Vitamin K Deficiency
The normal full-term infant is born with levels of factors II, VII, IX, and X that are low by adult standards Table 11-3 . The coagulation factors fall even lower over the first few days of life, reaching their nadir on about the third day. This is due to the low body stores of vitamin K at birth. As little as 25 g vitamin K can prevent this fall in activity of the vitamin K-dependent clotting factors. The vitamin K content of PTT, activitated partial thromboplastin time PT, prothrombin time...
Hematologic Manifestations Of Diseases Of Various Organs
The major hematologic complications of cardiac disease are discussed in the following subsections. Hemolysis occurs with prosthetic valves or synthetic patches utilized for correction of cardiac defects particularly when there is failure of endothelialization . It has the following characteristics Hemolysis is secondary to fragmentation of the red cells as they are damaged against a distorted vascular surface. Hemolysis is intravascular and may be associated with hemoglobinemia and...
Anaphylactoid Purpura
Henoch-Schonlein purpura is nonthrombocytopenic vascular purpura. The pur-puric eruption differs considerably from that due to thrombocytopenia in that lesions are maculopapular, initially resembling urticaria because of edema and perivascular infiltration and later becoming erythematous, with central areas of hemorrhage that finally fade to brown because of denaturation of the extravasated hemoglobin. The rash appears on the buttocks and on the extensor surfaces of the arms and lower legs....
Recurrent Or Refractory Disease
For patients with recurrent and or refractory disease, alternative treatment has not been standardized. Patients with recurrent disease, that is, disease that reappears Table 22-10. Risk Groups According to the Histiocyte Society LCH-III Trial Group 1 Multisystem Risk Patients Multisystem patients with involvement of one or more risk organs i.e., hematopoietic system, liver, spleen, or lungs . Group 2 Multisystem Low-Risk Patients Multisystem patients with multiple organs involved but without...
AdvancedStage BL BLL and DLCL Including BCell Acute Lymphoblastic Leukemia and
This category includes advanced-stage BL, BLL, and DLCL including B-cell acute lymphoblastic leukemia ALL and B-cell NHL with marrow involvement with or without CNS involvement. Patient eligibility criteria Greater than 25 lymphoblasts present in bone marrow. CNS involvement demonstrated by any of the following Presence of any L3 lymphoblasts in the CSF Cranial nerve palsy without other explanation Spinal cord compression Parameningeal disease Intracerebral mass Table 16-7. Protocol for...
Mtx Hc
15 mg m2 PO q6h x 12 doses6 15 mg ITa 250 mg m2 dose IV q12h 60 mg m2 IV 6-h infusion 60 mg m2 day PO or IV 5 g kg day SQ 3 g m2 over 3 hours IV 15 mg m2 PO q6h x 12 doses6 100 mg m2 day 24 continuous IV infusion 15 mg IT 15 mg IT 30 mg IT 5 g kg day SQ after cyclophosphamide Days 1-5 Day 7 until ANC gt 3000 mm3 aAge-adjusted doses for intrathecal use
Normal or Increased Megakaryocytes in the Marrow Megakaryocyte Thrombocytopenia
Neonatal Idiopathic Autoimmune Purpura Passive Transfer of Platelet Antibody from Mother Pregnant women with ITP are at a 50 risk for delivering thrombocytopenic infants, whether or not the mother is thrombocytopenic during pregnancy or at the time of delivery. This results from the transplacental passage of maternal IgG autoantibod-ies into the fetal circulation, with destruction of fetal platelets. Although self-limiting, neonatal ITP NITP may last for several weeks. Infants with severe...
Metabolic and Endocrine Emergencies
A total white cell count greater than 100,000 mm3 is considered hyperleukocytosis. It is seen in 9-13 of children with acute lymphocytic leukemia ALL and 5-22 of children with acute myeloid leukemia AML at presentation. It occurs in almost all children with chronic myeloid leukemia. Hyperleukocytosis leads to increased blood viscosity and emboli in the microcirculation. Hemorrhage and leukostasis leading to intracranial hemorrhage or thrombosis, pulmonary hemorrhage, and leukostasis are far...
