Download Section on Hematology/Oncology

Section on Hematology/Oncology
CME Needs Assessment
1. An approach to hypochromic microcytic anemia
 The most common cause of hypochromic microcytic anemia is iron deficiency.
The differential diagnosis includes disorders that are congenital, acquired, benign
malignant, common and extraordinarily rare diseases It is important that a
thorough history and complete physical exam occur, a test for blood in the stool
and the appropriate laboratory tests be ordered to determine the cause of anemia
and treat it properly. If a patient is unnecessarily prescribed iron, they are put in a
situation of being overloaded.
 Reference: The Committee on Nutrition is currently developing an Academy
Clinical Report entitled, “Diagnosis and Prevention of Iron Deficiency and Iron
Deficiency Anemia in Infants and Young Children (0-3 Years of old).” (Intent
approved 3/05)
2. An approach to the patient with a possible bleeding disorder
 General pediatricians are often confronted with increased bleeding in a patient,
whether it be in newborns, children that present with increased bruising or nose
bleeds, or teenage girls complaining of menorrhagia. Early recognition is
important to determine if the symptoms may or may not be the manifestations of a
congenital or acquired bleeding disorder. It is important for a thorough history
and physical to be completed including the child’s age, sex, and clinical
presentation along with a careful bleeding history. Early childhood bleeding
occurs most frequently in congenital disorders, while later presentation is more
likely associated with acquired disorders.
3. An approach to the patient with a potential hypercoagulable state
 Early diagnosis and recognition of a coagulation disorder is important. An
accurate diagnosis can be made with a careful history and physical along with the
appropriate diagnostic and laboratory screening tools. A pediatric hematologist
should be consulted with a confirmed or suspected diagnosis and development of
a long-term treatment plan. This is increasingly more important as deep vein
thrombosis is becoming more recognized in pediatrics.
Section on Hematology/Oncology
4. Medical Care of long-term survivors of childhood cancer
 Progress in therapy has made survival into adulthood a reality for children,
adolescents, and young adults diagnosed with cancer. The current overall
survival rate for childhood malignancies is estimate at 78%, this translates into
approximately 300,000 childhood cancers survivors in the US. Notably, this
growing population remains vulnerable to a variety of long-term therapy-related
sequelae. Systematic ongoing follow-up of these patients is therefore important in
order to provide for early detection of and intervention of potentially serious lateonset complications. In addition, health counseling and promotion of healthy
lifestyles are important aspects of long-term follow-up care that promote risk
reduction for health problems that commonly present during adulthood. Both
general and subspecialty pediatric healthcare professionals are playing an
increasingly important role in the ongoing care of childhood cancer survivors,
beyond the routine preventive care, health supervision, and anticipatory guidance
provided to all patients.
References:
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Children’s Oncology Group. Long-Term Follow-Up Guidelines for
Survivors of Childhood, Adolescent, and Young Adult Cancers; 2003
AAP Clinical Report (in progress): Long-Term Follow-Up Care for
Pediatric Cancer Survivors (intent approved July 2006)
AAP Technical Report (in progress): Preservation of Fertility in Pediatric
and Adolescent Cancer Patients (intent approved January 2006)
5. Guidelines for the management of sickle cell disease
 It is important to educate pediatricians on sickle cell disease because there are
80,000 people in the US (half adults) with sickle cell disease and 2,000 newborns
diagnosed yearly. Sickle cell disease is the most common life-threatening genetic
disease in childhood and the most prevalent disorder identified by US newborn
screening programs. It is important to improve the care of these patients through
the appropriate medical home, including transition of care to adult providers.
Even with appropriate care, patients may still suffer morbidity and mortality from
complications of the disease that appears disparate from other prevalent chronic
conditions.
 References: AAP Policy Statement, “Health Supervision for Children with Sickle
Cell Disease”