Pediatric Hematology and Oncology
Domain focus
Pediatric Hematology and Oncology tests anaemia, haemoglobinopathies, bleeding disorders, leukaemia and oncological emergencies.
Core rules
- Microcytic anaemia is usually iron deficiency or thalassaemia. Check ferritin and haemoglobin pattern; a therapeutic iron trial helps only after excluding other causes.
- Sickle cell disease needs penicillin prophylaxis, full vaccination and early fever assessment.
- Immune thrombocytopenia in a well child with isolated petechiae is usually managed with observation; avoid IM injections and contact sports.
- Febrile neutropenia is an emergency: obtain cultures and start broad-spectrum antibiotics within 1 hour.
- Suspected leukaemia needs urgent blood film, oncology referral and tumour lysis precautions.
Worked example
A 3-year-old has pallor, petechiae, hepatosplenomegaly and a white cell count of 50 × 10⁹/L with blasts. This suggests acute lymphoblastic leukaemia. Arrange urgent oncology admission, check coagulation and tumour lysis labs, hydrate and start allopurinol. Do not delay referral for a repeat count.
Traps
Giving iron without investigating anaemia; missing febrile neutropenia; delaying antibiotics; performing lumbar puncture before specialist advice; failing to check G6PD before certain drugs.