The infant or child with pallor or anemia

Question 1

Overview of etiology

Answer 1

1. Iron defiency
2. Thalassemia
3. Chronic renal disease
4. Hypothyroid
5. Chronic inflammatory disease
6. Lead posisening
7. Spherocytosis
8. AI hemolysis
9. Red cell enzyme
10. Hemaglobinopathies
11. Leukemia
12. Bone marrow infiltration
    Leukemia
    Lymphoma
    Histiocytosis
    Neuroblastoma
    Metabolic storage
13. Bone marrow failure
14. Sickle cell

Question 2

Investigations

Answer 2

1. FBC->type, bizarre cells, blast cells
2. Ferritin
3. Zn protoporphyrin
4. Lead level
5. Haemoglobin electrophoresis
6. UEC
7. Blood and urine culture
8. Bone marrow aspirate

Question 3

How is thalassemia diagnosed

Answer 3

1. Beta
   Electrophoresis
   ++HbA2 and HbF

Question 4

Sickle cell disease- important features

Answer 4

1. 1 in 4 West africans, 1 in 10 Afro-carribeans
2. Recurrent acute painful crises->infection, deH, hypoxia, acidosis
3. Splenic infarcts->pneumococcal vaccine and penicillin prophylaxis
4. Poor renal function
5. Mx of acute crises
   Analgesia
   ReH
   Antibiotics
   Warmth

Question 5

Common cancers in childhood

Answer 5

1. Leukemia
2. Lymphoma
3. Wilms tumor
4. Rhabdomyosarcoma
5. Retinoblastoma
6. Brain tumors
7. Germ cell tumors
8. Neuroblastoma
9. Bone tumors

Question 6

Overview management of childhood cancer

Answer 6

1. Diagnosis and referral to specialised oncology services
2. Surgery
   Biopsy
   Excision
   Insertion of IDCVC for chemoT
3. Radiotherapy
   Local
   TBE for bone marrow transplant
4. ChemoT
5. Prophylactic antibiotics
6. Nutritional support
7. Pain management
8. Social, OT, physioT, school, psychology

Question 7

Most common malignancy of childhood

Answer 7

1. Leukemia 30%

Question 8

Subdivisions of ALL

Answer 8

1. Common
2. T cell
3. Null
4. B cell

Question 9

Short term/long term side effects of treatment leukemia

Answer 9

1. Tumor lysis syndrome
2. Bone marrow suppression and febrile neutropenia
3. Immunosuppression
4. Nutrition
   Mucosal ulcers
   Gut inflammation
   Anorexia
5. Short stature, aymmetrical growth
   Radiotherapy
   Irradiation of HPA->delayed puberty, hypothyroidism, cortisol deficiency, gonadal failure
6. Subfertility
7. Deafness
8. Pulmonary fibrosis
9. Cardiomyopathy
10. Risk of secondary cancers
11. Chronic ill health and poor school attendance
    Poor academic performance

Question 10

Where do most childhood brain tumors occur, management and long term

Answer 10

1. Brainstem
2. Cerebellum

Neurosurgical resection, chemoT and radioT
Can have growth and endocrine abnormalities

Question 11

What is neuroblastoma and how does it normally present

Answer 11

1. Proliferation of neural crest cells
2. Abdominal mass, skin nodules, periorbital bruising, unwell child
3. Increase in urinary catecholamines

Question 12

Two common bone tumors in children

Answer 12

1. Ewing sarcoma

2. Osteosarcoma->most common type

Question 13

Most common sites of rhabdomyosarcoma

Answer 13

1. Head and neck
2. Genitourinary tract
3. 50% 5 year survival with optimal treatment

Question 14

Most common tumor in infancy

Answer 14

1. Retinoblastoma

Question 15

Even without anemia, some negative consequences of iron deficiency in children

Answer 15

1. Impaired weight gain
2. Reduced/abnormal appetite
3. Reduced exercise tolerance
4. Increased muscle fatiguability
5. Diminished immune response to infections

Infants required oral iron elixir for 3 months