Folate Deficiency Anemia

8/20/2019 Folate Deficiency Anemia

1/14

Morning Report 8/28

Hannah Dufey, MDPGY3


2/14

CaseHPI: This 7M 29D e!a"e pre#ious"y hea"thy $hi"% presenting &ith #o!itingan% %e$rease% energy'

(ine %ays prior to a%!ission )( *egan #o!iting' +he &ou"% on"y #o!it a e&ti!es per %ay'

Her #o!iting has *een !u$ousy an% o$$asiona""y has appeare% ye""o& *utnon-*"oo%y'

+he a"so %e#e"ope% &atery, %iarrhea aroun% the sa!e ti!e her #o!itingstarte%'

+i. %ays prior to a%!ission her #o!iting *e$a!e !ore reuent'

+he a"so see!e% tire% an% ha% %e$rease% po inta0e'

Her stoo" output %e$rease% an% stoo"s ha#e inter!ittent"y *een !oreor!e%'

+he ha% inter!ittent ta$ti"e e#ers o#er the "ast &ee0'

+he has *een ha#ing a "east 3 &et %iapers per %ay'

The %ay o a%!ission she &as #o!iting !ore reuent"y an% appeare% #ery

pa"e so $aregi#ers %e$i%e% to ta0e her to the )D'


3/14

History

PAST MEDICAL HISTORY:

1irth h. ter!, (+D, no $o!p"i$ations(o !a4or or $hroni$ i""nesses

PAST SURGICAL HISTORY:

(o surgeries

IMMUNIZATIONS:

5p to %ate

MEDICATIONS:

(one regu"ar"y

ALLERGIES:

(o 0no&n %rug a""ergies


4/14

Physi$a" ).a!

T 37'7' HR 6' RR :' 1P 9/:' +a;2 6::< on (asa" Cannu"a at 6 =PM'>)?GHT - '9@g, A7


5/14

Di-erential dia'n!%i%8 !onth o"% &ith #o!iting, %iarrhea, %e$rease%energy an% pa""or


6/14

Diferentia" %iagnosis

He!e/;n$

==, M=,"y!pho!a

ne!ia- H5+,o"ate, iron or 162%e, perni$iousane!ia,autoi!!unehe!o"yti$ %isease,

here%itarysphero$ytosis,

(euro*"asto!a

C

CHD, CMP

Resp

Congenita"%iaphrag!ati$hernia, CPM

)n%o$rine

Hypothy%roi%is!

6


7/14

Diferentia" %iagnosis

?D

1a$teria" Astrep,staphB sepsis,*a$teria" pneu!onia

Par#o#irus1ron$hio"itis

ire!ia, a%eno#irus,entero#irus

5T?, pye"onephritis

Giar%ia,$ryptospori%iu!

)H)C

G?

Ce"ia$ %isease

+e#ere oo% a""ergies

?ntussus$eption

?1D+u$rase iso!a"tase%eI$ien$y

Pan$reati$ insuJ$ien$y

(euro

?n$rease% ?CP A!ass,hy%ro$epha"us, $hiari!a"or!ationB

7


8/14

?nitia" &or0-up in )D

Co!p"ete Meta*o"i$ Pane" (a K 637, . / *, C" K 666, C;2 K 7, 0UN / (1,Cr K :'32, G"u$ose K 6:7, Ca K 8', Protein K '7, "*u!in K 3'7, 1i"iru*in K2'9, "0' Phos' K 63, =T K 6, +T K 2

@ '9

LDH 2314Dire$t *i"i :'

?n%ire$t *i"i 2'

C1C >1C 9'7, H' (56, H$t 754, Plt 44 MC8 292, RD> 8:'

?!aging

CFR

in%ings !ost suggesti#e o p#l"!nar ede"a it& %"all ple#ral e-#%i!n%'?!aging In%ings are not typi$a" or #ira"or *a$teria" ine$tion' Corre"ation &ith 0no&n $"ini$a" inor!ation &ou"% *ehe"pu"' 8


9/14

Periphera" *"oo% s!ear!a$ro$ytosis,thro!*o$ytopenia,s$histo$ytes, 3< *"asts

162- 28, Ho!o$ysteine "e#e"s

, !ethy"!a"oni$ a$i% :'63

o"ate

Coo!*s testing negati#e per*"oo% *an0

+too" $u"ture nor!a" stoo"ora )H)C an% par#o negati#e

Reti$ < 6'2o"ate an% 162 6'9

9


10/14

UpT!Date

Al'!rit&"?n arti$"e Approach to the child with anemia—Diagnostic approach to isolated anemia inchildren: Morphologic classifcation


11/14

o"ate DeI$ien$y

ne!ia

11


12/14

;!lateDe


13/14

;!lateDe


14/14

Treat"ent

o"ate supp"e!entation

14

Documents

Folate Deficiency Anemia