Pallor in children: diagnostic approach — formative SAQs

SAQ 1 (10)

An 18-month-old has progressive pallor, drinks large volumes of cow’s milk, and is otherwise interactive. CBC shows microcytic hypochromic anaemia with low ferritin. ^[1]

1. State a one-sentence problem representation. (2) ^{[1] [6]}
2. Explain how MCV and reticulocyte count organise the broader anaemia differential beyond this case. (4) ^[6]
3. Outline cause-directed management and how you will prove response. (4) ^[1]

Model answer

Problem representation. Toddler with dietary risk and confirmed iron-deficiency anaemia without clinical red flags for marrow failure. ^[1]

Classification grid. MCV sorts micro/normo/macrocytic patterns. Reticulocytes ask whether the marrow is responding: high suggests loss/haemolysis; inappropriately low with severe anaemia suggests production failure. Film refines morphology (hypochromia, spherocytes, blasts). ^[6]

Management. Reduce excessive cow’s milk, improve dietary iron, start iron per local product guidance, safety-net, and recheck for expected laboratory response; failure to rise triggers rethink of diagnosis, loss or adherence. ^[1]