Pathogenesis of Central Nervous System Toxicity
Altered capillary wall permeability, resulting in alterations in cerebral blood flow Primary damage to glial cells, especially oligodendroglia Demyelination of glial tissue Focal white matter destruction Impaired neuronal differentiation, including dendritic formation and synapto-genesis. The pathogenesis of chemotherapy-induced central nervous system CNS toxicity is not well understood. In addition to damage to the glial and capillary tissue, the neu-rotransmitter function of the brain may...
Ependymomas
Fifty percent of all ependymomas occur during childhood and adolescence and constitute approximately 9 of all primary childhood CNS tumors. The tumors occur either infratentorially or supratentorially. The fourth ventricle is the most common location. Ependymomas can also occur in the spinal cord and account for 25 of spinal cord tumors. Obstructive hydrocephalus is the most common presenting condition. Total removal of these tumors is difficult to accomplish, especially in tumors originating...
Info Mts
Assays quoted are biologic unless otherwise specified. SE, standard error NA, not available. Adult levels attained prenatally. 'Values vary among laboratories, depending on reagents employed. From Hathaway WE. The bleeding newborn. Semin Hematol 1975 12 175, and from Gross SJ, Stuart MJ. Hemostasis in the premature infant. Clin Perinatal 1977 4 260, with permission. Assays quoted are biologic unless otherwise specified. SE, standard error NA, not available. Adult levels attained prenatally....
Info Gzi
The true incidence of ITP is unknown because the disease is often transient. The estimated incidence is about 1 in 10,000 children per year. Figure 10-1 shows the possible pathophysiology of immune thrombocytopenia. Platelet Antibodies ITP is caused by autoantibodies against platelet membrane glycoproteins such as GP Ilb IIIa, GP Ib IX, GP Ia IIa, GP V, and GP IV. These antibodies are detected by the antigen capture method either on the platelets or in the plasma of patients with ITP. However,...
Treatment Kge
Treatment of HD in children usually consists of combined modality treatment CMT , consisting of chemotherapy and low-dose 20-25 Gy involved field radiotherapy IFRT Table 15-11 . Standard chemotherapy in HD is six cycles of alternating MOPP or MOPP derivatives and ABVD or ABVD derivatives see Tables 15-12 and 15-13 . In selected patients, chemotherapy alone may be curative treatment. Non-cross-resistant chemotherapy alone without radiation therapy prevents Radiation-induced growth complications...
Neutrophil Production and Destruction in Newborn Infants
Neutrophil production Using soluble Fc receptor III sFcR III as a surrogate marker for estimation of total neutrophil mass, it has been shown that newborn infants born before 32 weeks of gestation have 20 of the adult neutrophil mass. Normal levels of neutrophil mass are attained at 4 weeks of age in premature neonates. However, full-term neonates have neutrophil stores within the normal adult range. Chemotaxis Decreased in newborn infants. Normal chemotactic ability is attained at 2 weeks of...
Nadp
Pyruvate kinase PK is an enzyme active in the penultimate conversion in the Embden-Meyerhof pathway. Although deficiency is rare, it is the most common enzyme abnormality in the Embden-Meyerhof pathway. 1. Autosomal recessive inheritance 2. Significant hemolysis seen in homozygotes 3. Found predominantly in people of northern European origin 4. Deficiency not simply quantitative probably often reflects the production of PK variants with abnormal characteristics. 1. Defective red cell glycolysis...
Glutathione Synthetase Deficiency
4. Severe metabolic acidosis as a result of increased levels of 5-oxoproline, a metabolite formed during the biochemical steps of glutathione synthesis 5. Hemolysis induced by oxidant stress b. Use of vitamin E, 400 units per day, to treat hemolysis and infections c. Antibiotic therapy for infections 7. Respiratory burst is normal in neutrophils, and phagocytosis abnormal only in patients with severe deficiency of glutathione synthetase.
Malignant Histiocytic Disorders in Children
Table 22-2 shows a contemporary classification of malignant histiocytic disorders, based on recently available phenotypic and genotypic data. Figure 22-2 shows the nosology for malignant histiocytic disorders in children. general term for cells of the mononuclear phagocytic system Antigen-presenting cells dendritic cells Dendritic cell-related histiocytic sarcoma localized sarcoma or disseminated Follicular dendritic cell sarcoma Dermal dendrocyte sarcoma Monocytic interdigitating dendritic...
