Haem/onc Flashcards
Is demand for iron high or low in early years?
High
How can giving cow’s milk too early cause anaemia?
Chronic microscopic bleeding
Are infants born with iron stores?
Yes
What iron intake do babies require to maintain stores? (daily)
400-700ng
Why is iron in breast milk well absorbed?
Lactoferrin (iron binding protein)
Are artificial formula feeds a good source of iron?
Yes generally sufficiently fortified with iron to prevent deficiency
When might babies need prophylactic iron supplementation? Across what time period?
LBW and solely breast fed
Start 4-6w until mixed feeding established.
Presentation of iron deficiency anaemia
Can be asymptomatic
Pallor
If severe- anorexia and irritability
Decreased neuro/intellectual functioning such as attention span and alertness (iron deficiency even in the absence of anaemia)
When do you investigate iron deficiency anaemia?
Only if failure to respond to treatment
What might blood film/count show in iron defic anaemia?
microcytic, hypochromic RBCs and poikilocytosis (abnormal shape RBCs)
Serum ferritin low
What investigations can you do other than blood count and film
Hb electrophoresis to r/o thalassaemia etc
U&Es- renal failure can cause low RBC via reduced EPO
Blood/urine culture for chronic infection (normocytic anaemia with low reticulocytes)
Bone marrow aspirate (leukaemia)
?Lead level- lead toxicity can cause microcytic anaemia
Management iron defic anaemia
R/o serious cause such as thalassaemia
ONLY IF DEMONSTRABLE IRON DEFICIENT STATE: oral iron salts
Dose oral iron salts?
3-6mg/kg (max 200g) daily in 2-3 divided doses
What do you need to consider when prescribing oral iron salts?
Each salt has different content of iron so specify the iron salt and elemental iron. Also consider the iron content of formula feeds.
How else can iron be given other than oral? When should it be given?
Parenterally
If oral unsuccessful for various reasons
Is parenteral better than properly taken oral iron?
Not really
Advice for parents re diet in iron deficiency?
1 pint milk per day max
Encourage more iron rich food
Tea can limit iron absorption so avoid
How quickly does iron supplementation treatment work?
Within 1w Hb levels should start to increase. If not then check compliance or consider alternative
Draw out flow chart of anaemias
see IDA notes
What is the commonest cancer cause of death in children and young people?
Brain tumour
60% brain tumour survivors are left with _____?
Life altering disability
What are the 2 most common locations for brain tumour
Brainstem and cerebellum
How do brain tumours present?
raised ICP or neuro signs
What are two long term sequelae of brain tumour?
Endocrine and growth problems