Return to Diagnosis ListShow Learning Points most relevant to Phase 1:

Infant or child with pallor

Clinical Discipline(s)/Organ System(s)
Haematology, Paediatrics
Progress Test Topic(s)
Blood and lymph
A 12 month old Samoan boy is brought to see you by his grandmother and mother. His grandmother is visiting and hadn't seen him for 4 months; she has noticed that he is pale and has encouraged his mother to take him to the doctor.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Normal and abnormal haematopoiesis
   - Normal nutrition and growth (iron, vitamin B12/folate, vitamin D)
   - Acquired and inherited disorders of red cells and bone marrow
   - Genetic basis of red cell disorders (e.g. thalassaemia, sickle cell anaemia)
Clinical and Communication Skills 
   - Identify common types and causes of anaemia in infancy and childhood
   - Recognise shock (or impending shock) in infants and children
   - Use of history, physical examination and basic laboratory tests to diagnose causes of anaemia
   - Interpret full blood count, inflammatory markers, iron studies, Coombs test
   - Importance of iron deficiency long-term (effects on learning, diminished immune response to infection)
   - Dietary history; advice and iron prescription (adherence, safety, overdose)
   - How to assess pallor
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Explain diagnosis including genetic aspects where appropriate (e.g. carrier status in thalassaemia) to parents
   - Evaluation of social history including dietary and financial stressors
   - Acknowledge impact of illness on family/whānau employment/income
Hauora Māori 
   - Higher rates of anaemia among Māori (and Pacific, ‘Other’) infants than Pākehā
   - Lower rates of breastfeeding among Māori
   - Awareness of Whānau dynamics (who is/are carers)
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in NZ relevant to anaemia in children including deprivation, chronic infection
Population Health 
   - Poverty, health literacy and nutrition
   - Immigrant health and screening for genetic traits (e.g. G6PD deficiency and thalassaemia traits in Asian/Mediterranean families)
   - Most common world population causes for anaemia (sickle cell, thalassaemia and iron deficiency)
Conditions to be considered relating to this scenario
hypochromic microcytic anaemia (iron deficiency; thalassemia)
Less common but 'important not to miss'
leukaemia and other malignancies, anaemia of chronic disease, anaemia of chronic renal disease, lead poisoning
haemolytic anaemias (hereditary spherocytosis, G6PD deficiency, autoimmune disease)