I’d make the child 13 to 17 years of age so head circumference would not be a factor, but it’s your choice. I have ploaded a file wk3 a 3 to give you an idea as to what she is looking for. When diagnosing a child with anemia, what do you want to consider? Family history and ethnicity are essential. In this case, the infant is Asian and has a family history of thalassemia. The complete blood count results are as follows: Hemoglobin=8.0 g/dL Hematocrit=25% Mean corpuscular volume (MCV)=65 Mean corpuscular hemoglobin (MCH)=29 pg/cell Red blood cell distribution width (RDW)=12% Red blood cell (RBC) count=12 White blood cell (WBC) count=1.0 Platelet count=150,000/mm3 The other essential piece of this puzzle is the dietary history. The infant consumes a lot of irondeficient milk. The differential diagnoses for this infant would be thalassemia, iron-deficiency anemia, and lead poisoning. How can the MCV and the RDW help you? Supplemental Lectures Page 3 of 4 Practicum III: Family Health: Pediatrics ©2016 South University 3 The MCV refers to the average volume of RBC and reflects the size of the RBC. A low MCV suggests small RBCs (microcytosis). The RDW is a derived measure of RBC size and variation (RBC/MCV = RDW). Additional diagnostic helpers include the Mentzer index, which is the MCVto-RBC ratio. This index differentiates anemias with uniformly small RBC from those producing variably sized cells (MCV/RBC=X). In iron-deficiency anemia, the Mentzer index will be elevated (greater than 13). The Mentzer index in beta-thalassemia is less than 13. In this case, 65/1=65, so the diagnosis is iron-deficiency anemia. This is not an uncommon finding in primary care. Be certain, particularly with children in this age group who have met their nadir for hemoglobin, that you specifically address their dietary intake. Daniel should be started on iron supplements. Follow-up should be done in about six weeks. Guidance on iron supplementation intake should encourage consumption of iron with juice rich in vitamin C and not with milk. In addition, encourage cleaning of infants’ teeth after administration of iron supplement so that it does not discolor the teeth. What are the indicators in our history and physical examination that led to our clinical decision making? When it comes to ordering diagnostic studies, you should be capable of defending your clinical decision making as well as of interpreting the results. Clinical signs of bleeding and blood disorders include abnormal patterns of bruising, petechiae, bleeding gums, prolonged menses, purpura, and paleness. Your most valuable information is the history and the most valuable laboratory studies are the complete blood count and prothrombin time/partial thromboplastin time (PT/PTT).
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