Case 63 – update 1

We have a pale four year old boy who appears to be generally unwell with occasional fever and sore throat. On examination his observations show a tachycardia of 140bpm and respiratory rate of 35rpm. There is no menginism. There are very small shotty lymph nodes bilaterally and he has a red throat. There is a possible palpable spleen just below the costal margin. There is no gum infiltration and no ulcers. Testicular examination was not performed but later was found to be normal. There has been no bleeding or bruising.


The GP is sufficiently concerned and after discussion with the paediatric team sends the child to hopsital. A full blood count is performed. Preliminary results show:

  • Hb 45g/l (115-145g/l)
  • WCC 12×10*9/l (5-15×10*9/l) with normal white cell differential
  • Platelets 352×10*9/l (150-450×10*9/L)



  • What are the differential diagnosis of anaemia in a four year old?
  • What further tests are going to help you here?
  • The paediatric team feel he needs a blood transfusion given his abnormal observations. Are there any special requirements for a child of this age?


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