Showing papers by "George R. Buchanan published in 2005"

Minor elective surgical procedures using general anesthesia in children with sickle cell anemia without pre-operative blood transfusion.

Abstract: Background Pre-operative red blood cell (RBC) transfusions are often recommended for patients with sickle cell disease (SCD) who require elective surgery under general anesthesia. However, definitive randomized studies demonstrating the benefit of transfusions in this setting have not been conducted. In particular, the merits of transfusion prior to minor or low-risk surgical procedures in children with SCD have not been demonstrated. Procedure We hypothesized that children with sickle cell anemia (Hb SS) who have minor elective surgical procedures develop few complications even without pre-operative transfusion. We accessed our Comprehensive Sickle Cell Program's Database to identify all such procedures performed during a 13-year period. Medical records were reviewed to characterize the surgical procedure, the use of transfusions, and perioperative complications. Results Twenty-eight children with Hb SS had a total of 38 minor surgical procedures. No perioperative transfusions were given in 34 of the cases (85%). Five of these 34 surgeries (15%) were associated with minor post-operative complications (fever or transient pain). No post-operative acute chest syndrome was encountered. Conclusions Minor or low-risk elective surgical procedures in children with Hb SS may not routinely require pre-operative transfusion. A randomized clinical trial to compare transfusion with no transfusion for minor surgical procedures is needed. Pediatr Blood Cancer 2005; 45: 43–47. © 2005 Wiley-Liss, Inc.

Thrombocytopenia During Childhood:: What the Pediatrician Needs to Know

Abstract: 1. George R. Buchanan, MD* 1. *Professor of Pediatrics, Director of Pediatric Hematology-Oncology, The University of Texas Southwestern Medical Center at Dallas and Children’s Medical Center, Dallas, Tex After completing this article, readers should be able to: 1. Describe the number, function, and life span of platelets. 2. Define the mechanisms of thrombocytopenia and the relative bleeding risk at any given platelet count. 3. Provide a differential diagnosis of neonatal thrombocytopenia and describe the clinical presentation and management of the most common forms. 4. Describe the usual presentation and laboratory tests in the child who has acute idiopathic thrombocytopenic purpura, review the treatments, and know the usual prognosis. 5. List the differential diagnosis of children who have chronic thrombocytopenia and methods of differentiating the various causes. Thrombocytopenia is defined as a platelet count less than 150×103/mcL (150×109/L), irrespective of the patient’s age. Thrombocytopenia is encountered commonly by pediatricians. Therefore, a review of the pathophysiology, differential diagnosis, and management of thrombocytopenia is in order. A 4-year-old boy who is recovering from a minor respiratory infection suddenly develops petechiae and bruises on his trunk and extremities. Two days later, after a transient nosebleed, he is brought to his physician’s office. His past medical history and family history are unremarkable. Findings on his physical examination are normal except for scattered crops of petechiae and multiple bruises. There is no active bleeding from the nose or other sites. A complete blood count (CBC) shows a hemoglobin of 12.7 g/dL (127 g/L), a white blood cell (WBC) count of 8×10 3 /mcL (8×10 9 /L), a normal differential count, and platelet count of 6×10 3 /mcL (6×10 9 /L). The diagnosis of idiopathic thrombocytopenic purpura (ITP) is suspected. Platelets are tiny acellular fragments produced in the bone marrow by polyploid cells called megakaryocytes. Platelets are about one fifth the diameter of erythrocytes, and their volume is 7 to 9 fL. They survive in the body for 9 to 10 days. Their major function is …

Blood transfusions in children with cancer and hematologic disorders: why, when, and how?

Abstract: We take many things for granted in medicine, among them blood transfusions. Little more than half a century ago there were no blood banks or means to fractionate blood into its components. Transfusions were given infrequently and haphazardly by directly connecting, through a surgical cutdown, a donor vein to a recipient. One could then only hope for the best! (Fig. 1). The subsequent identification of the Rh factor, the development of blood banks, the ability to separate whole blood into components, and the discipline of transfusion medicine, all had their genesis during World War II or shortly thereafter. Soon it actually became possible for physicians to ‘‘order’’ a blood transfusion. Blood transfusions represent one of the many supportive care advances in hematology–oncology that have permitted us to cure more children and to enhance their comfort [1]. These improvements in transfusion science have paralleled development of better antibiotics, analgesics, venous access devices, anti-emetics, and hematologic growth factors.