Musculoskeletal, Hematologic, and Oncologic Conditions
In this unit, you cover various musculoskeletal, hematologic, and oncologic conditions in children and management plans. In your initial discussion, please select a topic and include the following:
Pathophysiology
Epidemiology
Physical exam findings
Differential diagnoses and rationale
Management plan to include diagnostic testing, medications if applicable, follow-up plans, and referrals if needed
Topics may include:
Microcytic anemia
Hemolytic anemia
Sickle cell anemia and trait
Hereditary spherocytosis
Idiopathic thrombocytopenic purpura
Hemophilias
Leukemia
Non-Hodgkin lymphoma
Hodgkin lymphoma
Brachial plexus injury
Clavicle fracture
Costochondritis
Scoliosis
Developmental dysplasia of the hip
Legg-Calve-Perthes disease
Slipped capital femoral epiphysis
Genu varum, genu valgum
Osgood-Schlatter disease
Subluxation of the radial head
Sample Solution
Topic: Sickle Cell Anemia and Trait
Pathophysiology:
Sickle cell anemia is a genetic disorder characterized by an abnormality in the hemoglobin molecule (HbS). Instead of normal round red blood cells (RBCs), HbS causes RBCs to become sickle-shaped. These sickle cells are fragile, inflexible, and prone to clumping together. This clumping blocks blood flow, leading to tissue ischemia, pain crises, and organ damage.
Full Answer Section
- Iron Deficiency Anemia: Similar symptoms of pallor and fatigue, but iron studies will differentiate between the two conditions.
- Thalassemia: Another genetic blood disorder presenting with anemia, but specific blood tests can distinguish between sickle cell and thalassemia.
- Vitamin Deficiencies: Deficiencies in vitamin B12 or folate can cause anemia, but history and blood tests will help differentiate.
Management Plan:
- Hydration: Increased fluid intake to prevent sickling.
- Pain Management: Managing pain during acute crises with medications like opioids and nonsteroidal anti-inflammatory drugs (NSAIDs).
- Hydroxyurea: This medication reduces the formation of sickle cells and may decrease the frequency of crises.
- Blood Transfusions: Used in severe cases of anemia or to prevent complications like stroke.
- Folic Acid Supplementation: Essential for red blood cell production and reduces the risk of birth defects in pregnant women with sickle cell trait.
- Pneumococcal Vaccination: Recommended to prevent serious infections.
- Bone Marrow Transplant: A potentially curative option but carries significant risks.
Diagnostic Testing:
- Complete Blood Count (CBC): Low hemoglobin and hematocrit (percentage of red blood cells in blood) are indicative of anemia.
- Peripheral Blood Smear: Shows characteristic sickled red blood cells.
- Hemoglobin Electrophoresis: Confirms the presence of abnormal hemoglobin S.
- Newborn Screening: Most states screen newborns for sickle cell disease.
Follow-up Plans:
- Regular checkups with a hematologist to monitor for complications and treatment response.
- Annual vaccinations.
- Pre-conception counseling for women with sickle cell trait.
Referrals:
- Hematologist: A specialist in blood disorders for diagnosis and ongoing management.
- Pain specialist: For management of severe pain crises.
- Genetic counselor: For pre-conception counseling and family planning discussions.