tissues that trigger the ___ to produce __

Back 29

kidneys; erythropoetin

Front 30

Iron is reused by the body and ___ is released when RBCs break and can cause jaundice

Back 30

bilirubin

Front 31

What is the MCV?

Back 31

the size of the RBC

Front 32

How is the MCV measured?

Back 32

the palter machine

Front 33

How are MCH and MCHC found?

Back 33

they are derived values, not gotten by the palter machine

Front 34

What is the rule of 3

Back 34

Helps screen for artifact changes
-measure Hgb calculation should be 3 times the RBC count
-the calculated Hct is 3 times the Hgb value

Front 35

ToF: RBC are anucleate?

Back 35

true

Front 36

What is the shape of RBCs?

Back 36

flexible biconcave disc

Front 37

what is the normal survival time for a RBC?

Back 37

120 days

Front 38

where are RBCs recycled?

Back 38

in the liver and spleen

Front 39

A decrease in blood oxygen causes descreased O2 tesntion in tissues that trigger the ___ to produce __

Back 39

kidneys; erythropoetin

Front 40

Iron is reused by the body and ___ is released when RBCs break and can cause jaundice

Back 40

bilirubin

Front 41

Pt with kidney disease will have normal size RBCs but the __ will be smaller because they lack ___

Back 41

size; erythropoetin

Front 42

Erythropoetin is a __ that is produced by the kidney.

Back 42

cytokine

Front 43

Erythropoetin is necessary for ___ production

Back 43

RBC

Front 44

What are the acute symptoms and signs of anemia?

Back 44

Symptoms:
-SOB
-Fatigue
-unable to keep up

Signs
-Pallor
-tachy
-systolic murmur
-hepatomegaly
-CHF

Front 45

Why do SCD children not usually complain of SOB?

Back 45

because their anemia is not acute

Front 46

What is normocytic anemia?

Back 46

the size of the RBCs are normal but there is not enough of them

Front 47

What are things that change the Hgb screen?

Back 47

Increase: CHF, COPD, polycythemia vera, the cyanotic heart diseases

Decrease: Anemias, hemoglobinopathies, liver dysfucntion, hypothyroidism, hemorrhage

Front 48

What is RDW

Back 48

RBC distribution width

Front 49

How do you determine the lower limit of normal for MCV?

Back 49

Age (yrs + 70)

Front 50

What age range can the LLNL of MCV be used on?

Back 50

Only use between age 2 and 10

Front 51

It is rare to see a child with an MCV that is greater than __

Back 51

95

Front 52

ToF: reticulocytes are large enough to be seen microscopically

Back 52

True

Front 53

What does it mean if the child has an MCV that is lower than the LLNL?

Back 53

they have a microcytic anemia

Front 54

If a child has a lot of reticulocytes, how might the MCV look?

Back 54

it will be high because they are larger

Front 55

If someone has a BM failure you have a decrease in the ___ count

Back 55

reticulocytes

Front 56

Parvovirus causes aplasia of the BM since there is no RBC production for __ days

Back 56

7

Front 57

what kids have a big problem with with low parvovirus?

Back 57

HIV and SCD

Front 58

If there is a high reticulocyte count this means that the ___ is working.

Back 58

bone marrow

Front 59

What is the most common dysfunction of the platelets?

Back 59

ITP

Front 60

If a child has microcytic anemia you can use ___ ___ to find out the type of amemia.

Back 60

mentzer index

Front 61

Can a menzter's index be used for a normocytic or macrocytic anemia?

Back 61

NO!

Front 62

According the to the mentzer's index, what kind of anemia occurs if the MCV/RBC > 13?

Back 62

iron deficiency

Front 63

How is thalassemia found?

Back 63

the MCV/RBC (mentzer's index) is < 13

Front 64

What are the 3 common causes of microcytic anemia?

Back 64

-blood loss
-hemolysis
-bone marrow production problems

Front 65

How do RBC look in iron deficiency anemia?

