8/20/2019 Folate Deficiency Anemia
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Morning Report 8/28
Hannah Dufey, MDPGY3
8/20/2019 Folate Deficiency Anemia
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'
8/20/2019 Folate Deficiency Anemia
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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
8/20/2019 Folate Deficiency Anemia
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Physi$a" ).a!
T 37'7' HR 6' RR :' 1P 9/:' +a;2 6::< on (asa" Cannu"a at 6 =PM'>)?GHT - '9@g, A7
8/20/2019 Folate Deficiency Anemia
5/14
Di-erential dia'n!%i%8 !onth o"% &ith #o!iting, %iarrhea, %e$rease%energy an% pa""or
8/20/2019 Folate Deficiency Anemia
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$rine
Hypothy%roi%is!
6
8/20/2019 Folate Deficiency Anemia
7/14
Diferentia" %iagnosis
?D
1a$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, $hiari!a"or!ationB
7
8/20/2019 Folate Deficiency Anemia
8/14
?nitia" &or0-up in )D
Co!p"ete Meta*o"i$ 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
8/20/2019 Folate Deficiency Anemia
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
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UpT!Date
Al'!rit&"?n arti$"e Approach to the child with anemia—Diagnostic approach to isolated anemia inchildren: Morphologic classifcation
8/20/2019 Folate Deficiency Anemia
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o"ate DeI$ien$y
ne!ia
11
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;!lateDe
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;!lateDe
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Treat"ent
o"ate supp"e!entation
14
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