peds 3: hematologic or neoplastic disorders

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Created by
TH

Cards (83)

  • Hematologic and neoplastic disorders
    Disorders affecting the blood and cancers
  • Function of Blood Components
    • Plasma
    • Coagulation Factors
    • Red Blood Cells
    • White Blood Cells
    • Platelets
  • Plasma

    Contains coagulation factors that stop prolonged bleeding
  • Red Blood Cells

    Carry oxygen
  • White Blood Cells

    Fight infection
  • Platelets

    Stop immediate bleeding
  • FIRST CELL LINE is RBC's OR HEMOGLOBIN
  • Two Ways to Classify Anemias
    • Pathophysiologic Approach to Anemia
    • INAPPROPRIATELY LOW RETICULOCYTES
    • APPROPRIATELY INCREASED RETICULOCYTES
  • WORLDWIDE IRON DEFICINECY ANEMIA IS PREVALENT IN ABOUT 33% of the POPULATION! MORE PREVALENT IN CHILDREN AND WOMEN! THINK OF IT AS BY TREATING IT CAN OPTIMIZE LEARNING & QUALITY OF LIFE!
  • Factors in Iron Deficiency Anemia
    • Increased Demand
    • Inadequate Intake
    • Excessive Loss
    • Impaired Absorption
  • Iron Deficiency Management

    1. Dietary education: Iron rich foods (Red meats, fish, eggs, tofu, lentils, green leafy, iron fortified cereals)
    2. Limit Milk Intake
    3. Iron Supplementation
    4. Dosing
    5. Discuss side effects of iron & management of these (constipation, tarry stool, teeth staining)
    6. Follow up
    7. Ensure adherence
    8. Monitor response to treatment
  • SECOND BLOOD CELL LINE is PLATELETS
  • Low Platelets

    • Excessive bruising
    • Epistaxis (nose bleeding)
    • Bleeding of the gums / teeth
    • Petechiae
    • Purpura
  • Causes of Low or Dysfunctional Platelets
    • Infections
    • Idiopathic thrombocytopenia purpura
    • Disseminated intravascular coagulation (DIC)
    • Medications (NSAIDS, etc.)
    • Familial inherited platelet disorders
  • COAGULATION DISORDERS cause prolonged bleeding so "oozing" bleeding
  • Coagulation Disorders
    • Hemophilia A (Factor VIII): X-linked recessive
    • Hemophilia B (Factor IX, Christmas Disease): X-Linked recessive
    • Von Willebrand disease (Autosomal recessive / dominant)
    • Other rarer factor deficiencies
  • Pattern of Bleeding DEPENDS ON AGE
    • Neonatal
    • Infant
    • Children & Adults
  • Coagulation Disorders

    • Recognize excessive bleeding symptoms
    • Recognize & Treat bleeds early by giving replacement factor so bleeds do not get worse or become life or limb threatening
    • Most kids with severe disease on prophylactic treatment to prevent bleeds!
  • THIRD AND LAST CELL LINE is WHITE BLOOD CELLS (WBC's)
  • Low WBC's

    More prone to infections. Type of infections / immunological disorder depends on exactly what type of WBC is not working properly
  • High WBC's

    • Infection
    • Inflammation
    • Tissue Damage
    • Leukemia
  • Most childhood cancers arise from embryonic mesodermal germ layer, and therefore, involve tissues of: CNS, bone, muscle, endothelial tissue, connective tissue, and blood, lymph tissue
  • Childhood cancers grow quickly & and spread quickly
  • Childhood cancer is not generally preventable – NOT BASED ON LIFESTYLE OR ENVIRONMENT
  • Occasional Genetic Syndromes (P53, Retinoblastoma, Fanconi anemia, etc.)
  • Developmental and Biologic Variances
  • Childhood Cancer – Incidence: Relatively rare, about ~1000 cases/year in Canada. Most common disease-related cause of death in children in Canada. Leukemia accounts for 32% of new cancer cases and is the most common childhood cancer. Prior to 1960's few survived. Now, survival improved due to cooperative group research into combination therapy. Approximately 85%-90% of Canadian children and adolescents with acute ALL are alive 5 years after diagnosis.
  • Types of Pediatric Cancers (0-14 years)
    • POGO 2020 Surveillance Report
  • The improvement in childhood survival rates reflects biological differences in adults compared to children, and differences in treatment approaches. International collaboration in research and clinical care. Success of clinical trials in identifying new agents & treatment approaches. Multidisciplinary treatment approaches. All helped achieve improved outcomes & decreased mortality.
  • 2 year old girl, previously well
  • Presents with 2 week history of looking pale, 3 day history of being "cranky" and refusing to walk and wanting to be carried around, 1 day history of petechial rash
  • WBC 38, Hgb 75, Plt 21, Neut 3.4, Blasts
  • Acute Lymphoblastic Leukemia (ALL)

    Cancer of the Blood Cells = Leukemia. Most common malignancy of childhood. WBC growing out of control – do not respond to body's stop signals. Involves the bone marrow (Where blood is made), lymph nodes, and the spleen. ALL >>> AML >> CML
  • Lymphomas

    Tumors of the lymph tissues (lymph nodes, thymus and spleen). Lymphoma is the second most common group of cancer in children. Two categories (Hodgkins and Non-Hodgkins). Sixty percent of lymphomas are non-Hodgkin's lymphomas. Approximately 17% of new cases of cancer.
  • Clinical Manifestations

    • Usually a very short duration of symptoms weeks to few months
    • Age 2-6 more common but can be in any age of child
    • Constitutional symptoms (fever, chills, weight loss)
    • Extramedullary infiltration (lymphadenopathy, gums inflamed, kidney or spleen involvement)
    • Bone marrow infiltration: normal cells can't grow
    • Cytopenia secondary to marrow failure (Neutrophils, Platelets, Red cells)
  • Urgent consult to PEDIATRIC oncology

    1. Admit to hospital
    2. IV hydration &medications to prevent tumour lysis
    3. Transfusion support if needed (Platelets, PRBC)
    4. IV Antibiotics if fevers or signs of infection
    5. Definitive Diagnosis (bone marrow & Lumbar puncture)
    6. Family Discussions
    7. Start therapy ASAP
  • PEDIATRIC BRAIN TUMOURS
  • Signs & Symptoms Depend on Location & Size

    • Headaches – especially in am or getting worse
    • Nausea or vomiting
    • Visual disturbance, hearing problems
    • Seizures, Abnormal eye movement
    • Slurred speech or Trouble swallowing
    • Difficulty with balance / walking /weakness
    • Confusion, irritability, Memory problems, Personality or behavior change, difficulty concentrating
  • Pediatric Brain Tumours

    • Posterior Fossa (60%): Medulloblastoma, Astrocytoma, Ependymoma, Diffuse intrinsic pontine glioma (DIPG), Atypical teratoid rhabdoid tumour (ATRT)
    • Cerebral Hemisphere (40%): Astrocytoma, Ganglioglioma, craniopharyngiomas, Supratentorial primitive neuroectodermal tumors (PNET), Germ cell tumors, Dysembryonic neuroepithelial tumors (DNET), Oligodendrogliomas & meningiomas
  • OTHER PEDIATRIC SOLID TUMOURS