Q
Quebec platelet disorder QPD , 286-287 R Radionuclide scanning, Hodgkin disease, 470 Radiotherapy cardiovascular system, late effects of childhood cancer, 756 central nervous system, late effects of childhood cancer, 759-762, 761t endocrine system, late effects of childhood cancer, 764-766, 7651, 767t hepatoma, 666 musculoskeletal system, late effects of childhood cancer, 749, 753, 753t Non-Hodgkin lymphoma, 508 ovarian dysgerminoma, 653-654 regimens for initial cycle of, 7411 respiratory...
Info Ivy
Severe hemorrhage only following moderate to severe trauma or surgery Gynecologic and obstetric hemorrhage common, other symptoms depend on plasma factor level. Table 11-12. Common Sites of Hemorrhage in Hemophilia Hemarthrosis Intramuscular hematoma Hematuria Mucous membrane hemorrhage Mouth Dental Epistaxis Gastrointestinal High-risk hemorrhage Central nervous system Intracranial Intraspinal Retropharyngeal Retroperitoneal Hemorrhage causing compartment syndrome nerve compression Femoral...
Info Qhm
From Janka G, Imashuku S, Elinder G, Schneider M, Henter JJ. Infection and malignancy associated hemophagocytic syndromes. Hematol Oncol Clin North Am 1998 12 435-43. From Janka G, Imashuku S, Elinder G, Schneider M, Henter JJ. Infection and malignancy associated hemophagocytic syndromes. Hematol Oncol Clin North Am 1998 12 435-43. Table 22-16. Malignancies Associated with the Development of Hemophagocytic Syndromes 1. Development of a hemophagocytic syndrome before and or during the treatment...
Mediastinum
The frequency of involvement of the mediastinum is 26 . Patients may present with superior vena cava SVC syndrome distended neck veins, edema of the neck and face, marked dyspnea, orthopnea, dizziness, headache, dysphagia, epistaxis, altered mental status, and syncope associated with bending . In this condition a large anterior mediastinal mass compresses the SVC because of the thinness of its wall and its close apposition to the vertebral column. The rapid growth of the mass does not permit...
Hemostasis in the Newborn
Table 11-3 lists the hemostatic values in healthy preterm and term infants. Plasma Factors In comparison with hemostatic mechanisms in older children and adults, that of the newborn infants is not uniformly developed. In newborns plasminogen levels are only 50 of adult values and a2AP levels are 80 of adult values, whereas PAI-1 and t-PA levels are significantly increased over adult values. The increased plasma levels of t-PA and PAI-1 in newborns on day 1 of life are in marked contrast to...
Differential Diagnosis
Although hypochromic anemia in children is usually due to iron deficiency, it is not necessarily attributable to this condition. A list of the causes of hypochromia is given in Table 3-9. In some of these cases, there is an inability to synthesize hemoglobin normally in spite of adequate iron e.g., thalassemia, lead poisoning . In unusual or obscure cases of hypochromic anemia, it is necessary to do additional Table 3-8. Diagnostic Tests for Iron-Deficiency Anemia a. Hypochromic microcytic red...
Adm Mtx Cdp Ifo Adm Mtx Cdp Ifo Adm Mtx Cdp Ifo Adm Mtx
0 3 4 7 9 12 13 16 18 21 22 25 27 30 weeks ADM 45 mg m2 day as an 8 h infusion for 2 consecutive days CDP 150 mg m2 as a 72 h continuous infusion IFO 2 g m2 day as a 1 h infusion for 5 consecutive days. In patients with localized disease and total necrosis the last 3 cycles of chemotherapy were omitted. Fig. 21-5. Chemotherapy regimen as per Rizzoli's 4th protocol. From Bacci G, Briccoli A, Ferrari S, Longhi A, Mercuri M, Capanna R, Donati D, Lari S, Forni C, DePaolis M. Neoadjuvant...
Autoimmune Lymphoproliferative Syndrome CanaleSmith Syndrome
Autoimmune lymphoproliferative syndrome ALPS is characterized by Chronic splenomegaly can result in hypersplenism. Lymphadenopathy usually involves cervical and axillary lymph nodes may undergo waxing and waning of the severity of enlargement other peripheral and intracavitary lymph nodes may also be enlarged lymph nodes histologi-cally benign. Significant reduction in lymph node size occurs during certain viral and bacterial infections. Expansion of a p, CD3 , CD4-, CD8- T cells, known as...
aThalassemias
The major syndromes resulting from decreased a-chain synthesis are listed in Table 7-23. a-Thalassemia may present as silent carrier, thalassemia trait, hemoglobin H disease, or hydrops fetalis. Hemoglobin H disease is clinically milder than homozygous P-thalassemia and does not require a hypertransfusion protocol. Hydrops fetalis is not compatible with life and presents with intrauterine or neonatal death, though some babies have survived with fetal packed red blood cell transfusions when...
