Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
What is your preferred strategy for young adults with ITP complicated by recurrent autoimmune neutropenia?
This is a great question, and I'll say that AIN can be particularly difficult to treat! I'd first ask how low the ANC is and if the patient is presenting with frequent infections/hospitalizations. If not, there may not be a need to treat the AIN (we may just be treating ourselves); oftentimes, there...
How do you explain the use of an AI scribe to patients the first time it is used in their care?
In residency, we had to get patient permission to videotape sessions and allow our supervisors to watch sessions from behind a one-way mirror. If I were to use a scribe, especially an AI scribe, or if I were audio or video taping the sessions, I would definitely want to get a patient’s approval. I d...
What is the best way to prepare children with von Willebrand disease for tonsillectomy to reduce the risk of post-operative hemorrhage?
I am an adult provider, but the treatment is similar regardless of age. The exact treatment plan will vary depending on the type and severity of VWD (i.e., mild type 1 VWD vs type 2B VWD); however, for tonsillectomies, I provide VWF concentrate 40-80 IU/kg 5-30 min preoperatively, followed by postop...
What is your target Hgb/Hct for women who are pregnant and have sickle cell disease in whom you are doing scheduled transfusions?
Assuming that the patient is truly transfusion-dependent, the usual target range is a Hb of 9.5-10.5.
At what point would you recommend initiating psychotherapy or psychotropic medications to manage mood and anxiety symptoms following a new oncology diagnosis in pediatric patients?
Perhaps the most important piece to this question is missing, and that is that more history is required to determine what to do with a recently diagnosed cancer patient. What was the patient’s psychiatric status pre-cancer? If the patient had undiagnosed mental health problems–anxiety or depressio...
In an adult patient with asymptomatic, isolated neutropenia in whom you suspect a Duffy null phenotype, at what ANC or in what situations would you do a bone marrow to look for other etiologies of neutropenia?
What a great question! Happy to answer. As you know, as many as 60% of individuals who have the Duffy null phenotype will have an ANC that is lower than the lower limit of normal in many labs BUT as you also know, the total body (in circulation + in tissues) neutrophil count in such individuals is n...
When would you consider use of emapalumab for HLH/MAS?
The FDA has approved emapalumab for familial HLH. For secondary HLH/MAS, I typically begin with anakinra (100 mg q 6 hrs for those 40 kg or more). If this is not enough and if CXCL9 (I send on day one to have the data available) is notably elevated, then consider adding emapalumab. Alternatively, a ...
What are your top takeaways in Hematologic Malignancies from ASH 2024?
Years ago, I was consulting with a patient who had moved to the Pacific Northwest after being diagnosed elsewhere with multiple myeloma. After engaging in initial pleasantries and just before I was about to peel away the specifics of her medical history, she stopped me in my tracks. “Did you go to A...
Do you use G-CSF for a patient with ALL admitted for febrile neutropenia with prolonged count recovery?
Acknowledging the lack of definitive data, in our group we use G-CSF as primary prophylaxis in adult patients with ALL treated with intensive chemotherapy and hardly ever need to re-administered if they develop FN subsequently. That said, for prolonged neutropenia despite prior G-CSF, we may adminis...
How would you manage aplastic anemia refractory to multiple agents?
If indeed the patient has been treated with all reasonable alternatives to BMT, the choices are 1) watch and wait with supportive care or 2) bone marrow transplantation. I understand the reluctance of transplanting someone in their 70s with aplastic anemia; however, we do this routinely in patients ...