Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
Is there any indication for hydroxyurea in patients with sickle cell trait?
No. Of course, be sure it is the correct diagnosis and not HgA + HgS (beta+) which, as you know, shows HgA and HgS on electrophoresis and can/will be called trait if not looked at by someone experienced to note if A> S or if S > A. If MCV is low. If HgA2 is up. HgF up etc... If indirect Bili/LDH/AST...
How do you manage arthritis resulting from deferiprone in transfusion dependent thalassemia?
The precise pathophysiology of deferiprone associated arthropathy is not well understood but some reports have suggested that there may be some deposition of iron in the synovial membranes, and some subchondral bone damage. Unfortunately, there is no specific treatment for this arthritis, other than...
How do you manage mild Type 1 von Willebrand disease undergoing wisdom teeth removal?
This depends on the patient's past personal and family bleeding history with past challenges and on the VWF levels. If past challenges are known and no bleeding has occurred, and if the VWF levels are 30 IU/dL or greater, I would give only EACA p.o. pre and post. Intranasal DDAVP 2 hours prior and 4...
Is there a correlation between spleen size and degree of thrombocytopenia?
In a normal individual, approximately 1/3 of total body platelets are sequestered in the spleen at any given time. As the size of the spleen increases, so too does the proportion of platelets in the spleen increase. This is due to the total volume of the spleen, not just longitudinal measurement. It...
Would you consider continuing or re-trialing hydroxyurea for sickle cell patients after development of a leg ulcer?
I do not think HU is the cause of leg ulcers, neither does ASJ. Habibi et al., Blood 2023 Most cases of ulcers are multifactorial and studies have also included patients with thrombocytosis (even myeloproliferative disorders!!). Low nitric oxide is part of the cause of leg ulcers in most cases. HU r...
How do you manage prophylactic antimicrobial medications in patients who undergo ATG/cyclosporine/eltrombopag induction for severe aplastic anemia?
Yes for prophylactic antibacterials after ATG/cyclosporine and eltrombopag treatment of AA. Antiviral with valtrex 500mg oral twice daily and PJP prophylaxis while on immunosuppression with cyclosporine.Antibacterial with levofloxacin and antifungal prophylaxis with posaconazole 300mg oral daily or ...
Is it appropriate to substitute vincristine for vinblastine in ABVD for systemic therapy of Hodgkins lymphoma?
I would give vinorelbine.
What is the ideal period to wait until curative surgery for patients with acute pulmonary embolism and solid malignancy?
This is a very important and practical question. As with most clinical circumstances, there is no evidence-based recommendation. The approach will vary with individual situations. For example: 1) Incidentally discovered subsegmental PE: my bias would be to proceed with curative surgery after one mon...
What is your preferred formulation of parenteral iron?
The question is not simple. The formulation I use the most is ferumoxytol because four insurance carriers allow a total dose infusion of 1020 mg in 20-30 minutes. This has been published twice (Auerbach et al., PMID 21922526 and Karki and Auerbach, PMID 31155744). Otherwise, it must be given as two ...
What is the radiation volume for M+ pure germinoma with brain only extra-ventricular mets and negative CSF/spine imaging?
In general, I wouldn't recommend chemo for M+ Germinoma kids because it does not favorably improve the therapeutic ratio based on the findings from GCT96 (NCT00293358).Independent of chemo, 24 Gy CSI with a boost to 36-40Gy is sufficient for cure. With chemo, 21 Gy CSI & an involved field boost to 3...