WEEK 12 – THE WINE DARK SEA
D
Lead poisoning,
I
Bacterial, Viral, chronic urinary tract infection
M
Glucose metabolism
T
Leukemia
O
Anaemia – bleed, dietary, Hb malfunction, genetic; Cardiac – hole in heart
P
Neglect – failure to thrive
General comments:
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Appears to be a chronic/progressive condition rather than an acute condition
Chronic (> 3 months)
Progressive (implies the condition is getting worse)
What we need to know
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When was he weaned? (E.g: is there an underlying allergy)
Diet?
Timeline
Nature of food – iron?
Rate of growth
75th for weight; 75th for height;
TRIGGER TWO
1
What we found out:
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Iron deficiency in pregnancy = Can be common in pregnancy. Often appears only in pregnancy (not
in other times). Can be genetic.
Milestones at 9 months = stands holding on, crawls, sits unsupported
Centile chart = was in 75th centile at birth, now approx. 38th centile
URTI = quite common in young children. Usually about 3 – 8 each year. 25% of hospitalisations in
this age group due to this condition. Often coincides with severe anaemia (immune)
Sleep = after bacterial throat condition children can be especially tired (for quite a few weeks).
Anaemia can cause tiredness and increased sleep due to lack of circulating oxygen. Poor diet,
leukaemia, malabsorption, lack of care can also cause increased lethargy. Normal sleep for 6 months
= 14 hours a day (between night time and day time sleep).
Iron in babies = often iron stores run low in later half of babies first year. This is due to lack of iron
in the diet.
Thalassaemia = investigated due to family history and ethnic group. Consider when this changes
(neonate to young child); there is an α type and β that lead to an anaemia that cause to inefficient
building of RBC.
Anaemia = a decrease is a decreased ability of the blood to carry oxygen
TRIGGER 3
2
What does this mean?
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Hypochromic = less colour
Microcytic = smaller
Blood tests indicate that RBC production is increased (reticulocytes)
3
HBA2 = 2 x α and 2 x δ
HBA = 2 x α and 2 x β
Therefore he has β thallasemia because he cannot make β chains. This is usually caused by point
mutations that either reduce or abolish β chain. This is on chromosome 11.
Transferring  transport of iron  plasma protein  2 binding sites, usually only attaches on one and
mops up with another. As he has just been given a blood transfusion, there will be extra iron around he will
have to transport this. This number shows that there is not a lot of free transferrin left to pick up iron left.
Ferritin  increased levels can occur if tissue damage is occurring. Iron stores in heart, liver, spleen.
Dimitri probably has high ferritin because his body will try and store it. Indicative of the iron stored in the
blood.
This pregnancy:
50% - minor
25% - major
25% - ‘normal’
Outcome – into 3rd decade due to skeletal and system problems
Folate is required to make RBCs – its use in RBC is particularly important because of the making of DNA
and RNA. It is needed to prevent anaemia.
4
Dimitri gets given medication overnight so that it doesn’t interfere with daily activities
Note: problems with compliance during adolescence
Stem cell transplants are recommended early; before iron deposits have occurred.
generally high  but depends!
Survival rates are
5