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32 Cards in this Set
- Front
- Back
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What are the normal values for the
Granular Leukocytes make up ?% of WBCs monocytes? lymphocytes? Platelets number? RBC |
Granular Leukocytes make up 30-60%
Monocytes-first line of defense like granulocytes Lymphocytes protect body against antigens normal platelet count. |
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What is the basic definition of anemia?
What is pancytopenia? |
Anemia reduction of blood Hgb concentration
Decreased in all three formed element of the blood Erythrocytes, Leukocytes, Platelets |
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The epidemology of pancytopenia is (3)?
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Failure of production (intrinsic bone marrow disease as occurs in aplastic anema.
Sequestration (as occurs with hypersplenism) Increased peripheral destruction. |
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Clinical Findings in Pancytopenia
Diagnostic test? Management? |
Clinical findings
Child may present with an infection or bleeding HX: anemia, jaundice, etc. PE: Pallor, jaundice, petechiae, fundal hemorrhages, excessive bruising Diagnostic test Work-up for anemia Management Varied with identification of disease Adequate nutrition |
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Description of Iron Deficiency anemia
lab results? What are the three causes? |
Inadequate availability of iron to sustain bone marrow erythropoiesis
Mild to moderate iron deficiency (Hgb levels between 8 to 11g/dL Range from iron depletion, iron deficiency, to iron deficiency anemia. |
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Who is at most risk for Iron deficiency anemia?
What are the clinical findings? |
Infants around 9 months, toddlers and adolescent girls are at higher risk for iron-containing foods History of a diet low in iron containing foods
Clinical findings HX: irritability and restlessness Pica maybe present Anorexia Development delay |
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What are the diagnostic test for iron def anemia?
What is the management? |
Diagnostic test
Microcytic, hypochromic anemia on CBC; low or normal MCV; low RBC number; High RDW; low ferritin High TIBC Management Treatment with Fe supplement (4 to 6mg/kg/day of elemental Fe |
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Description of newborn jaundice
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Accumulation of bilirubin in the skin, causes a yellowish orange or sometimes green hue to the skin
Serum bilirubin level exceed 5 to 7 mg/dL Advances in a pattern from the infant’s head to toe |
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What are some causes of newborn jaundice?
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Physiologic jaundice
Breast milk jaundice |
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What is the Clinical Findings for the history and PE for newborn jaundice
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HX
Significant hemolytic disease, anemia Inborn error of metabolism Early or severe jaundice Hepatobiliary jaundice PE Jaundice at birth & during neonate period affected first Face, shoulders, chest, and abdomen; can be based on dermal zone |
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What are the diagnostic studies for newborn jaundice?
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TcB-transcutaeous bilirubin.
TSB level (indirect or direct) for infants who have a TcB more than 15, for darker skinned infants or for infants under phototherapy If provider suspect higher further test is completed i.e. ABO, Rh, Blood test, Coombs test on infant, Hgb, HCT, Reticulocyte count |
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Management of newborn jaundice?
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Management
Promote breastfeeding by advising mothers to breast 8 to 12 times a day for first several days In healthy full-term (> 35 weeks) infant physical findings, bilirubin level according to age are helpful Phototherapy to treat indirect hyperbilirubinemia. Contraindicated for elevated direct bilirubin. Infant should be dressed only in diaper and eye shields on |
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When is jaundice considered pathologic?
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Less than 24 hours within birth. and after 2 weeks it can be due to thyroid, sepsis, metabolic disorders.
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Sickle Cell Anemia?
Description Autosomal? Most seen in? |
HgB S
Low PaO2 African and mediterranean |
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SCD
Clinical Findings and Diagnostic Test |
Clinical findings
Pale and slightly jaundiced appearance Painful swelling of the hands and feet Low-grade fever, leukocytosis (pp.625) Diagnostic test Hematcrit RBC MCV; Hgb electrophoresis (after infancy |
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SCD Management?
