SAQ 1103 – infant pallor, lethargy and dark urine after recent illness

A 12-month-old Asian boy is brought to the emergency department by his parents. Over 48 hours his mother has noticed increasing pallor, lethargy and dark urine. Four days earlier he saw his GP with fever, vomiting and cloudy urine, which settled with trimethoprim. He is haemodynamically stable and afebrile. His blood results are shown below.

Test	Result	Reference range
WCC	11.8 x 10^9/L	3.6-11
Neutrophils	7.3 x 10^9/L	1.8-7.5
Hb	60 g/L	115-165
Hct	0.29 L/L	0.37-0.44
Platelets	500 x 10^9/L	140-400
RCC	3.5 x 10^12/L	3.8-5.8
MCV	90 fL	80-96
MCHC	320 g/L	285-300
Reticulocyte count	240 x 10^9/L	30-140
DAT / Coombs test	Negative
EUC	Normal

List four (4) possible causes of this presentation.

(Marked out of 4.0)

/ 4

Describe and interpret the results.

(Marked out of 2.0)

/ 2

List four (4) other investigations to help confirm the likely diagnosis and provide your reasoning.

(Marked out of 8.0)
</p> <table class="saq-prop-table" style="width: 100%; table-layout: fixed; border-collapse: collapse; max-width: 100%;"> <thead> <tr> <th style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">Investigation</th> <th style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">Reasoning</th> </tr> </thead> <tbody> <tr> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">1.</td> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">2.</td> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">3.</td> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;"></td> </tr> <tr> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;">4.</td> <td style="overflow-wrap: anywhere; word-break: normal; vertical-align: top; white-space: normal; box-sizing: border-box;"></td> </tr> </tbody> </table> <p>

/ 8

You suspect G6PD deficiency. List four (4) causes or precipitants of this condition.

(Marked out of 4.0)

/ 4

What treatment would you provide?

(Marked out of 2.0)

/ 2

Total Score: 0 / 20

Percentage: 0%