The Pale Child

Question 1

Normal Hb in newborn?

Answer 1

100-120

Question 2

Oxygen delivery

Answer 2

DO2 = CO X HB X Sp02 X 1.31(amount of O2 ml carried by 1g of Hb

Question 3

how to ask Diet for assessment

Answer 3

Cross section

Chronological: change: transition to solids, meats

Question 4

Breast milk good source of iron?

Answer 4

Yes. 6 months. Then need iron fortified cereals or meats

Question 5

How to ask about anaemia in child?

Answer 5

Symptoms - fatigue, lethargy, pallor, dizziness
Look for bruising in case more insidious cause
School performance
Sites of bleeding? IBS?
Family Hx

Question 6

how can Cow’s milk cause iron deficiency?

Answer 6

Poor source, poor bioavailability.

Question 7

When is iron transferred across placenta?

Answer 7

3rd trimester.

Question 8

When to start iron supplementation in premature baby

Answer 8

Not right away, increased risk of ecoli and other bacteria.

Start around 4 weeks.

Question 9

Bloods Ix for anaemia in child

Answer 9

FBE
Iron Studies: be careful cause acute phase reactant
Transferrin saturation
Reticulocyte count

Question 10

REd cell distribution (RDW), how does it look in anaemia?

Answer 10

Wider distribution

Question 11

Oral supplementation in kids, what to tell parents?

Answer 11

give with Vit. C, stool will go black, constipation
Not on empty stomach.
Keep it safe. Overdose.
Brush teeth after. May stain.

Question 12

Acute effects of iron overdose

Answer 12

Inflammation of GI mucosa and ulceration/perforation/strictures

Question 13

How long do you take oral for?

Answer 13

At least a few months. 2 months.

Question 14

How can you tell iron supplementation is working?

Answer 14

Within 72 hours. Reticulocyte count should come up

Question 15

Signs of thalassemia major

Answer 15

Hyper trophy of maxillary bones, more bone marrow

Hepatomegaly

Question 16

How to decide if need a blood transfusion?

Answer 16

1. Do they need one? Level(guideline only), symptoms
2. Factors: comorbidities
3. Decompensating
4. Progressive? Eg. Leukaemia

Question 17

What to do after you decide they need a blood transfusion

Answer 17

Consent

Question 18

After consent to blood transfusion, do what?

Answer 18

Group and Crossmatch
Calculate
Kg x deltaHb X 3or4 = ml. g/dL

Question 19

How long will a bag of blood last outside of fridge?

Answer 19

4 hours

Question 20

How long do you give blood over?

Answer 20

2-4 hours

Question 21

What do you add if child is normovolaemic with blood transfusion?

Answer 21

Add diuretic

Question 22

How long do you monitor someone on transfusion?

Answer 22

Every 5 minutes.

BP, HR, rash, strider, wheeze.