Zero to Finals

The pitfall is to call every infective dip in haemoglobin a haemolytic crisis. This episode is a strong refresher on jaundice, splenomegaly, gallstones, raised MCHC and the parvovirus B19 aplastic crisis that changes the interpretation of sudden deterioration.

The clue is microcytic anaemia that comes with jaundice, splenomegaly, or poor growth rather than sitting alone. This is a strong listen for anyone who wants a quick route from suspicion to haemoglobin electrophoresis, ferritin monitoring, and severity-based thinking.

Do not reassure yourself that chest pain or breathlessness in sickle cell disease is just another painful crisis. This is a strong refresher on acute chest syndrome, splenic sequestration, priapism, infection risk, and the practical checks that should happen every time a patient arrives in pain.

Isolated thrombocytopenia with bruising, petechiae, purpura or mucosal bleeding after a recent viral illness should trigger an early full blood count. Escalation depends on bleeding severity rather than the label alone, and platelet transfusion is reserved for life-threatening bleeding because correction is short lived.

Childhood leukaemia often presents as marrow failure rather than a single dramatic symptom. Fatigue, infections and bruising or petechiae together should trigger urgent blood testing, while unexplained petechiae or hepatosplenomegaly need immediate specialist assessment.

Iron deficiency anaemia in children is often hiding in the diet history. Microcytosis, low ferritin, pica and poor growth should prompt questions about excess cow’s milk, selective eating and menstruation, with treatment focused on oral iron plus correcting the cause.

Paediatric anaemia work-up starts with pattern recognition, not iron tablets alone. Reticulocyte count is the pivot: a raised count suggests haemolysis or blood loss, while a low count points towards reduced production and should trigger more targeted investigation.

Personality disorder assessment still starts with risk. Do not dismiss self-harm, suicidality or harm to others as 'just personality'; identify persistent interpersonal and emotional patterns, then prioritise psychological therapy and crisis planning over long-term sedative prescribing.

Developmental delay should be judged against thresholds, not reassurance alone. No words at 16 months or no sitting at 9 months warrants assessment, and early hand preference before 18 months can signal hemiplegic cerebral palsy rather than normal variation.

Eating disorders are missed when clinicians focus on weight alone. Parotid enlargement, dental erosion and Russell sign can indicate bulimia at normal weight, while more than five days of minimal intake should trigger refeeding-risk assessment before nutrition is restarted.