Back 65

hypochromic (pale) and microcytic

Front 66

In iron deficiency anemia, what may occur with the platelets?

Back 66

may have reactive thrombocytosis

Front 67

What does over consumption of milk often lead to?

Back 67

iron deficiency anemia

Front 68

What is the most common cause of microcytic anemia

Back 68

Thalassemia trait

Front 69

What are the common causes of microcytic anemia?

Back 69

-thalassemia trait
-iron deficiency
-chronic inflammatory disease
-lead poisoning

Front 70

ToF: it is a normal variance for African American's to have a low WBC as long as their ANC is normal.

Back 70

TRUe

Front 71

The RDW is a measurement of how much the RBC look __ __

Back 71

like eachother

Front 72

Which children are seen with macrocytosis?

Back 72

preemies with short gut syndrome from inability to absorb folate and B12

Front 73

What drugs can cause macrocytic anemia?

Back 73

zidovudine
Depakote

Front 74

What are the common causes of macrocytic anemia?

Back 74

-Preemies with gut syndrome
-increased reticulocyte count
-drugs
-cyanotic congenital heart disease
-down syndrome
-liver disease
-hypothyroidism

Front 75

What are the causes of normocytic anemia?

Back 75

-Blood loss
-decreased production of RBC (BM failure)
-increased destruction of RBC (hemolytic anemia)

Front 76

Lab studies for normocytic anemia should include...

Back 76

-Reticuloycte count *****
-MCV
-stool guiac from GI bleeds! Celiac disease
-Iron studies
-Ferritin level: it is an acute phase reactant. Goes up in times of illness

Front 77

Why is ferritin not the greatest lab test to trust for an indicator or normocytic anemia>

Back 77

because it is an acute phase reactant. it is elevated in chronic inflammation, infection, malignancy, uremie or heptocellular disease

Front 78

Why are CBCs discouraged?

Back 78

because a series of recent infections can cause decrease in RBC production due to elevated cytokine production and impaired iron utilization and thus a false positive for anemia

Front 79

Babies that are __ to ___ days old are not uncommonly amemic.

Back 79

60-90

Front 80

What are some signs and symptoms of hemolysis?

Back 80

-jaundice
-hepatosplenomegaly

Front 81

What are the 3 categories of nomocytic anemia?

Back 81

-immune mediated hemolysis
-congenital defects of RBC: AA males with G6P deficiency, if someone is deficient in the enzyme found in making the Red cell wall
-acquired defects of the RBC: can come from drugs

Front 82

What is a common genetic defect of RBC in african american males?

Back 82

G6P deficiency: which is the enzyme found in making the red cell wall

Front 83

What are the 4 different shapes of RBCs

Back 83

-normal
-spherical
-oval
-sickle

Front 84

What are the common causes of hemolysis?

Back 84

-infection
-hereditary disorder of red cell membrane
-red cell enzyme deficiency
-hemoglobin abnormalities
-isoimmunization: ABO set up of baby to mother

Front 85

What are the more common red cell disorders?

Back 85

-hereditary spherocytosis
-hereditary eliptocytosis

Front 86

what are the enzymes needed for the integrity of the RBC?

Back 86

-glucose 6 phosphate dehydrogenase
-pyruvate kinase
-hexokinase

Front 87

What are the 3 type of thalassemia?

Back 87

-beta
-alpha
-bart's

Front 88

What are the 3 main kinds of SCD?

Back 88

-Hgb SS
-Hgb SC (second kind)
-Sickle Thalassemia

Front 89

Hgb D is found in the ___ pop

Back 89

arabic

Front 90

What is elevated in sickle thalassemia?

Back 90

hgb F or A2

Front 91

The RDW is a measurement of how much the RBC look __ __

Back 91

like eachother

Front 92

Which children are seen with macrocytosis?

Back 92

preemies with short gut syndrome from inability to absorb folate and B12

Front 93

What drugs can cause macrocytic anemia?

Back 93

zidovudine
Depakote

Front 94

What are the common causes of macrocytic anemia?

