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PE26.1-17 | Hemato-Oncology — Assignment

CLINICAL SCENARIO

Students will evaluate a real or simulated paediatric case presenting with anaemia, thrombocytopenia, or bleeding disorder from the haemato-oncology spectrum. The write-up requires students to demonstrate a systematic diagnostic approach, interpret haematological investigations (CBC, peripheral smear, iron studies, haemoglobin electrophoresis), formulate a management plan, and provide evidence-based counselling aligned with national health programme recommendations. This exercise builds competency in integrating clinical, laboratory, and therapeutic reasoning for common and serious haematological conditions in Indian children.

Instructions

  1. Select a real paediatric inpatient or outpatient case presenting with pallor, bleeding, lymphadenopathy, or a known haematological diagnosis (IDA, thalassaemia, ITP, haemophilia, ALL/lymphoma). If no real case is available, your faculty will provide a standardised case vignette.
  2. Obtain patient/guardian consent for educational use (anonymise all identifiers).
  3. Complete the structured write-up in the sections below.
  4. Include actual or provided investigation results with your interpretation.
  5. Reference at least two current guidelines or textbook sources (Ghai Essential Pediatrics, Nelson, IAP guidelines, NACP).
  6. Submit as a typed document (1,000–1,400 words excluding tables and references).
  7. Peer review: after submission, review one assigned peer's write-up using the provided criteria.

Length: 1,000–1,400 words (excluding tables and references). References: minimum 2 (Ghai, Nelson, or IAP guideline).

What to Submit

Section 1: Case Presentation (History and Examination)

Guidance: Summarise the presenting complaint, duration, dietary history (cow-milk excess, vegetarian diet, access to IFA supplementation), bleeding history (epistaxis, petechiae, haemarthrosis, gum bleeding), family history (consanguinity, similar illness in siblings, known thalassaemia/haemophilia trait). Describe relevant examination findings: pallor (conjunctival/palmar), jaundice, petechiae/purpura, lymphadenopathy, hepatosplenomegaly. Use accurate clinical descriptors (mild/moderate/severe pallor; spleen measured in cm below costal margin in mid-clavicular line).

Section 2: Investigation Interpretation

Guidance: Present and interpret: (a) Complete blood count with indices (Hb — compare to age-appropriate cut-offs: neonate ≥14, infant 6-24m ≥11, child 5-11y ≥11.5 g/dL). Calculate and interpret Mentzer index (MCV/RBC) where relevant: >13 favours IDA, <13 favours thalassaemia trait. (b) Peripheral smear — describe RBC morphology (microcytic hypochromic, spherocytes, target cells, sickle cells, schistocytes, bite cells, Heinz bodies, blasts, hypersegmented neutrophils) and correlate with diagnosis. (c) Iron studies (serum ferritin, serum iron, TIBC, transferrin saturation) where applicable. (d) Haemoglobin electrophoresis/HPLC — interpret HbA, HbA2, HbF fractions. (e) Any additional tests (osmotic fragility, DAT, G6PD assay, bone marrow aspirate, LFT, LDH).

Section 3: Diagnosis and Pathophysiological Explanation

Guidance: State the final diagnosis with ICD classification if applicable. Explain the pathophysiology in 150–200 words: for IDA — explain the iron absorption-transport-utilisation chain and how depletion causes microcytic anaemia; for thalassaemia — explain globin chain imbalance and ineffective erythropoiesis; for ITP — autoimmune platelet destruction; for haemophilia — intrinsic coagulation pathway defect; for ALL — clonal blast proliferation and marrow failure. Use diagrams if helpful.

Section 4: Management Plan

Guidance: Write a structured management plan: (a) Specific treatment — drug, dose (mg/kg), route, frequency, duration (e.g. elemental iron 3–6 mg/kg/day for IDA; FVIII concentrate dose formula for haemophilia; IVIG 0.8–1 g/kg for acute ITP; chelation for iron overload). (b) Supportive care (diet, activity restrictions, avoid triggers/IM injections/aspirin). (c) Monitoring — what to check and when (reticulocyte count day 5–10, Hb at 4 weeks for IDA; ferritin every 3 months in thalassaemia). (d) Referral criteria — when and where to refer (tertiary haemato-oncology for ALL, haemophilia comprehensive care centre).

Section 5: Counselling and Family Education

Guidance: Describe the counselling you provided or would provide to the family: (a) Explanation of diagnosis in simple language. (b) Dietary counselling for IDA (iron-rich foods, avoid cow-milk excess, vitamin C enhances absorption). (c) Prevention of crisis/bleeding (activity modification, avoid oxidants in G6PD, avoid NSAIDs in haemophilia, penicillin prophylaxis in sickle cell). (d) Genetic counselling for inherited disorders (thalassaemia carrier testing, haemophilia X-linked inheritance). (e) National programmes — awareness of NACP IFA supplementation programme, availability of factor concentrates under national policy.

Section 6: Reflection

Guidance: Write 100–150 words on: What was the most important learning from this case? What clinical or diagnostic error was avoided by systematic investigation? How will this experience change your approach to the next child with pallor?

Grading Rubric — Haemato-Oncology Case Write-Up Rubric
Criterion Points Full-marks descriptor
History and Examination: Accurate, structured, with appropriate age-referenced clinical assessment including relevant haematological history (diet, bleeding, family history) and examination findings (pallor grade, organomegaly measurements). 20 pts Comprehensive, accurate history with all pertinent positives and negatives; examination described with precise clinical descriptors and measurements; no factual errors.
Investigation Interpretation: Correct interpretation of CBC, peripheral smear, and at least one specialised test (iron studies/HPLC/osmotic fragility/coagulation) with age-appropriate reference ranges cited. 25 pts All investigations interpreted correctly with age-appropriate reference ranges; peripheral smear morphology described accurately (specific RBC abnormality named and linked to diagnosis); specialised tests interpreted without error.
Pathophysiological Explanation: Clear, accurate mechanistic explanation of the diagnosis, appropriate for a final-year student, with correct disease-specific pathophysiology (not generic). 20 pts Accurate, disease-specific pathophysiology explained clearly; mechanisms correctly described (e.g. iron absorption cascade for IDA; globin chain imbalance for thalassaemia; autoimmune platelet destruction for ITP); no factual errors.
Management Plan: Evidence-based, weight-based dosing where applicable; correct drug choice, route, duration; monitoring plan; referral criteria stated appropriately. 20 pts Complete management plan with correct drug/dose/route/duration (weight-based); monitoring schedule appropriate; referral criteria correctly stated per national guidelines; no contraindicated drugs prescribed.
Counselling and Reflection: Patient-centred, culturally appropriate counselling with clear family education; reflection demonstrates genuine learning and self-awareness. 15 pts Counselling is empathetic, specific, and actionable (diet, triggers, genetic implications, programme awareness); reflection is insightful and identifies a specific learning point; connects to future practice.

PEER REVIEW

Review your assigned peer's write-up using the rubric criteria. For each criterion, assign a score and write 2–3 sentences of specific, constructive feedback. Identify: (1) one strength in their haematological reasoning, (2) one factual or dosing error if present, and (3) one suggestion for improving investigation interpretation or counselling. Feedback must be respectful and referenced to the case or guideline where possible. Submit peer review within 5 days of receiving the assignment.