Nonidiopathic Eosinophilia
Eosinophilia, for which a cause is ascertained, can be clonal or reactive. Primary Clonal Eosinophilic Disorders The primary clonal eosinophilic disorders include eosinophilic leukemias of exclusively eosinophilic lineage, for example, acute eosinophilic leukemia and chronic eosinophilic leukemia also known as myeloproliferative variant of idiopathic hyper-eosinophilic syndrome . The following karyotypic abnormalities associated with chronic eosinophilic leukemia have been reported The majority...
Mediastinal Adenopathy 60 of All Cases
The term mediastinal adenopathy includes the following nodal subgroups Prevascular, aortopulmonary Preauricular Occipital Post. Cervical Ant. Cervical Supraclavicular Preauricular Occipital Post. Cervical Ant. Cervical Supraclavicular Fig. 15-1. Lymph node regions involved in Hodgkin disease. From Thompson EI. Hodgkin's disease. In Fernbach DJ, Vietti TJ, editors. Clinical Pediatric Oncology. 4th ed. St. Louis Mosby, 1991 355-75, with permission. Fig. 15-1. Lymph node regions involved in...
Idiopathic Hypereosinophilic Syndrome
Idiopathic hypereosinophilic syndrome HES includes a heterogeneous group of disorders defined by 1. A persistent eosinophilia of gt 1500 mm3 for longer than 6 months 2. Absence of evidence of known causes of eosinophilia despite a comprehensive workup for such causes Idiopathic hypereosinophilic syndrome HES Eosinophilic leukemias, i.e., eosinophils being part of malignant clone Eosinophilia associated with noneosinophilic clonal disorders as a result of eosinopoietic cytokines released by...
I Flb
Rare miscellaneous causes Hexokinase deficiency Galactosemia Blood loss Iatrogenic sampling Fetomaternal fetoplacental Cord problems Twin to twin Internal hemorrhage Hereditary spherocytosis Hereditary elliptocytosis Hereditary stomatocytosis Infantile pyknocytosis Pyruvate kinase deficiency G6PD deficiency Disseminated intravascular Fig. 2-4. Approach to the diagnosis of anemia in the newborn. Table 2-6. Clinical and Laboratory Evaluation of Anemia in the Newborn Complete blood count...
Angioimmunoblastic Lymphadenopathy with Dysproteinemia
Manifestations of the clinicopathological syndrome of angioimmunoblastic lymphadenopathy with dysproteinemia AILD include Generalized lymphadenopathy 80 Fever 70 , malaise, weight loss, polyarthralgia Quantitative changes in serum proteins polyclonal hypergammaglobulinemia, 70 hypocomplementemia Autoantibodies circulating immune complexes, anti-smooth muscle antibody Pulmonary infiltrates, pleural effusions Hemolytic anemia often Coombs' positive . Diagnosis The lymph node shows architectural...
Eosinophils
Table 9-12 lists the nonclonal reactive causes of eosinophilia, and Figure 9-2 shows the nonclonal reactive and clonal causes of eosinophilia. Table 9-12. Nonclonal Reactive Causes of Eosinophilia Asthma, hay fever, urticaria, drug hypersensitivity Immunologic disorders Omenn syndrome severe combined immunodeficiency and eosinophilia Skin disorders Eczema, scabies, erythema toxicum, dermatitis herpetiformis, angioneurotic edema, pemphigus Parasitic infestation Helminthic Ascaris lumbricoides,...
Info Hpg
Normal hemoglobin is taken from Appendix 1 Blood volume is 80 mL kg or 40 mL lb body weight Multiplication by 3.4 is done to convert grams of hemoglobin into milligrams of iron The factor of 1.5 provides extra iron to replace depleted tissue stores Iron-dextran complex provides 50 mg elemental iron mL. Staining at the site of intramuscular injection may occur, especially in cases in which the solution is accidentally administered into the superficial tissues. Staining is of a transient type,...
