Pediatric Hematology/Oncology
Clinical discussions on pediatric blood disorders, childhood cancers, and specialized treatment protocols.
Recent Discussions
How do you counsel an otherwise healthy patient on how soon they can go back to moderate exercise after a bilateral pulmonary embolism?
Generally, the approach is to have the patient start their exercise regimen at a lower intensity and gradually increase it based on their tolerance.
How should dose homogeneity across bone be handled in pediatric patients?
The radiation-associated bone damage can be affected by many factors, including total radiation dose, fractionation schedule, treatment volume, age of the child, symmetry of the delivered dose over vertebrae, developmental status of the irradiated growth plates, treatments such as chemotherapy or su...
What is your approach to further work-up and management of neutropenia in patients with SLE/RA overlap?
This is an interesting situation that comes up in the routine evaluation of patients with rheumatoid arthritis and other autoimmune syndromes. The normocellular bone marrow suggests a peripheral destruction, in general, and raises some concerns for antibodies directed against neutrophils. These are ...
How do you approach managing depression symptoms in patients who have had repeated high risk of bleeding?
Overall, evidence suggests that while SSRIs do increase the risk of bleeding. The absolute risk of a bleeding event remains low and is usually not serious. A 2017 meta-analysis by Laporte et al., suggested that overall bleeding risk is increased by at least 36% while other meta-analyses suggest that...
How do you manage a patient with sickle cell disease during pregnancy?
I refer all pregnant women with SCD to maternofetal medicine/high risk pregnancy clinic for more frequent monitoring. I recommend a baby aspirin for preeclampsia prevention (see UK guidelines). I recommend folic acid 4 mg. If they do have iron overload, I do not recommend iron supplementation. For a...
Should special precautions be taken patients with Ehlers-Danlos syndrome receiving radiation therapy?
Not all EDS is the same. Most commonly, an EDS patient these days is a clinically diagnosed patient with hypermobile joints, possibly stretchy skin, and possibly chronic pain syndrome. That is a very different picture from vascular EDS with a COL3A1 mutation, which is rare and would have the extreme...
Would you recommend an allogenic stem cell transplant in an older patient > 50 with Ph negative acute lymphoblastic leukemia who is MRD negative after induction?
In general, I would not routinely recommend allogeneic hematopoietic cell transplantation (HCT) for Ph- acute lymphoblastic leukemia (ALL) that is in MRD-negative remission this early in their treatment. This sort of response demonstrates significant chemosensitivity. Therefore, I would favor contin...
When should you use caplacizumab in the treatment of acute TTP patients?
Whenever I encounter a patient with features of thrombotic microangiopathy and a normal coagulation panel (that rules out DIC), I consider the possibility they may have immune TTP.If my suspicion of immune TTP is high (e.g. history of autoimmune disease, possible relapse of immune TTP) and there is ...
Do you routinely recommend completion hysterectomy with contralateral salpingo-oophorectomy for patients with a history of fertility-sparing staging for borderline tumor of the ovary who have since completed childbearing?
Borderline ovarian tumors, also known as atypical proliferative tumors by WHO classification, account for about 10-20% of epithelial ovarian tumors, have histologic subtypes similar to invasive ovarian cancer, and are characterized pathologically by a high degree of proliferation of the epithelial c...
What is your approach to IV fluid resuscitation during a sickle cell vaso-occlusive crisis?
My approach to IV fluid resuscitation in vaso-occlusive crisis is cautious and individualized. Adequate hydration is important to prevent further sickling, but I avoid aggressive fluid loading because of the risks of pulmonary edema and acute chest syndrome. I typically use isotonic balanced crystal...