Paediatric Haem / Onc Conditions Flashcards
What are the common and less common presentations of HSP?
Common - purpuric rash over legs and buttocks - migrating arthlagia and swelling - abdominal pain Less common - HSP nephritis (HT, proteinuria, haematuria) - intussuception - malaena and haematemesis - scrotal swelling
Describe the management of HSP
Basics - analgaesia for joint pain (paracetamol not NSAIDs) - analgaesia for abdo pain (steroids have evidence) Place & Person - Referral to outpatient paeditrician for ongoing observation Definitive management - Education & supportive care Prevention - continue to review for 6 months (including BP and urine dipstick) - steroids are NOT indicated for nephritis prophylaxis
What are the DDx for brusing in children?
‘SHIELD’ Sepsis (meningoccoal) HSP / HUS / Haemophilia ITP Events (Trauma or non-accidental injury) Leukaemia DIC (usually in the setting of severe illness)
How do you diagnose ITP?
An isolated thrombocytpoaenia (platelet count of
What is the management of ITP?
Basics - stop any active bleeding Place and Person - refer to paediatric haematology Investigations and confirm diagnosis - FBE and blood film to confirm isolated thrombocytopaenia - BMAT if unsure / need to rule out leuakaemia Conservative Management - avoid contact sports / high-risk activities - monitor menstural bleeding if post-pubertal female - avoid NSAIDs and 5-ASA - ongoing follow up and FBE Definitive Management’ - steroids (low or high dose) - IVIg
What is the most dangerous complication of ITP?
Intra-cranial haemorrhage Although the risk if
What are the causes of Fe deficiency anaemia in a child?
Poor stores
- Maternal iron defficiency
- Prematurity / low birth weight
Reduced intake
- Haven’t switched to solids at 6 months
- Vegeterian (adolescents)
Reduced Absorption
- Coeliac disease
Increased Loss
- Meckel’s diverticulum
- Cows milk in the first 12 months (causes micro GI bleeds)
- Menstural loss (adolescents)
What are the “next step” investigations for anaemia?
microcytic –> ferritin + Hb electrophoresis
normocytic –> reticulocyte count
macrocytic –> vit B12 / folate
What are the causes of anaemia in a child?
Microcytic
- Fe defficicency
- Thalasseaemia
Normocytic
- With increased retics
- Haemolysis
- Blood loss
- With decreased retics
- transient erythroblastaemia of childhood (caused by parvovirus B19)
- leukaemia
Macrocytic
- B12 / folate defficiency - rare
What questions should you ask in history when presented with a child with anaemia?
Microcytic
- Fe defficicency
- “Diet, on solids, bleeding from anywhere, drinking cows milk before 12 months, abdmonial pain and bloating, prematurity, low birth weight”
- Thalasseaemia
- “FHx of thalassaemia”
Normocytic
- With increased retics
- Haemolysis
- Jaundiced at birth?
- Blood group? Child and maternal?
- Blood loss
- Bleeding from anywhere?
- Haemolysis
With decreased retics
- transient erythroblastaemia of childhood (caused by parvovirus B19)
- unwell with viral ilness?
- Slapped cheeks?
- leukaemia
- Brusing?
- Severe unusally persistent recurring infections?
Macrocytic
- B12 / folate defficiency - rare
What initial investigations should you order for a child with suspected anaemia?
FBE
Ferritin
Blood Film
Reticulocyte count
What is the management of iron defficiency anaemia in the paediatric population?
- Treat underlying cause
- Diet
- Foods rich in iron
- Avoid cows milk until after 6 months
- Encourage orange juice and vitamin C
- Avoid coffee and tea
- Supplementation
- Oral (tablet or drops) or infusion
- Oral will make stools turn very dark, and cause constipation or diarrhoea
- Beware of iron overdose! Keep in locked cupbpard
What would the coagulations studies of someone with ITP show?
The coags would be normal. This is a disorder fo platelets.
What are the different types of ITP?
Acute
- ITP < 12 months
- Occurs in children 2-5 years old
Chronic
- ITP >12 months
- Occurs in children older than 7 and in adults
- Females > males
Recurrent ITP
- Rare
What is the management of ITP
Conservative - watch and wait
Low dose steroids
High dose steroids
IVIg
Splenectomy is a very last line option
What advice would you give to a parent who has a child with ITP?
- Management options
- Conservative - watch and wait
- 75% of children will recover within 4-6%
- No side effects
- Steroids
- Side effects of steroids
- Quicker recovery
- IVIg
- Quicker recovery
- Would have to stay in hospital
- Conservative - watch and wait
- Risk of IVH
- Risk is <<1%, even with no treatment
- Precaitions
- Avoid contact sports
- Take to hospital if suffers trauma, especially to the head, or if symptoms of drowisness, dysarthria, dysphagia
- AVOID ASPRIN AND NSAIDs