Interpreting common paediatric laboratory reference ranges — viva

Stem

Examiner-led viva on paediatric laboratory interpretation. [1]

Examiner: How do you open any abnormal paediatric lab result? [6]

Strong answer: Confirm identity and sample quality, place the result in age/sex/day-of-life and assay context, then separate reference interval from decision limit from critical value before acting. [4] [6]

Examiner: The toddler’s ALP is high by adult standards. [2]

Strong answer: Growth-related bone turnover commonly elevates ALP; I check bilirubin, GGT, ALT/AST, growth and symptoms before cascading imaging, using paediatric interval evidence rather than adult cut-offs. [2]

Examiner: Why might day-2 neutrophils look “high”? [3]

Strong answer: Neonatal neutrophil expected ranges change with postnatal age in hours; I use neonatal references and the whole baby, not school-age bands. [3] [8]

Examiner: The potassium is called as critical but the child looks well. [4]

Strong answer: I still run a critical-value pathway: urgent clinical assessment, treat if threat, rapid verification for haemolysis/artefact, and documented closed-loop communication. Local critical lists vary. [4] [7]

Examiner: Name one landmark programme that improved paediatric biochemical intervals. [1]

Strong answer: CALIPER established multiethnic healthy-community paediatric biochemical reference intervals, reducing reliance on adult-derived ranges, while local verification and platform transfer remain required. [1]