Understanding Lymphadenopathy and Common Blood Disorders in Children

Posted on Aug 19, 2024 in Medicine & Health

Lymph Node Function

Lymphadenopathy

Causes

• Bacteria (Staphylococcus/Tuberculosis)
• Viruses (CMV)
• Protozoa
• Autoimmune (SLE/Rheumatoid Arthritis)
• Allergy
• Immune Response
• Inflammatory Cell Migration to Lymph Nodes (Macrophages + Neutrophils)
• Tumor Cell Infiltration

Lymph Node Changes in Lymphadenopathy

Diagnosis and Treatment

Lymph Node Biopsy in Children

• >2-3 cm for 2-3 weeks (in the absence of signs of infection)
• Enlarged Lower Cervical/Supracervical Lymph Nodes
• Lymph Nodes do not decrease in size within 5-6 weeks after treatment + symptoms of intoxication in addition to enlargement of liver or spleen
• X-ray findings in the mediastinum

Iron Deficiency Anemia

Degrees

• Mild – Hb 120-90 g/l
• Moderate – Hb 90-70 g/l
• Severe – Hb <70 g/l

Etiology

1. Deficiency in Production
2. Increased Demand (Low Birth Weight/Preterm)
3. Blood Loss (IBD/Extrusion of Fetal Blood into Mother)
4. Decreased Absorption (Celiac/Malabsorption/Postgastrectomy/IBD)

Clinical Features

• Mild (Asymptomatic)
• Anorexia
• Atrophic Glottis
• Pica (Geophagia)
• CNS (Irritability)
• Systolic Murmur

Diagnosis

• Decreased Hb
• Decreased RBC MCV/MCH/MCHC
• Elevated RDW
• Blood Smear (Hypochromic + Microcytic)
• Decreased Serum Iron

Treatment

I. Counseling

• No Cow’s Milk
• Iron in Cereal from 6 Months to 1 Year

II. Iron Supplements

• Ferrous Iron
• 3-7 mg/kg (3 times per day)
• Duration: 3-4 Months

• Parenteral Treatment if there is Bowel Disease
• Blood Transfusion in Severe Cases

Inherited Microspherocytosis

Forms (Jaundice/Anemia/Splenomegaly)

Diagnosis

1. Clinical Features and History
2. Hematologic Features

• Anemia – Mild to Moderate (may drop to 2-3 g/l)
• Decreased MCV, Increased MCHC, Increased RDW
• Reticulocytosis – 3-15%
• Blood Film – Microspherocytosis > 10%
• Coombs Test (-)
• Increased Red Cell Osmotic Fragility
• Increased Autohemolysis at 24 and 48 hours
• Bone Marrow – Normoblastic Hyperplasia; Increased Iron
• Raised Bilirubin, Mainly Indirect Reacting

Treatment

• Folic Acid Supplement (1 mg/day)
• Leucocyte-Depleted Packed Red Cell Transfusion
• Splenectomy for Moderate to Severe Cases (Severe Congenital Spherocytosis, Frequent Crises, Significant Splenomegaly)

Lymphadenopathy

Causes

• Immune Response to Infection
• Bacteria (Staphylococcus/Streptococcus/Mycobacterium Tuberculosis)
• Viruses
• Protozoa
• Spirochetes

Changes

Diagnosis

• History of the Disease and Clinical Work-Up
• Complete Blood Count, ESR
• Skin Tests – TB, Allergies
• Bacteriologic Tests
• Specific Serologic Tests
• Chest X-ray, CT Scan
• Ultrasound of the Abdominal Organs, CT Scan
• Lymph Node Biopsy

Treatment

• Bacterial: Antibiotics (10-14 days)
• Viral: None
• Abscess: Surgery

Lymph Node Biopsy Indications

• Lymph Node Increased in Size: >2-3 cm for 2-3 weeks (in the absence of signs of infection)
• Enlarged Lower Cervical or Supraclavicular Lymph Nodes
• Lymph Nodes do not decrease in size within 5-6 weeks after treatment + symptoms of intoxication in addition to enlargement of liver or spleen
• X-ray findings in the mediastinum

Immune Thrombocytopenic Purpura

General Information

• Autoimmune Thrombocytopenia
• The Most Common Acquired Bleeding Disorder in Children

Clinical Features (Depend on Platelet Count)

• > 50 x 10⁹/L: No Signs of Bleeding
• 30-50 x 10⁹/L: Mild Bruising, Important Bleeding After Trauma and Surgery
• < 30 x 10⁹/L: Spontaneous Bleeding and Bruising
• Bruising and Petechiae Appear Suddenly, Usually 1 to 3 Weeks Following a Viral Illness
• Bleeding in Dermal and Mucosal Areas
• Bleeding into the Skin (e.g., Lower Extremities)
• Gingival Bleeding, Epistaxis, Hematuria, and Prolonged Menses
• Conjunctival and Retinal Hemorrhage

Laboratory Tests

• CBC
• Bone Marrow Biopsy &/or Aspiration
• Bleeding Time (Rarely Performed)
• Platelet Aggregation
• Coagulation Test for Differentiation (Coombs’ Test)

Indications for Treatment

• If Platelets > 30 x 10⁹/L and No Signs of Active Bleeding: Observation (No Treatment)
• If Platelets < 30 x 10⁹/L and/or Signs of Active Bleeding: Treatment
• Active Hemorrhage
• Mucosal Bleeding

Treatment

Hemophilia

Degrees

• Severe – < 1% (Spontaneous Bleeding)
• Moderate – 1-5% (May Bleed Spontaneously, Bleeds Excessively After Surgery or Trauma)
• Mild – 5-20% (No Spontaneous Bleeding)

Clinical Features

• Most Serious: CNS, Pharyngeal
• Most Common: Joints (Knees, Elbows, Shoulders, Ankles, Hips). Repeated Hemarthroses Leads to Joint Damage
• Other: Urinary Tract Bleeding With or Without Trauma, Muscle Bleeds

Diagnosis

• Activated Prothrombin Time – Prolonged
• PTT and Platelet Count – Normal
• Specific Factor Assay: Factor VIII:C Decreased in Hemophilia A; Factor IX:C Decreased in Hemophilia B
• Factor VIII Levels Reflect Adult Levels at Birth
• Presence of Factor VIII or IX Inhibitors

Treatment

• Replace Missing Factors (VIII/IX)

Acute Leukemia

Types of Leukemia

1. Acute Lymphoblastic Leukemia (ALL) – Most Common Childhood Leukemia
2. Acute Myeloid Leukemia (AML) – 15%
3. Chronic Myelogenous Leukemia (CML) – <5%

Causes

• Oncogene
• Radiation Exposure
• Associated with Down Syndrome

Clinical Features

• Intoxication (Fever, Lassitude, Pallor)
• Hematological Effects (Anemia, Neutropenia, Thrombocytopenia)
• Lymphoid System (Lymphadenopathy, Splenomegaly)
• CNS/Skin/Hepatomegaly

Diagnosis and Treatment

Specifics of Childhood Tumors

Symptoms

• Intoxication Syndrome
• Bone Pain
• Frequent Infections
• Headaches with Nausea, Especially in the Morning
• Hemorrhagic Syndrome
• Seizures, Disorders of Balance
• Disorders of Vision
• Endocrine Disorders
• Systemic Disease
• Rapid Growth
• More Frequent Malignant Tumors (Sarcomas) Than Adults

Complex Treatment

• Surgery (Biopsy)
• Chemotherapy
• Radiation Therapy
• Autologous Stem Cell Transplantation