Conditions Treated
Benign Hematological Diseases
Thalassemia
Thalassemia major is a genetic disease where the child presents with severe anemia in infancy requiring lifelong blood transfusion. If such children are not transfused blood then they do not survive more than 1-2 years. Allogeneic bone marrow transplant is the treatment of choice for thalassemia major. Parents with thalassemia major child should be counseled that future pregnancies should be screened for thalassemia major by appropriate tests.
Aplastic Anemia
Aplastic anemia is characterized by pancytopenia where the patient resents with low hemoglobin causing weakness, low white blood cells causing infections and low platelets causing bleeding. This is a life-threatening situation, and the patient should be considered for allogeneic stem cells transplant from a matched related and unrelated donor. Those not having suitable donors should be given anti-thymocyte globulin (ATG).
Sickle Cell Anemia
Sickle cell anemia is a hemoglobinopathy where the patient present with painful crises involving joints, chest, brain etc. It increases the risk of morbidity and mortality. Treatment of SCD involves hydroxyurea and stem cell transplant.
Deep Vein Thrombosis or DVT
Deep vein thrombosis is due to clotting of the blood in vessels and can result in life threatening complications. It is diagnosed by doppler ultrasound of the limbs or by CT angiography. Its treatment involves anticoagulants.
Hemophilia
Hemophilia is a genetic blood disorder where the patient presents with bleeding manifestations. It is X linked inherited disorder and the child manifests with joint swellings due to bleeding. In severe hemophilia serious bleeding can be life threatening. Treatment involves infusing deficient factor, FFP or cryoprecipitate. Child should also be given maintenance treatment.
Fanconi Anemia
Fanconi anemia is an inherited bone marrow failure syndrome presenting as pancytopenia with anemia, bleeding manifestations and congenital anomalies. It should be differentiated from aplastic anemia. Treatment involves allogeneic stem cell transplant.
Hematological Malignancies Diseases
Acute Lymphoblastic Leukemia (ALL)
Acute Lymphoblastic Leukemia (ALL) is the most common hematological malignancy seen in children. It is a type of blood cancer and usually seen between 5 to 15 years age. The child usually presents with fever, bleeding, weakness, joint pains, loss of appetite, and glands swelling. The first test which should be done in such patients is complete hemogram with peripheral smear examination. It shows abnormal blood cells which are called cancer cells or blasts. Further testing involves bone marrow examination and special tests for evaluation of blood cancer called flowcytometry, genetic translocation and chromosomal analysis. Once diagnosed the child should be started on chemotherapy as soon as possible. Treatment involves induction, consolidation and maintenance phases and continues for 2-3 years. Child needs regular admission for chemotherapy and supportive care. The survival rate for childhood ALL is 75-90%. High risk patients or patient with relapsed/refractory leukemia should be considered for bone marrow transplantation. Adults with ALL usually have poor prognosis compared to children. Treatment in them also involves chemotherapy. High risk adults should be taken up for bone marrow transplant.
Acute Myeloid Leukemia (AML)
Acute Myeloid Leukemia (AML) is a cancer of white blood cells where patient presents with high blood cell counts and low platelets. The patient may have fever, bleeding, rash, weakness and bony pains. Blood investigations reveal presence of blasts in the blood and further special tests reveal the type of AML. Patient is given induction chemotherapy followed by high dose chemotherapy or stem cell transplant.
Non-Hodgkin Lymphomas (B Cell & T Cell NHL)
Non-Hodgkin lymphoma is a type of blood caner where the cancer cells cause swelling of lymph nodes and the patient presents with generalized lymphadenopathy, fever, weight loss, night sweats and weakness. Lymph node biopsy is required for making the diagnosis. PET-CT scan is done for assessment of stage of the lymphoma. Non-Hodgkin lymphoma can be B cell type or T cell type NHL. Treatment of lymphoma is by chemotherapy which is given periodically in cycles. Response assessment is by PET-CT. Relapsed/refractory NHL requires autologous or allogeneic stem cell transplantation.
Hodgkin Lymphoma
Hodgkin lymphoma is a type of blood cancer which has two peaks of presentation on in childhood and another in adults. It is also diagnosed by lymph node biopsy and PET-CT scan. Treatment of Hodgkin lymphoma consists of chemotherapy most commonly ABVD for 4 to 6 cycles. Relapsed patients are treated with autologous stem cell transplant.
Chronic Leukemia (CML & CLL)
Chronic leukemias like chronic myeloid leukemia and chronic lymphocytic leukemia are slow growing leukemias which can be easily diagnosed with special blood tests and can be easily managed by oral medicines.
Multiple Myeloma
Multiple myeloma is a cancer of plasma cells and presents with kidney failure, bone pains and anemia. Diagnosis is made by bone marrow examination and serum protein electrophoresis. Patients are treated with chemotherapy followed by autologous stem cell transplant.