Back 94

-Preemies with gut syndrome
-increased reticulocyte count
-drugs
-cyanotic congenital heart disease
-down syndrome
-liver disease
-hypothyroidism

Front 95

What are the causes of normocytic anemia?

Back 95

-Blood loss
-decreased production of RBC (BM failure)
-increased destruction of RBC (hemolytic anemia)

Front 96

Lab studies for normocytic anemia should include...

Back 96

-Reticuloycte count *****
-MCV
-stool guiac from GI bleeds! Celiac disease
-Iron studies
-Ferritin level: it is an acute phase reactant. Goes up in times of illness

Front 97

Why is ferritin not the greatest lab test to trust for an indicator or normocytic anemia>

Back 97

because it is an acute phase reactant. it is elevated in chronic inflammation, infection, malignancy, uremie or heptocellular disease

Front 98

Why are CBCs discouraged?

Back 98

because a series of recent infections can cause decrease in RBC production due to elevated cytokine production and impaired iron utilization and thus a false positive for anemia

Front 99

Babies that are __ to ___ days old are not uncommonly amemic.

Back 99

60-90

Front 100

What are some signs and symptoms of hemolysis?

Back 100

-jaundice
-hepatosplenomegaly

Front 101

What is Hgb F replaced by after 6 months of life?

Back 101

Hgb A

Front 102

What is the most common single gene disease in the world?

Back 102

SCD

Front 103

What % of the worlds pop has SCD?

Back 103

5

Front 104

What does SCD protect against?

Back 104

malaria

Front 105

What are the 3 kinds of SCD?

Back 105

-sickle cell anemia
-sickle cell thalassemia
-sickle C disease

Front 106

What tests are done to check for SCD?

Back 106

hemoglobin electrophoresis with A2 and F

Front 107

For Hgb S, what is the genetic defect?

Back 107

Valine for glutaminc acid at the 6th position on the beta chain

GAG--> GTG

Front 108

which form of SCD is caused by a switch to lysine from glutamic acid on the 6th position of the beta chain?

Back 108

Hgb C

Front 109

When does the RBC sickle the most in SCD?

Back 109

under low O2 tension

Front 110

Heme is metabolize to ___ in the macrophage?

Back 110

bilirubin

Front 111

What is the pathway for RBC destruction?

Back 111

• Heme metabolized to bilirubin in macrophage; globin metabolized intracellularly
• Unconjugated bilirubin
o Excreted into plasma and carried to liver
• Bilirubin conjugated in liver
o Excreted into bile and into the upper GI tract
• Conjugated bili
o Passes to lower GI tract and metabolized to urobilinogen, which is excreted into stool and urine

Front 112

What is the carrier frequency of SCD?

Back 112

8% in AA and 25% in west central africa

Front 113

Describe isoimmune hemolytic anemia.

Back 113

Rh and ABO isoimmunization
-Rh due to maternal anti-D antibody
-one of the most common forms of immune mediated hemolysis

Front 114

What is one of the most common forms of immune mediated hemolysis?

Back 114

isoimmune hemolytic anemia: Rh and ABO

Front 115

What causes WBC to decrease?

Back 115

o Infection
o Viral infections
o Drugs
o Radiation and chemo

Front 116

What are the causes of WBC to increase?

Back 116

o Acute infection
o Intoxications
o Leukemia

Front 117

What is the job of the neutrophil?

Back 117

they are the first line of defense on infection. Have to have enough to fight infection adequately

Front 118

segmented neutrophils are __

Back 118

mature

Front 119

immature neutrophils are called ___

Back 119

bands

Front 120

What causes basophils to increase?

Back 120

allergies

Front 121

What line does PMN come from?

Back 121

polymorphonuclear: myeloid line

Front 122

what are the granulocytes?

Back 122

-neutrophils
-basophils
-eosinophils

Front 123

What are the major function of neutrophils?

Back 123

• Phagocytosis
• Killing of microorganisms
 Enzymatic degradation

Front 124

How long do neutrophils take to be produced?

