Peds Heme-Oncology

Clinical Values

Normal HgbNormal Hct
2 month old9-1428-42
6-12 yr old10-1332-40

Acquired congenital hemolytic anemia

  • -hemolytic disease of the newborn (HDN)
  • -maternal antibodies directed against fetal antigens
  • -fetus is RH+ and mom is RH-
  • -we get antigens against it from mom which causes hemolysis of newborn’s RBC
  • -fairly rare, less than 10% of the time we get incompatibilities of RH between mom and baby
  • -it’s not the first time around that its a problem, its the second time because at that point, mom has developed antibodies
  • -we give the mom Rhogam to prevent mom from making antibodies so that if she does get pregnant again, the baby won’t get this
  • -aka erythroblastosis fetalis
  • -babies are very jaundice and anemic (moms antibodies have attacked blood cells)
  • -hyperbilirubinemia: bilirubin levels are elevated bc of dead RBC

Disseminated intravascular coagulopathy


Hemolytic disease of the newborn


Iron deficiency anemia

  • Etiology:
    • -most common thing we will see when talking about blood disorders of childhood/infancy
    • -from lack of iron intake or blood loss (lose iron stores)
    • -babies can’t tell us when something hurts so we have to look for irritability weakness, decreased activity from what they usually are, lack of interest from playing because they are tired

Idiopathic thrombocytopenic purpura (ITP)


  • Path:
    • -most common malignancy of childhood
    • -most of the time when a kid has leukemia, it’s ALL (acute lymphoblastic leukemia); the remainder is AML (acute myelogenous leukemia)
    • -5-year survival rate is 80% from tx
    • -having leukemia as a child puts you at higher risk for cancer as an adult
  • RIsk:
    • -down syndrome is at risk for leukemia
  • Presentation:
    • -children with leukemia will be tired, bruise for no reason, have intermittent fevers

Acute lymphocytic leukemia (ALL)

Acute myelogenous leukemia (AML)


Lymphadenopathy Evaluation

Myeloproliferative Disorders

Sickle cell anemia


  • Path:
  • Population Risk:
  • Types: 
    • -alpha thalassemia:
      • alpha chains are affected
    • -beta-thalassemia:
      • beta chains are affected
    • -if it’s major: you have both recessive chains
    • -if its minor: you only got one copy
    • -beta-thalassemia major= life-threatening
    • -alpha-thalassemia major= FATAL (usually die of HF)
    • -beta and alpha-thalassemia minor= both serious but aren’t always fatal
    • -in all of these there’s a problem with hemoglobin so they end up with anemia bc they can’t synthesize Hgb fast enough
  • Presentation:
    • -will have anemia symptoms
  • Management:
    • -blood transfusions to treat anemia, and may get iron overload (can cause heart and liver problems and liver failure and cancer)
    • -if they have beta-thalassemia major and don’t get treated they will usually die by 2 years old
    • -treat with regular lifetime blood transfusions (chelation treats iron overload, preventing them from getting liver failure from excess iron)
    • -may take out spleen bc it gets very enlarged from all defective RBC


Hematopoiesis– early production of blood cells
Hematopoiesis in the fetus begins in where?– the liver and spleen until 5 months gestation
– then the bone marrow takes over
Where do we get bone marrow aspirations from?– pelvis; hip
– superior posterior iliac crest
– may have to test both sides
After birth, the liver produces?– blood clotting factors (most)
– prothrombin
The proper liver function requires what? Where does this come from?– Vitamin K
– blood and food such as green leafy vegetables and fish
Vitamin K is essential to developing……?– clotting factors VII, IX, X, and prothrombin
What is the spleen responsible for in regards to RBCs?– balancing the amount of RBCs
– stores and destroys RBCs if needed
Petechiae– little red or purple pin point hemorrhages under the skin
– can see in variety of different diagnoses
Petechiae most often has to do with what? Who has this a lot?– platelet dysfunction
– acute leukemia patients
Ecchymosis– greater areas of pooling of blood under skin (very dramatic bruising)