SAQ 112 – Haematology – severe paediatric microcytic anaemia

Question 9. severe paediatric microcytic anaemia.

a. Pathological causes

• Iron deficiency, especially from poor dietary intake, cow's milk dependence, chronic blood loss, or poor intestinal absorption.
• Coeliac disease or Crohn's disease causing malabsorption.
• Thalassaemia major.
• Thalassaemia minor with a secondary medical condition such as unstable diabetes or folate deficiency.
• Haemolytic anaemia.

b. Further investigations

• Iron studies.
• Haemoglobin electrophoresis.
• Peripheral blood film.
• B12 level.
• Folate level.
• Faecal occult blood.
• LDH.
• Haptoglobin.
• Unconjugated bilirubin.
• Direct antiglobulin test / Coombs test.

c. Circumstances to override refusal

• Likelihood of death or serious permanent harm without treatment.
• Approval by hospital superintendent or appropriate statutory authority.
• Disagreement between parents, with the other parent consenting.
• Court order.
• Mother is not the legal guardian.
• Suspicion of non-accidental injury.
• Mother lacks capacity, for example due to mental health disorder.

d. Alternative treatments

• Iron infusion.
• Synthetic haemoglobin if available.
• Erythropoietin therapy.