hematology and oncology peds unit

iron deficiency anemia

• Inadequate iron in the diet

  • At birth, infant has iron stores from mom

    • Lasts 5-6 months in full term infant

    • Lasts 2-3 months in preterm infant

  • After birth, 0.8 mg must be absorbed until age 15

  • Inappropriate vegetarian diet

iron deficiency anemia symptoms

• Underweight infant OR overweight infant due to excuse milk ingestion

• Pale

• Poor muscle development

• Prone to infection

• Edema

• Retarded growth

• Irritability

• Tachycardia

• Fatigue

• Glossitis

• Angular stomatitis

• Koilonychia

• Impaired neurocognitive function

iron deficiency anemia prevention

• Breastmilk or iron fortified formula x 6 months (12 for premature)

• Iron supplementation of 1 mg/kg/day by 4-6 months

• Administer iron drops to breastfeed preterm infants after 2 months of age

• Limit formula to no more than 1 L/day to encourage intake of iron-rich solid foods

• Screen for anemia at 12 months of age

• Infants less than 12 months should not be given cow’s milk

sickle cell train

• 35-45% of total hemoglobin is HgS

• Typically asymptomatic but carriers of condition

sickle cell disease

• 60-80% of Hgb is HgS

• Symptomatic, prone to sickle cell crisis

sickle cell anemia general symptoms

• Possible growth retardation

• Chronic anemia (Hgb 6-9)

• Possible delayed sexual maturation

• Marked susceptibility to sepsis

sickle cell anemia vascular occlusive crisis symptoms

• Extremities - painful swelling of hands and feet, painful joints

• Abdomen - severe pain

• Cerebrum - stroke, visual disturbances

• Chest - resembling pneumonia

• Liver - obstructive jaundice, hepatic coma

• Kidney - hematuria

• Genitals - priapism

sickle cell anemia sequestration crisis

Pooling of large amounts of blood (hepatomegaly, splenomegaly, circulatory collapse

vaso-occlusive crisis

• sickle cell anemia complication

• painful episode or event

  • Most common types of non-life-threatening crisis

  • Ischemia

sequestration crisis

• sickle cell anemia complication

•  pooling of large quantities of blood

  • Spleen or liver

  • Decreased blood volume - shock

cerebrovascular accident (CVA)

Sudden and severe complication of sickle cell anemia

acute chest syndrome

• sickle cell anemia complication

• Clinically appears like pneumonia (infiltrate on chest xray)

• Chest pain, fever, cough, tachypnea, hypoxia

sickling triggers

• Trauma

• Fever

• Infection

• Dehydration

• Stress

• Hypoxia

• Vasoconstriction

sickle cell anemia treatment

• Bed rest

• Hydration

• Electrolyte replacement

• Analgesia

• Blood transfusion

• Exchange transfusion

• Antibiotics

• Prevention infection

  • Vaccine

  • PVK

hemophilia types

• Factor VII deficiency (hemophilia A or classic hemophilia)

• Factor IX deficiency (hemophilia B or christmas disease)

hemophilia symptoms

• Prolonged bleeding

• Bleeding into tissue and joint cavities

hemophilia treatment

• Replace missing clotting factors

• DDAVP

• NSAIDS only used with caution

• Avoid ASA

• Recognize bleeding episodes early

• Avoid contact sports

immune thrombocytopenia

• idiopathic thrombocytopenic purpura ITP

• acquired hemorrhagic disorder

immune thrombocytopenia symptoms

Petechiae, bruising, bleeding from mucous membranes, prolonged bleeding from abrasions

immune thrombocytopenia acute treatment

• Prednisone

• IVIG (IV immune globulin)

• anti-D antibody

immune thrombocytopenia chronic treatment

Splenectomy (if no response to meds)

henoch-schonlein purpura (HSP)

• Allergic vasculitis/allergic purpura/anaphylactoid purpura

what characterizes henoch-schonlein purpura (HSP)

• Nonthrombocytopenic purpura

• Arthritis

• Nephritis

• abdominal pain

henoch-schonlein purpura (HSP) symptoms

• Primary feature 

  • Symmetric purpura (buttocks and lower extremities)

• Other symptoms

  • Rash - maculopapular lesions, erticaria, erythema

  • Edema

  • Arthritis

  • GI involvement

  • Renal involvement

henoch-schonlein purpura (HSP) treatment

supportive

child cancer acronym

• Continued, unexplained weight loss

• Headaches, often with early morning vomiting

• Increased swelling or persistent pain in bones, joints, back, or legs

• Lump or mass especially in the abdomen, neck, chest, pelvis, or arm

• Development of excessive bruising, bleeding, or rash

• Constant infections

• A whitish color behind the pupils

• Nausea which persists or vomiting without nausea

• Constant tiredness or noticeable paleness

• Eye or vision changes which occur suddenly or persist

• Recurrent or persistent fevers of unknown origin

cancer diagnosis labs

CBC, CMP, LFTs, coagulation studies, UA, ANC

cancer diagnostics

• LP (leukemia, brain tumors, mets)