Treatment of Recurrent Retinoblastoma
The prognosis for a patient with recurrent or progressive retinoblastoma depends on the site and extent of the recurrence or progression. Responses as high as 85 have been reported following treatment with etoposide and carboplatin. If the recurrence or progression of retinoblastoma is confined to the eye and is small, the prognosis for sight and survival may be excellent with local ophthalmic therapy only. If the recurrence or progression is confined to the eye but is extensive, the prognosis...
HighRisk Group
The high-risk group Table 18-8 consists of patients with 1. INSS stage 2A, 2B, older than 1 year, amplified MYCN, and unfavorable Shimada pathology 2. INSS stage 3, younger than 1 year, amplified MYCN, and favorable or unfavorable Shimada histology 3. INSS stage 3, older than 1 year, nonamplified MYCN, and unfavorable Shimada histology 4. INSS stage 3, older than 1 year, amplified MYCN, with favorable or unfavorable Shimada histology 5. INSS stage 4, younger than 1 year, amplified MYCN, and...
Focal versus Diffuse Anaplasia
The criteria for distinguishing focal from diffuse anaplasia are dependent on the distribution of anaplasia. Focal anaplasia requires that anaplastic nuclear changes be confined to sharply restricted foci within the primary tumor. This definition restricts focal anaplasia to one or a few discrete loci within the primary tumor and with no anaplasia or marked nuclear atypia elsewhere. A diagnosis of diffuse anaplasia requires the following characteristics Anaplasia in any extrarenal site,...
Diagnosis
The age of presentation may help to focus on the most likely diagnosis Table 4-8 . a. Hemoglobin Usually reduced, may be marked. b. Red cell indices MCV increased for age and may be raised to levels of 110-140 fL MCHC normal. c. Red cell distribution width RDW Increased. d. Blood smear Many macrocytes and macro-ovalocytes marked anisocytosis and poikilocytosis presence of Cabot rings, Howell-Jolly bodies, and punctate basophilia. 2. White blood cell count Reduced to 1500-4000 mm3 neutrophils...
Chronic Benign Neutropenia
1. This is the most common form of neutropenia in infants under 4 years of age. The rate of infection decreases with age. 2. Ninety percent of cases occur before 14 months of age. 3. The clinical course is variable, ranging from benign to life threatening. Patients with an ANC greater than 400 mm3 do not have a higher incidence of infection than normal children. Day-to-day variations occur in the white cell counts. The ANC is usually less than 500 mm3. The bone marrow shows myeloid hyperpla-sia...
Avascular Necrosis Hyposthenuria
Fig. 7-5. The clinical problems of sickle cell disease by age. From Davies SC, Wonke B. The management of hemoglobinopathies. In Hann IM, Gibson ES, guest editors. Bailliere's Clinical Hematology. London Bailliere Tindall, 1991 361, with permission . 1. Vaso-occlusive or symptomatic crisis see Table 7-8 2. Splenic sequestration crisis a. Uncommon, but may be rapidly fatal b. Occurrence between 5 and 24 months of age c. Splenomegaly due to pooling of large amounts of blood in the spleen d....
Acute Infectious Lymphocytosis
This disorder can be characterized by 1. Discovery on routine blood count. It is caused by a Coxsackie virus. 2. Mild complaints vomiting, diarrhea, upper respiratory tract infection, abdominal pain, slight or absent fever symptoms of short duration. 3. No enlargement of liver, spleen, or lymph nodes. a. WBC counts varying from 40,000 to 100,000 mm3 b. Absolute increase in lymphocytes, with a lymphocyte predominance of more than 70 c. No anemia or thrombocytopenia. 5. No evidence of...
Castleman Disease Angiofollicular Lymph Node Hyperplasia Benign Giant Lymph
Castleman disease is characterized by an accumulation of nonneoplastic lymphoid tissue interspersed with plasma cells and blood vessels. Vascular hyperplasia has been attributed to a humoral vasoproliferative factor. Table 13-1 shows the relationship between the hyaline vascular solitary lymph node and plasma cell multiple lymph node histologic types and clinical features in Castleman disease. The production of interleukin-6 IL-6 by B cells in the germinal centers of hyper-plastic lymph nodes...
