Notes

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3 clinical features of IDA:
1. Pica or craving or chewing substances with no nutritional value.
2. Koilonychia.
3. Plummer Vinson syndrome.

💎Answer No. 2:
Investigation of iron deficiency anaemia:
1. Complete blood count:
*Hb%(reduced)
*TC & DC (normal)
*Reticulocyte count(low or normal)
*Pletlet count: normal but occasionally maybe high(throbocytosis)

2.Peripheral blood film: microcytic hypochromic RBS with anisocytosis, poikilocytosis, tear drop cell, pencil shaped cell and occasional target cell.

3.RBC indices: MCV and MCH are reduced but RDW( red cell distribution width) is high.

4.Serum iron profile: serum iron and ferritin are low and TIBC( total iron binding capacity) is high.

5.Other investigation: for detecting the aeitology of iron deficiency:
*Stool R/M/E and for occult blood test(maybe positive) and for helminthic.

💎Answer No. 3:

1.Observe patient upto 6-8 weeks untill Hb level return to normal
2.Treatment of underlying cause ex. Helminthic infestation
3.Advice to maintain dietary habits, personal hygiene

Once normal, the haemoglobin concentration and red cell indices should be monitored at intervals.
Usually three monthly for one year
and then after a further year.
Further investigation is only necessary if the haemoglobin and MCV cannot be maintained in this way.

💎Answer No. 4:
Dietary advice for IDA:
1. supplementation of diets rich in iron
2. Avoidance of foods deficient in iron
3. Avoidance of foods those interfere with iron absorption (ex.tea, coffee etc)

💎Answer No. 5:
Clinical features of lead poisoning :
1.Developmental delay & learning difficulties
2.Constipation or diarrhoea ( black stool)
3.Blue line on gum/ burtonian line.

💎Answer No. 6:
Investigation of lead poisoning:

1. History and examination:
*cognitive impairment
*behavioral changes
*headaches

2.Assessment of risk factors:
*age 9 to 36 months
*housing with lead hazards
*occupational lead exposure
*lead-contaminated water supplies.

3.Diagnostic investigation:
* Whole blood lead level
* complete blood count
* serum ferritin

4.other investigation to consider:
*24-hour urine lead with chelation
*abdominal radiographs
*nerve conduction studies.

5.Emerging test:
*x-ray fluorescence of long bones
*MRI brain

💎Answer No. 7:

Prevention of lead poisoning:
The goal is to prevent childhood lead exposure before any harm occurs.

Primary prevention – the removal of lead hazards from the environment before a child is exposed is the most effective way to ensure that children do not experience harmful long-term effects of lead exposure.

Secondary prevention: including blood lead testing and follow-up remains an essential safety net for children who may already be exposed to lead.


💎Answer No. 8:
Investigations for Aplastic Anaemia (AA) with findings:
CBC with PBF :
✅usually pancytopenia (low hemoglobin, leukopenia and thrombocytopenia)
occasionally bi/Monocytopenia
✅reticulocyte count :low
✅PBF: normocytic anaemia, no abnormal cells

Bone Marrow findings :
✅cellularity: markedly hypocellular marrow,
largely devoid of hematopoietic cells, often there is presence of only fat cells, fibrous stroma and few scattered Lymphocytes and plasma cells
✅markedly reduction in granulopoiesis, erythropoiesis and megakaryopoiesis

Chromosomal analysis: to detect Fanconi's Anaemia

Cytogenic analysis: to detect leukaemia

Viral markers: HBsAg

💎Answer No. 9:

Treatment of Aplastic Anaemia:
A. Counsel parents
B. Comprehensive supportive care:
- Quick evaluation of a febrile case & prompt starting broad spectrum antibiotics. Consider adding anti-fungal drugs if necessary.
- To alleviate symptoms of anaemia: Transfusion of peaked cells.
- In Life threatening bleeding: Platelet transfusion.
- Neutropenic diet (Raw meat, dairy products prohibited)

C. Immuno-modulation:
>Anti-thymocyte globulin
>Cyclosporine
>Tacrolimus

D. Specific: Hematopoietic Stem-cell transplantation

💎Answer No. 10:

Bone Marrow findings in Aplastic Anaemia:

✅cellularity: markedly hypocellular marrow,
largely devoid of hematopoietic cells, often there is presence of only fat cells, fibrous stroma and few scattered Lymphocytes and plasma cells
✅markedly reduction in granulopoiesis, erythropoiesis and megakaryopoiesis