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NG-379

🥦 Pediatric cancers & bleeding disorders

Wilms versus neuroblastoma, osteosarcoma versus Ewing, and the two bleeding disorders that look alike until you check the labs.

🚨 The one idea

A child with a known or suspected abdominal tumor does not get their abdomen palpated. Sign the bed: DO NOT PALPATE ABDOMEN. Handling the mass can seed tumor cells.

Bathe and dress the child carefully for the same reason.

🧿 Wilms vs neuroblastoma — the midline tells you

WILMS TUMOR smooth, firm, one side only does NOT cross the midline NEUROBLASTOMA irregular, lumpy, often adrenal DOES cross the midline
 Wilms (nephroblastoma)Neuroblastoma
Comes fromThe kidneySympathetic nerve tissue, often the adrenal gland
Usual age2–5 yearsUnder 5, often under 2
The massSmooth, firm, one-sidedIrregular, crosses the midline
Also seenHypertension, blood in the urineBruising around the eyes, bone pain, a droopy eyelid
Found byUsually a parent, while bathing or dressing the child
NursingDo not palpate. Sign the bed. Handle gently.

🦴 Osteosarcoma vs Ewing sarcoma — where on the bone

METAPHYSIS the wide end, near the knee OSTEOSARCOMA during the growth spurt DIAPHYSIS the middle shaft — also pelvis and ribs EWING SARCOMA can look like a bone infection
 OsteosarcomaEwing sarcoma
WhereMetaphysis — the end of a long bone, classically around the kneeDiaphysis — the shaft — and flat bones
SymptomsPain worse at night, a palpable mass, a limpThe same, plus fever and a raised white count
Mistaken forA sports injuryOsteomyelitis
On X-rayA “sunburst” patternAn “onion-skin” pattern
TreatmentChemotherapy plus surgeryChemotherapy plus radiation — it is radiosensitive
Spreads toThe lungs — a new cough or breathlessness is not nothing
🧠 Osteo → the End of the bone. Ewing → the middlE. And Ewing is the one that comes with a fever.

🩸 Hemophilia vs immune thrombocytopenia

Both children bruise. The pattern of the bleeding, and one lab, separate them.

 HemophiliaITP (low platelets)
ProblemA missing clotting factor — VIII in A, IX in BPlatelets destroyed by the immune system, often after a virus
InheritanceX-linked — boys affected, mothers carry itNot inherited
Classic bleedInto a joint — warm, swollen, painful, will not bendInto the skin — petechiae, purpura, nosebleeds
LabsaPTT long; platelets normalPlatelets low; PT and aPTT normal
TreatmentFactor replacement; desmopressin for mild AOften watchful waiting; IVIG or steroids if severe
🧠 Hemophilia bleeds into joints. ITP bleeds into skin. Deep versus surface.

🧵 A joint bleed — what to do first

Rest, ice, compress, elevate — and give the factor. Immobilize the joint in a position of comfort; do not exercise it while it is actively bleeding.

Long term: physiotherapy matters, because repeated bleeds destroy the joint.

✅ Bleeding precautions — the same for both

  • No aspirin and no NSAIDs — acetaminophen for pain instead
  • No rectal temperatures, suppositories or enemas
  • Soft toothbrush; electric razor for teenagers
  • Avoid intramuscular injections where there is a choice; hold pressure longer when there is not
  • No contact sports — swimming and cycling with a helmet instead
  • A head injury is an emergency in either condition, even with no visible bleeding
DO NOT PALPATE→ WHERE IS IT→ PROTECT FROM BLEEDING
NG-379 · Pediatrics unit · ADHD-friendly visual edition