• Bone marrow aspiration, tumor biopsy

• CT, MRI, PET

cancer treatments

• Surgery

• Chemo

• Steroids

• Radiation

• Biologic therapy

• Stem cell transplant

• Immunotherapy

stem cell transplant

• Kill original bone marrow

• Transplant with donor marrow

risks of stem cell transplant

• At risk for GVHD

• At risk for infection

• May cause change of blood type

chemotherapy

• Primary form of treatment

• Interferes with cells ability to grow and reproduce

  • Chemo kills rapidly growing cells

• Used alone or in combo with other treatments

myelosuppression

• a condition where the bone marrow's activity is reduced, leading to fewer red blood cells, white blood cells, and platelets

• can be a side effect of chemo

what is golden hour associated it

Neutropenic fever in a cancer patient

acute tumor lysis syndrome

a serious, potentially life-threatening condition caused by the rapid breakdown of cancer cells, leading to a release of their contents into the bloodstream

acute tumor lysis syndrome symptoms

• Anorexia

• Vomiting

• Weakness

• Lethargy

• Edema

4 metabolic abnormalities in acute tumor lysis syndrome

• Hyperphosphatemia

• Hypocalcemia

• Hyperuricemia

• Hyperkalemia

acute tumor lysis syndrome treatment

• allopurinol to help with prevention

• supportive care

chemotherapy side effects

• Extravasation

• Alopecia

• GI problems

  • nausea/vomiting

  • Nutrition

    • Offer small meals

    • Give child choices

  • constipation/diarrhea

  • Mucosal ulcers

• GU problems

  • Hemorrhagic cystitis

  • Neuropathy

ALL vs AML

• Group of malignant diseases of the bone marrow, blood, and lymphatic system

• ALL: most common form of childhood cancer

  • Boys more than girls

  • Whites more than african americans

  • Peak age 2-3 years

  • 90% survival rate

• AML

  • 20% of leukemia

  • Boys = girls

  • Higher rates during first year of life

  • 65% survival rate

are AML and ALL tumors?

no

AML and ALL treatment induction therapy

• 4-5 weeks

• Corticosteroids to maintain high levels

• Chemo

• Family support

• Achieves a complete remission

AML and ALL treatment consolidation therapy

• Several months

• Eradicates residual leukemia cells and prevents further cloning

AML and ALL treatment maintenance therapy

• Chemo

• Maintains the remission phase

osteogenic sarcoma

• Most common bone cancer

• Peak - 10-25 years

• Tumors in long bones especially lower extremities

osteogenic sarcoma treatment

• Surgery

  • May amputate

  • Limb salvage procedures

• Chemo

  • Given preoperatively

  • Postoperatively

ewing sarcoma

• Arises in the marrow spaces of bone

ewing sarcoma treatment

• Limb salvage procedures are recommended for better outcomes

• Chemo and radiation

hodgkin’s lymphoma

Disorder of lymphoid system

hodgkin’s lymphoma symptoms

• Firm, non tender lymphadenopathy

  • Enlarged, moveable nodes

  • Supraclavicular or cervical area

• Fever of unknown origin

• Night sweats

• Anorexia

• Weight loss

• Other symptoms related to locations of involvement

hodgkins lymphoma treatment

• Radiation

• Chemo

non-hodgkins lymphoma

• More common than hodgkins

• Predominantly in 15-19 year olds

• Large group of cancers of lymphocytes

  • Lymphoblastic

  • Burkitt

  • Non-burkitt

  • Large cell

• Aggressive or slow growing

• B or T cell

non-hodgkins lymphoma symptoms

• Painless swollen LN

• Fever

• Fatigue

• Weight loss

non-hodgkins lymphoma treatment

• Chemo and radiation tailored to stage of disease

• Removal of tissue mass if necessary/possible

what virus does Burkitt’s lymphoma often preceed

• epstein-barr virus

CNS tumor symptoms

• Infants hard to detect

• Symptoms increased ICP

• Increased head circumference

• Headache when waking and vomiting unrelated to feeding

CNS tumors treatment

• Surgery

• Radiation

• Chemo

• Maintain low ICP

neuroblastoma

• Most common extracranial solid tumor

• Most common cancer in infancy

• Silent tumor

  • Arise from adrenal gland or in the neck, chest, or spinal cord

neuroblastoma treatment

• Surgery to remove affected kidney

• Chemo

• Radiation

wilm’s tumor

• Malignant tumor that arises from the kidney

• Swelling or mass in abdomen

• DO NOT palpate abdomen - encapsulated tumor

• Rapid growing - can double size in 11-13 days

retinoblastoma

• Sporadic or genetic intraocular tumor

• Congenital malignant tumor

• Unilateral or bilateral

• Leukocoria

• Strabismus - second most common sign

retinoblastoma treatment

• Enucleation

• Radiation

• Cryotherapy

• Chemo