Back 124

7-10 days in the BM

Front 125

What is the lifespan of the neutrophil?

Back 125

6-12 hours in circulation
2-4 days in tissue

Front 126

o when you have an overwhelming infection the immature form goes out in the are and get a ___ or elevated band count

Back 126

bandemia

Front 127

What causes neutrophils to go up?

Back 127

infection
-medication (steroids)
-

Front 128

What happens to neutrophils over the lifetime of the person?

Back 128

• at birth, decrease rapidly after birth within first few days
• infancy 20-30% of circulating WBC
• at age 5, equal neutrophil and lymphocytes
• at puberty reaches 7-% predominace found in adult

Front 129

What is considered severe neutropenia? Why is this significant?

Back 129

< 500. this increases the likelihood of infection

Front 130

How do you calculate the ANC?

Back 130

add the # of neutrophils plus the # of bands.

-That value is a % that should be multiplied by the total white cell count
ex: a value of 9 = 0.09
and the total white = 10000 then the ANC is 900

Front 131

What causes neutrophils to increase?

Back 131

o Bacterial infections
o Granulocytes leukemia
o Burns

Front 132

what causes neutrophils to decrease?

Back 132

o Drugs
o Viral infections
o Bone marrow invasion or aplasia

Front 133

what are the major functions of eosinophils?

Back 133

destroy membrane of parasite within tissue, by release of granule contents
• capable of phagocytosis

Front 134

What causes eosinophils to increase and decrease?

Back 134

•increase: eosinophilia > 3%
o allergic disorder
o parasitic infection (giardia, parasitic)
o pernicious anemia
•decrease
o infections
o hypercortisolism

Front 135

What are the drugs that cause neutropenia?

Back 135

phenothiazines, sulfaonamides, anticonvulsants, penicillin

Front 136

A person with an intrinsic disorder of proliferation and maturation of myeloid cells can cause __

Back 136

secondary neutropenia

Front 137

What are examples of the rare instrinsic disorders that can cause neutropenia?

Back 137

o Severe combined immunodeficiency, hyper IgM syndrome, severe congenital neutropenia (Kostman disease), glycogen storage disease, scwachman-diamond syndrome.

Front 138

What causes basophils to increase

Back 138

o CML
o Polycythemia
o Myeloid metaplasia

Front 139

ToF: basophils are phagocytic?

Back 139

false

Front 140

basophils are involved in __reactions

Back 140

allergic

Front 141

what are the non-granulocytes?

Back 141

-lymphocytes
-monocytes

Front 142

When do lymphocytes increase?

Back 142

• viral infections
• TB
• Lymphocytic leukemia

Front 143

When are monocytes seen to be increased>?

Back 143

• recovering from viral infection
• monocytic leukemia
• TB
• Collagen disease
• Chronic infection or inflammation

Front 144

What is the site of B and T cell differentiation?

Back 144

lymphoid tissue

Front 145

What are the functions of lymphocytes?

Back 145

• Assist the phagocytes in the defense of the body, against infection and other foreign invasion
• Add specificity to the attack
• Found in lymph nodes, tonsils and spleen

Front 146

what are the 2 groups of lymphocytes and their jobs?

Back 146

o t-cells
• cell mediated immunity
• secrete a number of lymphokines
o b cells
• humoral immunity: selective IgA deficiency is most common (respiratory infections in general)

Front 147

Monocytes become __ when they leave the circulation

Back 147

macrophages

Front 148

What is the job of marcophages?

Back 148

o Specialized for phagocytosis
• Foreign material, deal cells, apoptotic cells
• Antigen presentation to helper T cells

Front 149

List the secondary lymphoid tissues .

Back 149

 Lymph nodes
 Spleen
 Adenoid
 Tonsils
 Peyers pathches (ileum)

Front 150

what are the primary lymphoid tissues?

Back 150

• Bone marrow B lymphocytes
• Thymus- t lymphocytes