Pediatrics
Anemia, Hematology and Oncology
Paediatric haematology-oncology for NEET-PG: approach to anaemia, iron deficiency, ITP, haemophilia and leukaemia, mapped to NMC PE29 codes.
MedNext Academy | 3 min read
Anemia, Hematology and Oncology
Paediatric haematology-oncology for NEET-PG: approach to anaemia, iron deficiency, ITP, haemophilia and leukaemia, mapped to NMC PE29 codes.
This chapter covers paediatric haematology and oncology, from the reticulocyte-based approach to anaemia through iron, B12 and haemolytic anaemias, immune thrombocytopenia and haemophilia, to leukaemia and lymphoma with their emergencies. It anchors interpretation on the complete blood count, smear and electrophoresis read together.
High-yield: Anemia, Hematology and Oncology
- The reticulocyte count is the pivot in anaemia: a low count means inadequate marrow production, while a high count means blood loss or red cell destruction until proven otherwise.
- Do not call every microcytic anaemia iron deficiency, because thalassaemia trait, anaemia of inflammation, lead toxicity, sideroblastic anaemia and mixed deficiency are common traps.
- Ferritin can be falsely normal or high during infection or inflammation and should be interpreted with C-reactive protein and transferrin saturation.
- Therapeutic elemental iron for diagnosed iron deficiency anaemia is 3 to 6 mg/kg/day, which is not the same as programme prevention doses.
- Never give folate alone when vitamin B12 deficiency is possible, because the anaemia may improve while neurologic injury continues.
- In known haemolysis, a sudden fall in haemoglobin with a low reticulocyte count is an aplastic crisis until proven otherwise, often triggered by parvovirus B19.
- Do not transfuse platelets routinely in immune thrombocytopenia, because transfused platelets are rapidly destroyed unless there is life-threatening bleeding or urgent procedure support.
- Wet purpura in the mouth predicts a higher bleeding risk than scattered dry petechiae on the legs.
- Haemarthrosis is a coagulation-disorder pattern such as haemophilia, whereas petechiae are unusual in haemophilia and should trigger a platelet differential.
- Suspected serious haemophilia bleeding is treated with factor replacement first and confirmed later, because waiting for imaging can cost joint, airway or brain function.
- Bone pain with cytopenias is leukaemia until proven otherwise and is often mislabelled as rheumatologic disease, growing pain or trauma.
- A normal total white cell count does not exclude leukaemia, because blasts and cytopenias matter more than the headline count.
- Do haemoglobin electrophoresis or high-performance liquid chromatography before transfusion whenever possible, since donor red cells can obscure the child's own pattern.
- A raised haemoglobin A2 supports beta thalassaemia trait, but coexisting iron deficiency can lower haemoglobin A2 and blur the result.
- A leukocoria photograph from a parent is reason enough for urgent eye-oncology assessment, and post-splenectomy fever is a medical emergency from overwhelming encapsulated-organism sepsis.
Anaemia and bleeding anchors
- **Reticulocyte count:** Low means underproduction; high means blood loss or haemolysis.
- **Therapeutic iron:** Elemental iron 3 to 6 mg/kg/day for diagnosed iron deficiency anaemia.
- **ITP transfusion:** Platelets are not routinely transfused; reserved for life-threatening bleeding or urgent procedures.
- **Bleeding pattern:** Haemarthrosis suggests coagulation factor deficiency; skin-mucosal petechiae suggest platelet disorders.
NMC competencies in this chapter
- **PE29.1:** Approach to a Child With Anemia
- **PE29.2:** Iron Deficiency Anemia
- **PE29.6:** Thrombocytopenia and Immune Thrombocytopenic Purpura
- **PE29.7:** Hemophilia in Children
- **PE29.8:** Acute Lymphoblastic Leukemia
- **PE29.16:** Hemoglobin Electrophoresis and High-Performance Liquid Chromatography
Frequently Asked Questions
Why is the reticulocyte count the key first step in anaemia?
It separates the two mechanisms: a low reticulocyte count in a pale child means inadequate marrow production, while a high count means blood loss or red cell destruction until proven otherwise. This single test directs the entire work-up.
What is the therapeutic dose of iron for iron deficiency anaemia?
Elemental iron is given at 3 to 6 mg/kg/day for diagnosed iron deficiency anaemia. This differs from the lower doses used in public-health prevention programmes.
Should platelets be transfused in immune thrombocytopenia?
No, not routinely. Transfused platelets are rapidly destroyed, so they are reserved for life-threatening bleeding or urgent procedure support. Wet purpura in the mouth predicts higher bleeding risk than dry petechiae.
What clinical clue points to leukaemia in a child?
Bone pain with cytopenias is leukaemia until proven otherwise, and is often mislabelled as rheumatologic disease, growing pain or trauma. A normal total white cell count does not exclude it, since blasts and cytopenias matter more than the headline count.
Continue reading
MBBSAll Pediatrics chapters
Continue through the Pediatrics chapter map.
Continue studying Pediatrics
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans