Pediatrics Subject Collection: Blood

Index of Suspicion [ARTICLES]

Vo, M. — 2009-11-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Case 3 Discussion A previously healthy 9-year-old girl presents with a 1-week history of intermittent confusion, dysphagia, visual changes, and involuntary movements of the face and left hand. During this period, she has had two episodes of disorientation and memory loss that were not associated with alteration in consciousness or behavioral changes. The involuntary movements of the left arm and leg have become progressively worse throughout the week. The facial movements are described as lip smacking and excessive blinking. Four days ago, she complained of one episode of diplopia. She denies nausea, vomiting, fever, symptoms of uppe ...

Prospective, Observational Study of Outcomes in Neonates With Severe Thrombocytopenia [ARTICLES]

Stanworth, S. J. — 2009-11-01

OBJECTIVE: A cross-sectional, observational study of outcomes for neonates with severe neonatal thrombocytopenia (SNT; platelet count of <60 x 109 platelets per L) was performed to examine hemorrhage and use of platelet transfusions. METHODS: Neonates who were admitted to 7 NICUs and developed SNT were enrolled for daily data collection. RESULTS: Among 3652 neonatal admissions, 194 neonates (5%) developed SNT. The median gestational age of 169 enrolled neonates was 27 weeks (interquartile range [IQR]: 24-32 weeks), and the median birth weight was 822 g (IQR: 670-1300 g). Platelet count nadirs were <20 x 109, 20 to 39 x 109, and 40 to 59 x 109 platelets per L for 58 (34%), 64 (39%), and 47 (28%) of all enrolled infants, respectively. During the study, 31 infants (18%) had no recorded hemorrhage, 123 (73%) developed minor hemorrhage, and 15 (9%) developed major hemorrhage. Thirteen (87%) of 15 episodes of major hemorrhage occurred in neonates with gestational ages of <28 weeks. Platelet transfusions (n = 415) were administered to 116 infants (69%); for 338 (81%) transfusions, the main recorded reason was low platelet count. Transfusions increased the platelet count from a median of 27 x 109 platelets per L (IQR: 19-36 x 109 platelets per L) to 79 x 109 platelets per L (IQR: 47.5-127 x 109 platelets per L). CONCLUSIONS: Although one third of neonates enrolled in this study developed thrombocytopenia of <20 x 109 platelets per L, 91% did not develop major hemorrhage. Most platelet transfusions were given to neonates with thrombocytopenia with no bleeding or minor bleeding only.

Athletic Participation in Severe Hemophilia: Bleeding and Joint Outcomes in Children on Prophylaxis [ARTICLES]

Ross, C. — 2009-11-01

OBJECTIVES: We sought to determine joint outcomes relative to impact level of athletic participation among school-aged children who had hemophilia and were taking prophylactic factor replacement, as well as to investigate prognostic factors for joint outcomes. METHODS: School-aged boys with severe hemophilia A or B at a single center were included in the study. Clinical data on baseline joint status, BMI, hemophilia treatment, bleeding episodes, joint assessments, athletic participation, and injuries were retrospectively reviewed. Data on athletic participation were supplemented, when incomplete in the medical record, via structured telephone interview. RESULTS: Among 37 children with severe hemophilia A or B receiving factor prophylaxis, 73% participated in high-impact activities, whereas 27% participated in exclusively low-impact activities. The frequency of joint hemorrhages and new injuries did not appreciably differ between high- and low-impact athletics. In most instances, children developed <1 bleed or injury per season. A new target joint developed in 1 (3%) child. Sixteen percent of children met established BMI criteria for overweight, and 3% were obese. In logistic regression analyses with adjustment for prophylaxis frequency, level of athletic participation was not a significant prognostic factor for joint hemorrhage. CONCLUSIONS: In the setting of regular prophylaxis and adult coaching and supervision, significant bleeding complications were uncommon and level of impact of athletic participation was not a prognostic factor for joint outcomes. Athletic participation with appropriate supervision and precautions should be encouraged in children with hemophilia receiving prophylaxis, given potential health benefits in an increasingly overweight pediatric population.