Sinus Histiocytosis with Massive Lymphadenopathy RosaiDorfman Disease
Manifestations of sinus histiocytosis with massive lymphadenopathy SHML include the following Worldwide occurrence with higher incidence among blacks Onset in first two decades of life Massive painless bilateral cervical lymphadenopathy with involvement of other groups of lymph nodes snoring, when there is involvement of retropharyngeal lymphoid tissue possibility of sleep apnea Extranodal infiltration in 25 of patients skin, orbit, eyelid, liver, spleen, testes, CNS, salivary glands, bone,...
Inherited Thrombocytopenia
Thrombocytopenia with a sex-linked pattern of inheritance has been reported in a number of families. The presence of a normal number of megakaryocytes in the bone marrow suggests that the thrombocytopenia is a result of shortened platelet survival due to an intrinsic platelet defect. The response to steroids is poor. A complete response to splenectomy has occurred in some patients. X-linked anemia with severe thrombocytopenia, due to defects in the GATA-1 gene, has been reported. Bone marrow...
Info Ehc
Platelet Secretion Defects with Normal Granule Stores and Normal Thromboxane Synthesis Table 10-12 Several studies have identified patients with a mild bleeding diathesis whose platelets have normal granule stores and normal thromboxane A2 synthesis during stimulation. This category also includes patients with behavioral attention deficit disorder or minimal brain damage syndrome and easy bruising. Many affected patients have abnormalities in the aggregation and secretion responses to weak...
Lymphomatoid Papulosis in Children
Lymphomatoid papulosis LyP is a clinically benign skin disorder characterized by chronic and recurrent self-healing papulonodular lesions. This disorder occurs rarely in children. The sites of lesions include the limbs and or trunk. The eruption recurs episodically, often ulcerates, and heals spontaneously in 3-8 weeks, leaving an atrophic scar occasionally. LyP results from a clonal T-cell proliferation, which may explain its evolution or coexistence with Hodgkin disease, mycosis fungoides, or...
Juvenile Myelomonocytic Leukemia
Incidence 1.2 per million children per year Median age at diagnosis 1.8 years 35 below 1 year of age, and only 4 above 5 years of age Male female ratio of 2 1 Association with neurofibromatosis type 1 NF-1 Children with NF-1 have more than a 200-fold increased risk of JMML. Fifteen percent of children with JMML have NF-1. Children with Noonan syndrome or trisomy 8 mosaicism are at increased risk of developing JMML. Most cases of neonates with Noonan syndrome with JMML-like presentation resolve...
I Ncp
Damage to cellular organelles and cell membranes B Involvement of A alone Sideroblastic anemia without mitochondrial cytopathy Involvement of B alone Mitochondrial cytopathies without sideroblastic anemia Involvement of A and B Sideroblastic anemias with mitochondrial cytopathies, e.g., Pearson syndrome, Pearson syndrome with Kearns-Sayre syndrome, Wolfram syndrome Fig. 6-2. Simplified view of pathophysiologic consequences of mitochondrial diseases. 2. Removal of the reactive oxygen radical by...
Nonimmune Hemolytic Anemia
This group of conditions is due to extracorpuscular causes of hemolytic anemia in which the antiglobulin Coombs' test is negative. The various causes are listed in Table 7-2. Those conditions caused by various infections, drugs, and underlying hematologic disease respond to treatment of the underlying condition, as well as the necessary acute supportive care. Microangiopathic hemolytic anemia MAHA is a result of diverse causes that have in common a relatively uniform hematologic picture and in...
Visceroptosis
In children, a palpable spleen may occasionally be due to visceroptosis rather than true splenomegaly. This distinction is important to make so that extensive investigations for the cause of splenomegaly are not undertaken unnecessarily. Visceroptosis may result from congenital or acquired defects in the supporting mechanism responsible for maintaining the spleen in the correct position. The visceroptosed spleen may be felt anywhere from the upper abdomen to the pelvis and may undergo torsion....
Essential Thrombocythemia
Essential thrombocythemia ET is rare in infants and children. It is a clonal myelo-proliferative disorder characterized by increased platelets without any attributable cause. The course of ET in young patients is more benign than in adults however, thrombotic in 30 of cases and hemorrhagic complications usually minor do occur. The diagnostic criteria of ET are as follows 1. Platelet count gt 600,000 mm3 3. Normal red cell mass males, lt 36 mL kg females, lt 32 mL kg 4. Normal stainable iron in...