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Pediatric Hematology/Oncology Archive Questions

Below are Dr. York’s answers to Pediatric Hematology/Oncology questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 16.

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Q : 1

What is the chance of survival for a 10-year-old at an intermediate stage of Non-Hodgkin's lymphoma.

Non-Hodgkin's lymphoma is very treatable, especially in children.

Q : 2

My son was diagnosed 1 year ago with ITP after 2 years of regular symptoms. He has since been treated with IVIG, Steriods, Direct Platelets and just finished one month of chemo. None of these treatments have worked for him. Some have brought his platelet count up to the mid 50s but they continue to drop. His normal count has been holding at 16000. He had a bone marrow analysis done and all was normal. We are at a point that we just don't know what to do. Can you please offer any advise?

I would advise you to discuss with your doctor about a referral to a specialist (Pediatric Hematologist) and if you have already seen a specialist, then I would talk to them about getting another opinion on options for your son.

Q : 3

What test can I request for my 2 sons (ages 3 and 6) to detect familial lymphoma tendency? My husband's father and brother, now deceased, suffered from this cancer. I am concerned that my children may be predisposed to the same condition.

You should ask your pediatrician to refer you to a genetics doctor. They will take a detailed family history and recommend testing, if indicated.

Q : 4

I have a 7-year-old that bruises extremely easily. We've had a full blood panel done and everything came back normal. Her iron was a bit low, but not enough to put her on a supplement. She doesn't eat meat. Other than that she eats pretty healthy. I worry about the bruising and am concerned that it may have to do with her diet. Any advice?

If she bruises easily, she should be tested for vonWillebrand's disease. There is nothing she can eat to stop the bruising.

Q : 5

My 2-year-old granddaughter has leukemia (ALL). She is in remission now, but we don't know which way to go, standard or intense chemo. My daughter is having a hard time making the decision. The doctor has said there is a chance of it coming back with either treatment. Any thoughts or suggestions?

If she is being asked to participate in a study which would assign her to standard vs intense chemo, your daughter should discuss the two treatments with the oncologist. I think this is a very personal decision to make. Either treatment would treat her leukemia.

Q : 6

My 8-year-old son's blood test shows elevated pt and ptt. This was done a second time with the same results. I'm worried; please tell me what this means.

This means that your son needs to have different clotting factor's tested to see if he bleeds easily. He should be seen by a blood specialist (Hematologist) to do this work up. It can also be an error in the lab so you have to be careful of misinterpreting this test but a hematologist would be able to help with this.

Q : 7

My 9-year-old son's blood work says his EBV early ag is 1:40 and his doctor ordered more test for leukemia and lymphoma. Should I be worried and what should I do next? His symptoms are overweight, fatigue and sweats when during minor activities.

It is typical for a doctor to screen patients with fatigue and sweats for infection with viruses as well as screening for leukemia and lymphoma. I would wait and see what the results are.

Q : 8

My daughter had a benign tumor of the spleen removed. She had anemia for 5 years until the tumor was discovered. Since the removal in March 09, she had very high platelets that are now in the 600's. She often complains of achy legs, could this be a side effect from the elevated platelets? All other blood work has returned to normal.

The high platelet count is from the splenectomy. I am not aware of high platelets causing leg pain. Platelet count of 600 would not increase her risk of a clot. I am not sure if something else could be going on and I would discuss this with your primary care doctor.

Q : 9

How can ABO incompatibility occur in infants when the mother is type O? Type O is the universal donor, why doesn't that matter in these instances?

When ABO incompatibility occurs in mothers with type O blood, it is because their babies have A, B or AB blood type. Because of the difference in blood types, the mother's body can form antibodies to the baby's red blood cells. This occurs in the umbilical cord where baby's red blood cells get into maternal circulation. The good news is that the baby will eventually make its own antibodies that will not attack red blood cells and the destruction of red blood cells will cease.

Q : 10

Due to unavailabilty of Dactinomycin in Egypt,(very hard to provide) some practitioners recommend using DOXOrubicin instead of it in Wilms' tumor, RMS and other regimens. Is there any reliable evidence for this? If so, what are the equivalent doses? Is there a certain guideline of intervals between vincristine, dactinomycin, and doxorubicin administration according to cell cycle specificity concept?

Dactinomycin and Doxorubicin are different classes of chemotherapy and I am not aware that this is an appropriate substitution. Dosing of chemo would be based on staging and type of disease that you are treating. Unfortunately I am not aware of any data treating the lower risk Wilms or Rhabdo with Doxorubicin instead of Dactinomycin.

Q : 11

My 10 year old son was admitted to the hospital after he began throwing up blood (105 fever & bad virus). They found that he had an elevated PTT (about 118) and referred us to another hospital. He has no symptoms of a bleeding disorder nor is there a family history of any. The doctors said they believe the high PTT may be due to the virus/inhibitor present and should return to normal in 4-6 weeks. They also mentioned that we might want to take him to a rheumatologist. Why?

It is correct that an elevated PTT can mean the presence of an inhibitor, but it can also be a sign of different factor deficiencies. The PTT can be repeated using a mixing study to see if it corrects and this would help the hematologist to figure out if an inhibitor is present or not. If you are unhappy with your current hematologist, have your primary care refer you to another one in your area.

Q : 12

I am interested in obtaining information pertaining to improving the health of joints for hemophilia patients such as exercises, diet, etc. Do you have any information along these lines?

I am not aware of anything such as exercises or diet to improve the health of joints for hemophilia patients. Their joint problems are secondary to bleeding which is due to low Factor 8 or Factor 9 depending on what type of hemophilia they have. However, prophylaxis therapy can help reduce the severity and frequency of joint bleeds.

Q : 13

Could a child under the age of 2 develop hemolytic anemia after being bitten by fleas at day care?

Hemolytic anemia can be autoimmune meaning the body's immune system is attacking its own red blood cells or it can be idiopathic meaning that the cause is unknown. I have not personally known of a case of the fleas directly causing this. I would see a dermatologist and make sure these are "flea bites" and if you have anemia your child should be seen by a pediatric hematologist.

Q : 14

My 2 year old son has too few platelets and has been diagnosed with ITP. How long does this condition usually last and will it have any long term effect on his health?

Unfortunately there is no test to do at diagnosis to tell how long this will last. You just have to do labs and see when it goes away. This does not progress to a health problem. It means he is at risk for bleeding currently, but when his platelet count improves, that risk is gone.

Q : 15

My 6-year-old daughter was diagnosed with hereditary spherocytosis. After many blood transfusions and a low red count she had a spleenectomy done in May 2008. She takes penicillin every morning and every night. Doctors told us whenever she gets a fever of 101 or higher, we have to come to the hospital for precaution reasons. They give her a strong dose of antibiotics. Is this a normal routine? We've already been there twice since her spleenectomy. I would just like another opinion. Also how long do you think she will need to take the penicillin? At what age can she stop?

I would definitely support and agree with the management of taking precautions for fever due to her splenectomy. The age of stopping penicillin has been discussed in our group with our infectious disease experts and we tend to recommend through age 18 and lifelong vaccinations. You could discuss this more with your hematologist and pediatrician. The penicillin helps prevent an infection and the vaccines are also prevention. The type of infections your daughter is susceptible to can be life-threatening, which is why they have you bring her in every time she has a fever.

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