Friday, December 16, 2016

WILTIMS #508-509: Pediatric Heme/Onc

[Same old story: this post recounts days long past. I refuse to let this blog stay dead! "Once more unto the breach, dear friends, once more..."]

As hinted in my last post via my TodayILearned facts, the specific service I'm on for my pediatric sub-I is hematology, oncology, and transplant. This service is actually a lot of fun, with fantastic attending doctors, and dedicated nurse practitioners and nurses. But I was quickly reminded of the life and death realities of working in this field.

We recently had a teenager transferred to our service from general pediatrics. The kid came in with some vague symptoms that just weren't going away. All but cleared to go home, one last test, a bone scan, was done and to everyone's surprise it showed metastatic cancer. A biopsy was done which the medical staff knew was going to all but determine the kid's fate. Most childhood cancers are very treatable; some are not. It came back as Ewing's sarcoma which has a <10% survival rate. It was a sobering reminder that not all of our pediatric patients leave with happy endings.

ThursdayIL: Patients with suppressed immune systems (like cancer or transplant patients) must have their blood glucose carefully watched. Fungus loves high sugar levels and can thrive (and kill) if the immune system isn't there to fight it.

From: Nabil M. Elkassabany, M.D., et al. ; Green Plasma—Revisited.
Anesthesiology 2008;108(4):764-765.
Somewhat relatedly, if a patient has a bad reaction to a transfusion, the blood products may have been contaminated. But if the patient received several kinds of products, like red blood cells, plasma and platelets all at once, which is the most likely culprit? Units of platelets are far more likely to start growing bacteria or fungus for the simple reason that they don't need to be refrigerated.

Tangenting again, blood plasma is usually an orangish-yellow but occasionally a healthy person will donate green plasma. No, these are not Vulcans/Romulans in disguise; unusually high, but still completely safe, amounts of ceruloplasmin, a copper containing compound in blood, cause the color change.

FridayIL: The top four causes of death for pediatric patients with sickle cell disease are:
  1. Infection
  2. Splenic sequestration
  3. Acute chest syndrome
  4. Multi-organ failure
The vast majority of children with diagnosed sickle cell in the developed world will live well into adulthood. But these kids do often end up in the hospital once and awhile for pain management during sickle cell crises, and it's important for us to know which extreme tragic outcomes we must make sure don't happen on our watch.

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