Paediatric Haematology

Question 1

what are the 5 most common causes of thrombocytopaenia/ platelet function abnormalities in a child?

Answer 1

Malignancy - Leukaemia / lymphoma
Bone Marrow Failure - aplastic anaemia, fanciness anaemia, Ewing’s sarcoma
Inheritied Platelet Conditions - Glanzman;s thrombasthenia

Question 2

What is the most commonly seen symptom in a child presenting with a a disorder of the blood or bone barrow?

Answer 2

Pallor or anaemia

Easy bruising, abnormal bleeding, hepatosplenomegaly or propensity to infection can also be the presenting feature

Question 3

What are the 3 main causes of iron deficiency anaemia in children?

Answer 3

Nutritional
Occult blood loss (meckels)
Malabsorption (coeliac disease)

Question 4

What is the most common haemoglobinpathy in children?

Answer 4

beta-thalassaemia

Question 5

What are the most common haemolytic causes for anaemia in children?

Answer 5

spherocytosis
Sickle cell disease
Thalassaemia
enzyme deficiencies

Question 6

What are the 2 most common enzyme deficiencies which cause haemolysis in children

Answer 6

G6DP def

pyruvate kinase deficiency

Question 7

What are the 2 main causes of GI blood loss in children?

Answer 7

Meckel’s diverticulum

Hookworm infection

Question 8

What 2 things may a pancytopenia in children suggest?

Answer 8

Bone marrow failure

Hypersplenism

Question 9

What are the 2 most important differentials in excessive bruising?

Answer 9

Bleeding disorder

Non-accidental injury

Question 10

What 4 investigations would you arrange in a child whom you suspect has a bleeding disorder?

Answer 10

Blood film
LFTs & U+Es
Platelet count
Coagulation Screen

Question 11

Bleeding disorders can be categorised into 3 groups of causes, what are they?

Answer 11

Vascular defects
Platelet defect
Coagulation defect

Question 12

What are the 4 most common acquired causes of vascular defects leading to bleeding disorders in children?

Answer 12

Henoch-schonlein purpura
Vit C def (scurvy)
Cushings
Meningococcal Septicaemia

Question 13

What are the 4 most common inherited causes of vascular defects leading to bleeding disorders in children?

Answer 13

Hereditary Haemorrhagic Telangactasia

Ehlers-danlos syndrome

Question 14

What is Ehlers-Danlos Syndrome?

Answer 14

An inherited disorder which leads to the malformation of collagen and bleeding disorders

Question 15

What are the 3 inherited coagulation defects leading to bleeding disorders in children?

Answer 15

Haemophillia A
Haemophilia B
Von Willebrand disease

Question 16

A child presents with a newly formed purpuric rash of the buttocks and lower limb, what is the most likely diagnosis?

Answer 16

Henoch-schenlein purpura

Question 17

Give some causes of splenomegaly in children

Answer 17

Infections - EBV, CMV, Septicaemia, Malaria

Haematological - Spherocytosis, Beta-thassasaemia

Malignancy - lymphoma, myleoma

Connective tissue disease - Ehlers-Dalos, SLE

Question 18

What are the 5 features of an enlarged lymph node that would make you worried in children?

Answer 18

Rapid growth 
Skin ulceration
Fixation to skin or fascia
>3cm with hard consistency 
>3cm for more than 6 wk despite treatment

Question 19

What are the likely causes of a persistent enlarged cervical lymph node in children

Answer 19

Malignancy - Lymphoma, neuroblastoma

TB

Question 20

What are the 3 investigations you would carry out in a child presenting with a persistently swollen cervical lymph node

Answer 20

FBC
CXR - for TB or lymphoma
Tuberculin Skin Test

Question 21

What 6 investigations would you carry out in a child with generalised lymphadenopathy?

Answer 21

FBC
Monospot and EBV Abs
CXR
Abdo USS
?bone barrow aspirate
?lymph node biopsy

Question 22

What antibody types is tested while investigating epstein-barr virus?

Answer 22

IgM

Question 23

What does the Monospot blood test for?

Answer 23

Epstein-Barr Virus

Question 24

What are the foetal complications of Rh isoimmunisation?

Answer 24

Erythroblastosis fetalis with haemolytic anaemia

Jaundice and hepatosplenomegaly

Kernicterus

Hydrops fetalis