Haematology

Question 1

ANAEMIA IN CHILDREN
i) what causes most anaemia in infancy? name three other causes of anaemia in infants? name three causes of haemolysis in a neonate?
ii) why is physiologic anaemia of infancy? what causes it?
iii) name three things that cause anaemia of prematurity? what test can contribute?
iv) what are the two key causes of anaemia in older children?

Answer 1

i) mostly caused by physiologic anaemia of infancy
other causes - anaemia of premat, blood loss, haemolysis and twin twin transfusion syndrome
haemolysis - haem disease newborn, hereditary spherocytotis, g6PD deficiency
ii) physiol anaemia - dip in Hb 6-9 weeks in healthy babies - high o2 delivery to tissues due to high Hb at birth causes neg feedback > decreased EPO prod by kidneys therefore less Hb produced
iii) premature - less time in utero recieving iron from mother, RBC creation cant keep up with rapid growth in first few weeks, reduced EPO levels
blood tests remove a significant portion of circ volume
iv) older children - iron defic anaemia (dietary) and blood loss

Question 2

CAUSES OF ANAEMIA
i) what are the causes of microcytic anaemia? (TAILS)
ii) what causes normocytic anaemia (3A’s and 2H’s)

Answer 2

i) Thalassemia, Anaemia of chronic disease, Iron defic, Lead poisoning, Sideroblastic anaemia
ii) Acute blood loss, Anaemia of chronic disease, Aplastic anaelia, Haemolytic anaemia, Hypothyroidism

Question 3

LEUKAEMIA
i) what is it? what is the most common form in children? what is next most common? what is rare?
ii) what is the peak age of ALL? peak age of AML?
iii) what is the main environmental factor for leuk dev? name three other syndromes that increase the risk?
iv) name six symptoms? which two symptoms should result in immediate referral? which urgent investigation should be done?
v) what may be seen on FBC? what is seen on blood film?

Answer 3

i) cancer of stem cells in the BM
ALL most common then AML and CML is rare
ii) peak age for ALL is 2-3 years, AML is <2yrs
iii) main enviro factor is abdominal xray during pregnancy
syndromes - downs, klienfelter, noonan, fanconis anaemia
iv) persistent fatigue, unexplained fever, fail to trhive, weight loss, nigh sweat, petechiae/abnormal bruising (thrombocytopenia), unexplained bleeding, general lymphado, bone/joint pain, hepatosplenomegaly
refer if unexplained petechiae or hepatomegaly
do FBC within 48 hours
v) FBC - anaemia, leucopenia, thrombocyto with high numbers of abnormal white cells
blood film - blasts
may do CXR, LP, CT scan and genetic analysis/imm phenotyping of abnormal cells

Question 4

IDIOPATHIC THROMBOCYTOPENIC PURPURA
i) what is it? what is it caused by? what type of cells are destroyed?
ii) below which age does it usually present? what is there usually a recent history of? name three symptoms? what type of rash is seen?
iii) what ix needs to be done urgently? what needs to be excluded? when may tx be required? (2)
iv) name three things that can be given to treat?
v) name three things that should be avoided? name three complications

Answer 4

i) charac by spontaneous low plat count causing a pupuric rash (non blanching)
caused by a type II hypersens reaction - production of antibodies against plats (spont or triggered by something eg viral infec)
ii) usually px under 10 and hx of viral illness
symptoms = bleeding (nose, gums, mennoraghia), bruising, petechial (small spots) or purpuric (large spots) rash - non blanching
iii) do urgent FBC for plat count - need to exclude other causes of low plats eg heparin induced thrombocyto and leukaemia
tx may be required if patient is active bleeding or there is severe lot plats (below 10)
iv) tx - prednisolone, IV Ig, blood or plat transfusion (only temp as antibodies to plats will destroy the transfused plays)
v) avoid contact sportd, IM injection or LPs, NSAIDs or blood thinners
complicats - chronic ITP, anaemia, intracranial subarach haemm, GI bleed
(patient is more prone to bleeding due to low plat levels)