Abnormal CBCs - Yale University：异常CBCS -耶鲁大学.pptVIP

Teacher’s Notes: Take a detailed history of blood loss: how much blood?, how frequently?, mixed in stool/on outside of stool/bright red blood per rectum, are there any other sites of bleeding/bruising?. Is there a history of constipation?. Take a detailed dietary history: length of breastfeeding?, timing of introduction of cow’s milk and quantity?, any other types of milk that the child has been given (i.e. goat’s milk), what types of other foods does the child eat? Any pica (eating dirt/clay) or pagophagia (eating ice)? Was the child premature? Has there been a history of jaundice? Family history of abdominal surgeries ? (i.e. splenectomy, cholecystectomy) Are there any known lead exposures? * Teacher’s Notes: Classification of anemia (see next slide) Without additional testing, is there a way to predict what type of anemia using the cbc indices? Calculate the Mentzer Index = MCV/RBC= 22.6. Typically 13 c/w iron deficiency anemia (small cells and small number produced) vs. Mentzer 13 c/w Thalassemia, small cells, but making large number. The red cell distribution width (RDW) can also help discriminate between iron deficiency anemia (IDA) and Thalassemia. Increasing RDW can be the earliest detectable laboratory change in IDA. An RDW14 supports the diagnosis of IDA. * Teacher’s Notes: Anemias can be classified based on morphology. Mean Corpuscular Volume (RBC size) has been used, see chart above. Normal values for MCV depend on age. Also, remember that MCV can be influenced by reticulocytosis. * Teacher’s Notes: What’s normal? The diameter of the normal red cell is about the size of the nucleus of lymphocyte. The red cell central pallor is about one-third of its diameter. * Teacher’s Notes: Reticulocyte count can be misleading in anemia since it is a percentage, rather than an absolute count. You should calculate the reticulocyte index. * Teacher’s Notes: Additional history revealed cow’s milk intake ~25-30oz/day, low intake of iron rich