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Management
Focus should be on: pain management, anemia, infection prophylaxix, avascula bone necrosis, osteomyelitis, skin ulcers, renal dysfunction, retinophathy, heart and pregnancy Baseline laboratory , pneumococcal vaccines Pen-VK 125 mg orally twice a day is initiated by 2 month-old, at 3 the dos e is increased to 250 mg orally Folic acid supplements Aggressive treatment or management for infections and maintenance (see more, pp626) Current therapies: Hydroxyurea, Erythropoietin, Butyrate, Clotrimazole, Nitric Oxide, Fluocor, Bone marrow transplantation and gene replacement therapy |
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Hemophilia A and B and von Willebrand Disease
Description? |
Factor VIII (hemophilia A) or factor IX (hemophilia B)
Factor VIII and von Willebrand factor (vWf) |
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Epidemology of Hemophilia A and B and von Willebrand Disease
hemophilias --Affects? Carriers? |
Sex linked
X chromosome is the carrier and recessive Affects primarily males & females only carriers 1 in 5000 males affected with Hemophilia A & 5 times more than hemophilia B von Willebrand disease in both sexes; incidence 1 in 100 individuals |
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Hemophilia A and B and von Willebrand Disease Clinical factors? and Diagnostic Test
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Clinical findings
Factors A family positive history Excessive bruising Pain and swelling in the elbows, knees, and ankles Prolonged aPTT von Willebrand Mucous bleeding Ecchymosis of trunk, upper arms, and thighs Diagnostic test Assays for Factor VIII or IX PTT, PT |
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Management of Hemophilia A B and vonWillebrand
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Treatment –replacement therapy-Factor VIII or Factor IX
treatment of vonwillibrands-is desmopressin, facotr VIII-vWF concentrates and local measures to control bleeding. |
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Idiopathic Thrombocytopenia
cause? occurs usually after? |
Most common thrombocytopenic purpuras in childhood
Autoimmune response to circulating platelets are destroyed Occurs usually after viral illness (pp629) |
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What is the diagnostic information in idopathic thrombocytopenia?
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Low platelets normal PT aPTT
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What are some of the clinical findings for leukemias
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History of repeated infection
Bleeding episodes Lymphadenopathy and hepatosplenomegaly |
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Diagnostic test for Leukemias
Management |
CBC with differential: WBC, platelet
Peripheral smear Bone marrow Referral to a Pediatric oncologist. |
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Non-Hodgkin Lymphomas (NHL)
Description? Classifications (3) |
Diverse group of solid tumors of the lymphatic tissues that form from malignant proliferation of T cells, B cells, or indeterminate lymphocyte cell
Pediatric classification Small noncleaved cell lymphoma Lymphoblastic lymphoma Large cell lymphoma |
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NHL
Incidence Occurs most when? Most frequent malignancy in AIDS children. |
Incidence rate <20 years old (10.5 per 1 million white children compared to 7.3 per 1 million black children)
Occurs in second decade of life |
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Non-hodgkins lymphoma clinical findings:
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Clinical findings
Most common site lymphoid structures of the intestinal tract lymphoblastic NHL –Intrathoracic tumors in contrast, small noncleaved cell lymphomas (80% of US) Other site-CNS and bone marrow Acute abdomen-pain, distention, fullness, and constipation Nontender lymph node enlargement |
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Non-Hodgkins lymphomas
Diagnostic test? Management? |
Diagnostic test
Depend on location Chest radiograph CT MRI Position emission tomography CBC, liver function test, Uric acid Confirmed by surgical biopsy Management Referral for irradiation and chemo 90% long-term disease-free survival |
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Hodgkins Disease?
Description % of lymphomas in childhood? 60% of children with it is between what age? |
Description
A malignancy of the lymph nodes Originates in a cervical lymph nodes Epidemiology 50% of the lymphomas in childhood 60% of children with Hodgkin disease between 10 and 16 years |
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What are the clinical findings and the diagnostic test needed for Hodgkin Disease?
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Clinical Findings
Painless enlarge lymph nodes in cervical area, firm and matted together Chronic cough Fever, decreased appetite, weight loss, and night sweats Diagnostic test Hematologic findings often normal Anemia/abnormal liver function/elevated ESR Depressed leukocytes or platelets. |
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Management of Hodgkin Disease
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Management
Referral to Pediatric Oncology for irradiation and chemotherapy. Children have better response rate than adults with a overall 75% at more than 20 years (Burns et al. 2009) |
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A 3-year-old is seem in the clinic for a well-child visit. The mother reports that the child was recently diagnosed and treated for an Ascaris infection. The NP would expect which of the following to be elevated in the complete blood count (CBC)?
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Eosinophils
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