Pediatric Hematology

  • 08/05/2018 - 10:00
  • King George's Medical University

1. Nutritional anaemia is the most common cause of anaemia in children.
2.For treatment of iron deficiency anaemia, oral iron needs to be supplemented @ 4-6mg/kg/day for 3-4 months.
3.Iron should not be consumed together with calcium preparations and milk.
4.Deficiency of Vit B12 and Folate are other important cause of nutritional anaemia in children. Presents with macrocytic anaemia.
5.Infants with B12 deficiency can present with ITS.
6.For treatment of megaloblastic anaemia, oral therapy with B12 (1000mcg/day) + Folate (1mg/day) can be tried if there is no malabsorption.
7.Whenever ordering investigations for a child with anaemia, always include CBC (with RBC indices), Peripheral smear, and Reticulocyte counts, ant not just Hb, TLC, DLC.
8.3-5% of indian Population is Carrier for Thalassemia.
9.Suspect Thalassemia major if an infant presents with Anemia and Hepatosplenomegaly after 6 months of age.
10.Always try to make a diagnosis before giving blood transfusion to the child (at least store some pre transfusion sample if transfusion is emergent).
11.Molecular testing for children with Thalassemia is available and should be done to identify the causative mutation. Will help in genetic counselling and pre-natal testing in subsequent pregnancies.
12.Children with Thalassemia major require life long regular blood transfusion marinating a pre transfusion Hb ~9.5-10 g/dl.
13.Regular monitoring for iron overload needs to be done and chelation should be started once Ser Ferritin is >1000ng/ml.
14.Hematopoetic stem cell transplantation (HSCT) offers cure for children with Thal major, but cost and availability of matched donor are the limitations.
15.Pancytopenia is decrease in all three cell lines in peripheral blood below the lower limit of age adjusted normal.
16.Aplastic anemia, megaloblastic anemia, leukaemia and infections are the most common causes in India. 17.Megaloblastic anaemia being more common in non-hematology centres, esp. those catering to low income families.
18.Good clinical examination with CBC & a PBS may preclude the need for BM examination in some cases but follow-up with repeat CBC is mandatory.
19.Bone marrow aspiration may be diagnostic in majority but trephine  biopsy is important to assess cellularity of marrow.
20.Presence of Splenomegaly virtually excludes a possibility of Aplastic anaemia.
21.If blasts in PBS refer to pediatric Oncology Centre without BM after managing emergencies.
22.Hematopoetic stem cell transplantation (HSCT) is a modality of treatment used for treatment of certain hematologic and genetic syndromes.
23.HSCT can be allogenic or autologous. Donor in Allogenic HSCT can be matched sibling (MSD), matched unrelated donor (MUD) or half matched parent (Haplo).
24.Source of stem cells for HSCT include Bone marrow, Peripheral blood or Cord blood.
25.Private cord blood banking should not be encouraged and promoted.
26.Urgent need to have HLA registries and public cord blood bank in India.
27.80% of childhood ITP- spontaneous recovery.
28.Complex interplay of cellular and humeral immunity.
29.Both increased destruction and reduced production.
30. Treat symptoms not platelet count.
31.IVIg, Anti D, and Steroids are mainstay.
32.Splenectomy/Rituximab/ Eltrombopag in Chronic ITP.

EVENT INFO :

  • Start Date:08/05/2018
  • Start Time:10:00
  • End Date:08/05/2018
  • End Time:02:00
  • Location:King George's Medical University