Paediatric Haematology

Question 1

What are the changes in Haemaglobin as the baby grows?

Answer 1

=> Trimester:

• Rising Hb and MCV
• Transfer maternal iron stores
• HbF more predominant

=> Birth:

• More oxygenation of tissues
• HbA production
• HbF production switched off

=> 8-12 weeks:

• Hb stops being produced
• Stable at 90-120
• RBCs start being produced again

=> Anaemia for a 3 month old baby is NORMAL

Question 2

What are the main cause of Neonatal Anaemia?

Answer 2

=> Being born pre-term

• Small spleens
• Red cells are resistant to osmotic lysis
• Red cells have altered shape

=> ≤ 28 weeks:

• Marked macrocytosis
• Plentiful nucleated red cells

=> < 28 weeks:

• Can see oxidative haemolysis 4-6 weeks of age
• Short lived acquired deficiency of red cell enzymes

Question 3

What are the different causes of Anaemia of Prematurity?

Answer 3

• Iatrogenic blood sampling
• Rapid weight gain
• Lower iron stores
• Shortened RBC survival
• Lower baseline Hb

Question 4

What are the investigations of for anaemia in newborn?

Answer 4

• FBC, Reticulocyte levels DAT, blood group
• Maternal Ab screen
• Kleihuer test
• Cranial USS in cases of blood loss
• Parvovirus PCR

Question 5

What is the pathophysiology of Haemolytic disease of the New-born?

Answer 5

• Foreign blood (baby’s blood) enters the mother’s circulation
• As the foreign blood expresses different antigens to the mother’s RBC, the mother’s immune system makes antibodies against it
• These antibodies cross the placenta and bind to the antigens on fetal RBC
• Cause haemolysis

Question 6

What is the prevention and management of Haemolytic Disease of New Born?

Answer 6

• Early detection of alloimmunisation (does mother have anti-D, anti-c or anti-Jell antibodies)
• Monitor baby for signs of anaemia

Question 7

What does intrauterine haemolysis result in?

Answer 7

Hydrops foetalis

Question 8

What is Neonatal Thrombocytopenia?

Answer 8

• Babies are born with the normal number o platelets that adults have
• Therefore neonatal thrombocytopenia if platelets < 150 x 10^9

Question 9

What is the main cause of Neonatal Thrombocytopenia?

Answer 9

Alloimmunisation (similar to haemolytic disease of newborn but this time involving platelets)

Question 10

What is Acute Immune Thrombocytopenia?

Answer 10

• Affects children more than adults
• Typically occurs after viral infection or immunisation
• Lasts up to 6 months and typically resolves itself, treatment not given unless bleeding

Question 11

What are the causes of Leucopenia in neonates?

Answer 11

=> Leucopenia is very rare in neonates

• Intrauterine Growth Retardation
• Congenital Sepsis
• Bone Marrow Failure
• Pearson Disease (Mitochondrial syndrome)

Question 12

What are the causes of Neutropenia?

Answer 12

• Transient myelosuppression
• Autoimmune neutropenia
• Cyclic neutropenia
• Drug related
• Severe congenital neutropenia
• Nutritional deficiencies