Young Driver Education Programs That Build Resilience Have Potential to Reduce Road Crashes [ARTICLES]

Senserrick, T. — 2009-11-01

OBJECTIVE: The research aimed to explore associations between participation in 2 education programs for school-based learner drivers and subsequent road traffic offenses and crashes among a large cohort of newly licensed drivers. METHODS: DRIVE is a prospective cohort study of 20822 first-year drivers aged 17 to 24 in New South Wales (NSW), Australia. Participants completed a detailed questionnaire and consented to data linkage in 2003-2004. Questionnaire items included year of participation in 2 specific education programs: a 1-day workshop-only program focusing on driving risks ("driver-focused") and a whole-of-community program also including a 1-day workshop but also longer term follow-up activities and a broader focus on reducing risk-taking and building resilience ("resilience-focused"). Survey data were subsequently linked to police-reported crash and offense data for 1996-2005. Poisson regression models that adjusted for multiple confounders were created to explore offenses and crashes as a driver (dichotomized as 0 vs [≥]1) after program participation. RESULTS: Offenses did not differ between groups; however, whereas the driver-focused program was not associated with reduced crash risk, the resilience-focused program was associated with a 44% reduced relative risk for crash (0.56 [95% confidence interval: 0.34-0.93]). CONCLUSIONS: The large effect size observed and complementary findings from a comparable randomized, controlled trial in the United States suggest programs that focus more generally on reducing risks and building resilience have the potential to reduce crashes. A large, representative, randomized, controlled trial is urgently needed to confirm road safety benefits and ensure evidence-based spending and practitioner recommendations in this field.

Index of Suspicion [ARTICLES]

George, R. P. — 2009-10-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Footnotes Case 3 Discussion A 3[1/2]-year-old boy, who lives in the southeastern United States, is referred for evaluation of eosinophilia that was detected on laboratory tests performed during a routine health supervision visit. A few days ago, he had loose stools, without blood or mucus, associated with low-grade fever. He has no history of significant illness, allergies, respiratory symptoms, weight loss, sick contacts, or travel. He is not taking any medications. He lives with his mother, aunt, three siblings, four cousins, and two dogs in a rural area that has city water ...

Thrombocytopenia in the Neonatal Intensive Care Unit [ARTICLES]

Saxonhouse, M. A. — 2009-09-01

As the survival of neonates cared for in the neonatal intensive care unit (NICU) has improved, hematologic issues have been recognized as clinically significant problems in this population. Thrombocytopenia, in particular, is a common finding among sick neonates, but there is considerable debate regarding the appropriate evaluation and management of affected infants. This article provides state-of-the art information on the pathophysiology, diagnosis, and treatment of neonatal thrombocytopenia. Specifically, the risks associated with low platelet counts in neonates are discussed, and a practical approach to the differential diagnosis of neonates who develop thrombocytopenia is provided. Current recommendations for the management of immune and nonimmune varieties of thrombocytopenia also are reviewed, with an emphasis on the risks and benefits associated with platelet transfusions in this age group.

Immune-mediated Neutropenia in the Neonate [ARTICLES]

Black, L. V. — 2009-09-01

Neutropenia is a relatively common finding in ill neonates, occurring in approximately 32,000 infants each year in the United States. In this patient population, immune-mediated neutropenia results from the antibody-mediated destruction of neutrophils and is associated with such disorders as alloimmune neonatal neutropenia, neonatal autoimmune neutropenia, and autoimmune neutropenia of infancy. Such conditions only recently have begun to be understood and often are problematic in terms of clinical identification and laboratory confirmation. This article reviews the clinical presentation, laboratory diagnosis, and treatment options for these three disorders.

Preeclampsia and Neonatal Neutropenia [ARTICLES]

Moallem, M. — 2009-09-01

Neutropenia is a common hematologic disorder in the newborn intensive care unit, particularly in preterm neonates. Although its cause varies, a significant proportion of the episodes are associated with pregnancy complicated by preeclampsia. In this review, we provide a brief overview of preeclampsia and neonatal neutropenia, with a focus on the neonatal neutropenia associated with maternal preeclampsia. We discuss potential contributory mechanisms to and the natural history of this type of neutropenia, as well as reasonable management strategies in affected neonates.

Index of Suspicion [ARTICLES]

Bekmezian, A. — 2009-08-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Case 3 Discussion References An 18-month-old boy presents with a 1-year history of poor weight gain and vomiting. He weighed 3.3 kg when born at term and was growing well until 6 months of age, when he was switched from human milk to formula. His appetite is poor and he vomits intermittently, some weeks with every meal. The emesis is nonbilious, is nonbloody, and usually occurs within 30 minutes of eating but occasionally several hours after eating. The vomiting seems to be worse when he is lying down and has not improved with metoclopramide, lansoprazole, or formula change. He has had no swallowing difficulty or choking. ...

Index of Suspicion [ARTICLES]

Rizkalla, N. — 2009-07-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Footnotes Case 3 Discussion References A 14-year-old Hispanic boy is evaluated for progressive difficulty in breathing through his nose and nosebleeds over the past 9 months. In the past week, he has produced blood-streaked sputum. He has lost 8 lb. He denies fevers, rashes, vomiting, easy bruising, headaches, or vision changes. He has received medications for sinusitis and allergies without improvement of his symptoms. Physical examination reveals a well-developed boy who looks pale and is breathing through his mouth. His temperature is 97.2{degrees}F (36.3{degrees}C), heart rate is 133 beats/min, ...