Haematological disorders

Question 1

What are the clinical features of iron deficiency anaemia?

Answer 1

Asymptomatic until Hb drops <60 g/L
Fatigue
Feed more slowly
Pale
Pica (Eating non-foods like soil)

Question 2

What is the management of iron deficiency anaemia?

Answer 2

Investigations:
FBC - Microcytic hypochromic anaemia

Treatment:
Dietary advice
Ferrous sulphate tablets (200mg) - Continue until 3 months after anaemia resolved to ensure adequate iron stores
NOTE: GI side effects can be aided by taking tablets with meal

Question 3

What are the types of red cell aplasia?

Answer 3

Congenital red cell aplasia (Diamond-Blackfan anaemia)
Present at 2-3 months with anaemia
May have congenital abnormalities (Short stature)

Transient erythroblastopaenia
Triggered by viral infection
Self limiting

Parvovirus B-19 infection with haemolytic anaemia

Question 4

What investigation findings are suggestive of red cell aplasia?

Answer 4

○ Low reticulocyte count despite low Hb
○ Normal bilirubin
○ Negative DAT (Coombs test)
○ Absent red cell precursors on bone marrow examination

Question 5

What is the management of acute haemolysis?

Answer 5

Supportive
Folic acid supplementation

If severe, consider red cell transfusion

Question 6

What should be avoided in patients with clotting disorders?

Answer 6

IM injections
NSAIDs
Aspirin

Question 7

What are the clinical features of immune thrombocytopaenic purpura?

Answer 7

Most common cause of thrombocytopaenia in childhood
Destruction of platelets by anti-platelet IgGs

* Presents between 2-10 y/o
* 1-2 weeks after viral infection
* Petechiae, purpura and bruising
* Epistaxis/Mucosal bleeding
* Intracranial bleeding severe complication (rare)

Question 8

What is the management of immune thrombocytopaenic purpura?

Answer 8

Diagnosis of exclusion
Self-resolving in 6-8 weeks
Treat if major or persistent minor bleeding:
	• IVIG
	• Corticosteroids
	• Platelet infusion

Question 9

What are the clinical features of thrombotic thrombocytopaenic purpura?

Answer 9

TTP - The Terrible Pentad

1. Fever
2. Neurological (seizures, hemiparesis, reduced consciousness)
3. Renal dysfunction (AKI)
4. Anaemia (MAHA with jaundice)
5. Platelets (reduced)

On blood film, you will see schistocytes