Pallor in children: diagnostic approach — formative SAQs

SAQ 1 (10)

An 18-month-old has progressive pallor, drinks large volumes of cow’s milk, and is otherwise interactive. CBC shows microcytic hypochromic anaemia with low ferritin. [1]

1. State a one-sentence problem representation. (2) [1] [6]
2. Explain how MCV and reticulocyte count organise the broader anaemia differential beyond this case. (4) [6]
3. Outline cause-directed management and how you will prove response. (4) [1]

Model answer

Problem representation. Toddler with dietary risk and confirmed iron-deficiency anaemia without clinical red flags for marrow failure. [1]

Classification grid. MCV sorts micro/normo/macrocytic patterns. Reticulocytes ask whether the marrow is responding: high suggests loss/haemolysis; inappropriately low with severe anaemia suggests production failure. Film refines morphology (hypochromia, spherocytes, blasts). [6]

Management. Reduce excessive cow’s milk, improve dietary iron, start iron per local product guidance, safety-net, and recheck for expected laboratory response; failure to rise triggers rethink of diagnosis, loss or adherence. [1]

SAQ 2 (10)

A 6-year-old has fever, bone pain, bruising and marked pallor. Another child on the same shift has acute jaundice and dark urine after a new medicine. [3] [4]

1. What immediate actions protect the febrile bruised pale child? (3) [3]
2. What mechanism and testing caveat apply to suspected G6PD haemolysis? (3) [4]
3. State transfusion sampling principles for stable versus unstable anaemia. (4) [5]

Model answer

Threat pathway. Same-day CBC with film, assess stability, treat infection risk, early senior/haematology involvement — not an empiric iron trial. [3]

G6PD. Oxidative haemolysis after trigger; stop trigger and support. Assay during acute crisis can be falsely reassuring; retest later if needed; use medication-safety guidance. [4]

Transfusion. If stable, draw diagnostic samples before transfusion when safe. If unstable, resuscitate and transfuse per local paediatric protocol; do not delay rescue blood for a perfect pre-transfusion panel. [5]