Pediatric blood & cancer
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Pediatric blood & cancer · Jul 2005
Minor elective surgical procedures using general anesthesia in children with sickle cell anemia without pre-operative blood transfusion.
Pre-operative red blood cell (RBC) transfusions are often recommended for patients with sickle cell disease (SCD) who require elective surgery under general anesthesia. However, definitive randomized studies demonstrating the benefit of transfusions in this setting have not been conducted. In particular, the merits of transfusion prior to minor or low-risk surgical procedures in children with SCD have not been demonstrated. ⋯ Minor or low-risk elective surgical procedures in children with Hb SS may not routinely require pre-operative transfusion. A randomized clinical trial to compare transfusion with no transfusion for minor surgical procedures is needed.
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Pediatric blood & cancer · Jul 2005
Early complications in children with acute lymphoblastic leukemia presenting with hyperleukocytosis.
The optimal management of childhood acute lymphoblastic leukemia (ALL) with hyperleukocytosis is unclear, largely because the risk of leukostasis-related complications is poorly characterized. ⋯ Serious leukostasis-related complications are relatively uncommon in childhood ALL and most occur at presentation. Their incidence increases in proportion to the leukocyte count. A large subset of cases can be managed successfully without cytoreduction. Cytoreduction may be considered for patients with leukocyte counts >400 x 10(9)/L or patients who have complications at presentation.
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Pediatric blood & cancer · Jun 2005
ReviewPathophysiology of anthracycline- and radiation-associated cardiomyopathies: implications for screening and prevention.
Great progress has been made in treating childhood cancers over the past 40 years. Along with second malignancies, a major complication of anti-cancer therapies is adverse cardiovascular effects, especially cardiomyopathy and coronary artery disease. The pathophysiology and characteristics of cardiomyopathy associated with radiation therapy and anthracycline therapy are distinctive. ⋯ These distinctive cardiomyopathies require different screening tests. Appropriate screening of the entire cardiovascular system should be performed because radiation and chemotherapy affect the entire system. Prevention recommendations focus on cardiomyopathy and coronary artery disease.
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Approximately 70% of all children diagnosed with malignancy become long-term survivors. Anthracycline cardiotoxicity may complicate physical performance and invite a "spectrum of disuse." There is a paucity of information derived from longitudinal, prospective, randomized clinical trials of exercise in cancer survivors, and there are no guidelines concerning the risk of recreational (non-competetive) exercise in adolescent and young adult patients with anthracycline cardiomyopathy. This review will discuss screening procedures that should be performed when assigning exercise regimens to cancer survivors with or without evidence of left ventricular dysfunction. Current recommendations for exercise testing and exercise prescription are also provided.