Journal of pediatric hematology/oncology
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J. Pediatr. Hematol. Oncol. · Jan 2003
Comparative StudyWhole blood international normalization ratio measurements in children using near-patient monitors.
To report a comparison of international normalization ratio (INR) measurements on four near-patient (point-of-care or bedside) whole blood INR monitors in children. ⋯ Near-patient testing whole blood INR monitors offer acceptably accurate and precise measurements. Values obtained on near-patient monitors may vary considerably from the reference method, and data obtained should serve as a supplement to, but not a replacement for, routine clinical laboratory measurements.
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J. Pediatr. Hematol. Oncol. · Dec 2002
Case ReportsPseudotumor cerebri in two adolescents with acquired aplastic anemia.
A 13-year-old boy and a 16-year-old girl both presented with headaches and nausea after they were diagnosed with severe acquired aplastic anemia. Both patients had symptoms and signs consistent with the clinical syndrome of pseudotumor cerebri including headaches, nausea, papilledema, and elevated intracranial pressure. ⋯ Acetazolamide dosage was given while the patients underwent an immunosuppressive regimen. We hypothesize that the pseudotumor cerebri in these two pediatric patients was the result of an increased production of cerebrospinal fluid in response to anemia and that the removal of fluid and treatment with acetazolamide appear to be helpful in such cases.
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Hypothermia has been demonstrated to induce pancytopenia in animals, but whether this association exists in humans is unknown. The authors report the case of an 8-year-old girl in whom hypothermia (temperature 33 degrees C-35 degrees C) is the cause of pancytopenia. The patient developed thermoregulatory dysfunction subsequent to surgical resection of a craniopharyngioma. ⋯ The pancytopenia improved upon rewarming the patient to a temperature of 36 degrees C. This association between hypothermia and pancytopenia has rarely been reported in humans and may be underdiagnosed especially in cases of transient or milder presentations. The authors recommend careful hematologic monitoring of patients with thermoregulatory dysfunction.
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J. Pediatr. Hematol. Oncol. · Nov 2002
ReviewUse of tissue plasminogen activator (rt-PA) in young children with cancer and dysfunctional central venous catheters.
To determine the efficacy and safety of low, nonescalating dose tissue plasminogen activator (rt-PA) in restoring the patency of occluded central venous access devices (CVCs) in children with cancer who weigh less than 30 kg. ⋯ This article describes the use of rt-PA (0.5 mg, without dose escalation) to lyse CVC-associated thrombi specifically in small children with cancer, a patient population in which it is particularly desirable to minimize the degree of fibrinolysis. One dose of 0.5 mg rt-PA, with an additional dose if necessary, is as safe and effective as previously reported escalating dose regimens for CVC clot lysis. There is no statistically significant correlation of treatment failure with patient age, weight, or catheter lumen size, and no significant propensity for rapid rethrombosis following a single dysfunction and treatment. Patients initially treated with a single dose of rt-PA appear to have more subsequent dysfunctions in the month after treatment, an observation that warrants further study.
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J. Pediatr. Hematol. Oncol. · Nov 2002
Home management of pain in sickle cell disease: a daily diary study in children and adolescents.
To determine the incidence of pain and the types of home pain management techniques used by children and adolescents with sickle cell disease (SCD) and their caregivers. ⋯ Pain went untreated on a modest number of days, and many patients relied on relatively ineffective single analgesics. Other patients and families appropriately used potent analgesic combinations in a time-contingent and intensity-dependent pattern. This study suggests that recurrent acute pain from SCD can be successfully managed at home with appropriate training and supervision, and suggests several areas for intervention to improve patient outcomes.