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Iran Specialty Board - Pediatrics study materials
Iran Specialty Board - Pediatrics study resources

Iran Specialty Board - Pediatrics: Pediatric Hematology and Oncology

Iran Specialty Board - Pediatrics · Work through your exam, one topic at a time.

All guide sections

Pediatric Hematology and Oncology

This domain tests the microcytic anaemias, sickle cell complications, bleeding disorders and the early recognition of childhood malignancy.

Anaemia

  • Iron deficiency is the commonest cause in children: low ferritin, high TIBC, high red cell distribution width. Treat with oral iron 3-6 mg/kg/day; reticulocytosis appears in 1-2 weeks and haemoglobin rises about 1 g/dL in 2-4 weeks.
  • Thalassaemia trait shows microcytosis with a normal red cell distribution width and normal ferritin.

Sickle cell disease

  • Vaso-occlusive crisis, acute chest syndrome, splenic sequestration, aplastic crisis with parvovirus B19, and stroke.
  • Penicillin prophylaxis and pneumococcal vaccination, hydroxyurea, and transcranial Doppler screening for stroke risk.

Bleeding and platelets

  • Immune thrombocytopenia: isolated thrombocytopenia in a well child with petechiae; treat with IVIG or corticosteroids only for significant bleeding or platelets below 20,000/microlitre.
  • Haemophilia A (factor VIII) and B (factor IX): haemarthrosis, replacement therapy; avoid intramuscular injections and NSAIDs.

Oncology

  • Acute lymphoblastic leukaemia is the commonest childhood cancer, peaking at 2-5 years, with fever, pallor, bone pain, hepatosplenomegaly and blasts on the blood film.
  • Wilms tumour: abdominal mass, haematuria, hypertension.
  • Neuroblastoma: under 2 years, abdominal mass, periorbital ecchymoses, opsoclonus-myoclonus, raised catecholamines.
  • Retinoblastoma: leukocoria and strabismus.
  • Febrile neutropenia (absolute neutrophil count below 500/microlitre with fever) requires empirical antipseudomonal beta-lactam within 60 minutes.

Worked example

A 3-year-old has pallor, bruising, hepatosplenomegaly, haemoglobin 6 g/dL and 40,000 white cells with blasts. Reasoning: this is acute leukaemia until proven otherwise. Refer urgently, transfuse cautiously and avoid intramuscular injections.

Traps

Starting iron before confirming ferritin; transfusing platelets routinely in ITP; and delaying antibiotics in febrile neutropenia.