Where are my cells? SAQ added anonymously 

 
This SAQ is worth 12 marks

A 2 year old girl is referred by the GP with a high temperature. On examination she is pale and has increased work of breathing. She has a fine non blanching petechial rash on both her arms, legs and torso. Her lungs are clear. She has hepatosplenomegaly.

Her initial investigations show:

Hb 34 g/L (120-180)
WCC 30 x 10^9 (4-10)
Platelet 40 x 10^9 g/L (150-400)
Blood film: Immature blasts

Question 1.
List two (2) abnormalities on this result and give one (1) treatment for each. (4 marks)

     Abnormality Intervention
1    
2    



Question 1.
List four (4) likely potential complications arising from the underlying condition. (4 marks)

 

1. _____________________________________________________________________________________

 

2. _____________________________________________________________________________________

 

3. _____________________________________________________________________________________

 

4. _____________________________________________________________________________________



Question 3.
List four (4) likely potential complications arising from the emergency treatment of this patient. (4 marks)

1. _____________________________________________________________________________________



2. _____________________________________________________________________________________



3. _____________________________________________________________________________________



4. _____________________________________________________________________________________



 
This SAQ is worth 12 marks

A 2 year old girl is referred by the GP with a high temperature. On examination she is pale and has increased work of breathing. She has a fine non blanching petechial rash on both her arms, legs and torso. Her lungs are clear. She has hepatosplenomegaly.

Her initial investigations show:

Hb 34 g/L (120-180)
WCC 30 x 10^9 (4-10)
Platelet 40 x 10^9 g/L (150-400)
Blood film: Immature blasts

Question 1.
List two (2) abnormalities on this result and give one (1) treatment for each. (4 marks)

  • Listing abnormalities is not consultant level, interpretation is! Pick abnormalities on FBC and treat.
  • It is important to specifically answer the question.
  • Add haematology consult in any shape or form including administration of chemotherapy or BM aspirate (required by construct of question). This is the required response for Blasts!
  • The first part of the question asked for the listing of 2 abnormalities demonstrated in the haematological result and the treatment of each abnormality. 
  • The question was generally answered well overall.
  • Good candidates listed the formula to demonstrate the amount of RBC or platelets to be given for the correction of anaemia and thrombocytopenia respectively. 
  • As a response to identifying an elevated WCC good candidates gave doses of antibiotics. 
  • Some candidates inappropriately interpreted blood count results beyond what was demonstrated e.g. ‘bacterial meningitis’, ‘urosepsis’. 
  • Poor answers include ‘hydration’ for ‘leukocytosis’
  • Candidates
    • Generally got full marks.
    • If not: usually because Rx inadequate spectrum AB Tx.


Question 1.
List four (4) likely potential complications arising from the underlying condition. (4 marks)

Candidates

  1. Tended to not score marks for extremely rare complications.
  2. Tumor lysis syndrome is not a complication of the condition. It is a complication of therapy
  3. Physiological manifestations of the pathological process (e.g. hypoxia, decreased oxygen carrying capacity and pain) aren’t complications.


Question 3.
List four (4) likely potential complications arising from the emergency treatment of this patient. (4 marks)

  • Candidates often seemed to have overlooked the word “likely”
  • There was a tendency to essentially continue the list of complications of the condition from section 2.
  • Chemotherapy is not an ED therapy so its complications (e.g. tumor lysis and electrolyte abnormalities) are not a complication of ED therapy.
  • Listing 2-4 different blood transfusion reactions indicated a very limited appreciation of all the possible complications of all the various ED therapies that might have been given.
  • IV catheter/line, etc. complications

TACO (transfusion associated cardiac overload) was a surprisingly common answer but with an incidence of between 1:100-10,000 transfusions could hardly be considered “likely”.

Accepted any extension of current situation

  • Anaemia
  • Thrombocytopaenia
  • Immunosuppression

 




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