Diseases & Treatment



Physicians from the Division of Pediatric Hematology and Oncology work as part of an integrated team to provide efficient, coordinated care for children suffering from blood and cancer disorders. Some diseases treated within the division are listed below:



Pediatric Hematology


The bone marrow is the source of the red cells, white cells and platelets that circulate in the blood. The red cells help to carry oxygen to the tissues and the white cells help in fighting infections. Platelets are small cells in the blood that prevent bleeding after a cut or injury.


Sickle cell disease


Sickle cell disease is a genetic condition that causes a lifelong anemia (low blood count). This happens because of a change in the makeup of the heamoglobin (a protein in the red blood cells) which carries oxygen to the body.
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Red Cell Disorders


Anemia


Anemia is defined as decrease in the oxygen carrying capacity of the red blood cells. It may be due to the decrease in the production of red cells as in iron deficiency, aplastic anemia, increase in the destruction of red blood cells as in hemolytic anemias or due to excessive blood loss.
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Anemias commonly encountered in the pediatric age group are below.


Iron Deficiency Anemia

Iron deficiency anemia: Iron is an essential component of the red blood cells. Anemia due to deficiency of iron is stills the most common cause of anemia. The body needs iron to make hemoglobin (the chemical structure which carries the oxygen), a decrease in the hemoglobin levels lead to lesser oxygen carrying capacity leading to anemia. The main cause for iron deficiency anemia is insufficient oral intake of iron.
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Thalassemia

Thalassemias are a group of disorders in which there is a defective production of one of the component protein in the hemoglobin molecule. This leads to a red blood cell which has lost the normal functional efficacy and is destroyed prematurely. Thalassemias are broadly classified into α- thalassemia and β-thalassemia.
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Hemolytic Anemia

Causes of anemia where the red cell is destroyed include enzyme deficiencies such as G6PD in the red blood cells, defects in the red blood cell membrane proteins, antibody mediated destruction of the red blood cells etc.
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Aplastic Anemia

In this condition, the bone marrow stops working and does not produce enough blood cells. There could be a reduced production of at least 2 of the 3 cell types produced in the marrow. This could be due to a specific reason or no apparent reason.
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Bleeding Disorders


Bleeding disorders are defined as the conditions in which the blood fails to form a clot and there is excessive or prolonged loss of blood within or outside. When there is an injury, the platelets attach to each other and to the blood vessel wall and reduce the bleeding; they release chemicals that allow the blood to start the clotting process and form a clot in an effort to stop bleeding.
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Classification of bleeding disorders


Platelets Numbers


Due to acute or chronic decrease in number of platelets. This reduction could be inherited or due to a condition called ITP or immune thrombocytopenic purpura. In ITP, there is a reduction in platelet count and the child is referred to a hematologist. The treatment depends on the platelet count and the symptoms caused by it.
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Defect in the platelet structure or platelet function


These conditions are inherited and rare
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Defect in Blood vessels


Causes originating from the blood vessels may be due to a defect in the vessel formation, trauma to the vessel, generalized infection or inflammation of the vessels.

Coagulation system


Causes originating from the blood vessels may be due to a defect in the vessel formation, trauma to the vessel, generalized infection or inflammation of the vessels.

Hemophilia A and B


These genetic disorders are inherited and are commonly seen in males. The condition often presents at birth with excessive bleeding after circumcision. It is a life long condition and requires life long follow up by a hematologist.
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Von Willebrand’s disease (VWD)


This is believed to be the most common inherited bleeding disorder in humans. Symptoms may be quite mild and it often goes undiagnosed. The severity of the disorder is related to the amount of Von Willebrand factor in the blood. Severe disease (little or no factor in the blood) is not common and can be confused with severe factor VIII deficiency until the diagnosis is confirmed by laboratory tests. Patients with VWD may have recurrent nosebleeds, easy bruising, bleeding gums, and heavy menstrual flow. Joint and muscle bleeding are rare but they may bleed heavily after surgical or dental procedures. They are often diagnosed when they come in with heavy menstrual bleeding.
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Clotting Disorders


Clotting disorders are due to defects in the clotting system and factors which regulate the clotting system like factor V Leiden, Protein S and C and antiphospholipid antibody syndromes.
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White Cell Disorders


Abnormal white cells may be a reason for a referral to a hematologist.These include


  • Leukemia- high white cell count with abnormal cells
  • Leukopenia- Low white cell count – reason to be determined
  • Neutropenia where there are less numbers of Neutrophils which are the cells that help fight infections.
  • Eosinophilia- Increase in the eosinophils which is seen in allergic disorders, certain infections and other causes

Treatment depends on the condition and its cause.
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Pediatric Oncology


Leukemia


Leukemia’s are a group of blood disorders where in the white blood cells divide and multiply in an uncontrolled fashion. This leads to overcrowding of such cells in the bone marrow compromising the other normal blood components.



Lymphoma


Lymphoma is a general term for a group of cancers that originate in the immune/lymphatic system. Lymphoma results when a lymphocyte (a type of blood cell) undergoes a malignant change and accumulates because of exaggerated multiplication and/or a failure to die. This excess of lymphocytes interferes with the growth of normal blood cells and creates masses of tumors in lymph nodes. The two main types of lymphoma are Hodgkin lymphoma and non-Hodgkin lymphoma.



Brain tumors


Tumors of the Central Nervous System (CNS) arise from the brain tissue itself or from the cells of the layers covering the brain and the supportive tissue.
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Neuroblastoma


This is one of the commonly encountered solid cancers seen usually in the early childhood. It develops from the autonomic nervous tissue, and in most cases found atop the kidneys.
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Bone Tumors


Osteosarcoma and Ewing’s sarcoma are the bone cancers frequently seen in the pediatric age group.



Rhabdomyosarcoma


Rhabdomyosarcoma is the most common soft tissue tumor in children. This is a cancerous tumor of the muscles that are attached to the bones. It can occur in many places in the body. The most common sites are the structures of the head and neck, the urogenital tract, and the arms or legs.
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Wilms' Tumors


Also known as Nephroblastoma, is a rare yet most common type of cancer involving the kidneys in children. It causes a tumor on one or both kidneys.
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Special Treatments


Treatments such as blood transfusions, bone marrow exams, lumbar punctures, chemotherapy administration and special medications which may require close observation during administration are given in our office or in our Ambulatory Infusion/Therapy Unit (AITU) which has a dedicated staff. We also work closely with the Department of Anesthesiology's Pain Management Center to design individual treatment plans. Maintaining our patient's comfort and integrity is our primary responsibility.


Contact


The Brookdale University Hospital and Medical Center


Division of Pediatric Hematology/Oncology
One Brookdale Plaza
Suite 346 CHC
Brooklyn, NY 11212-3198

Phone: (718) 240-5904

Fax: (718) 240-6730

Emergency Beeper Number
(917) 433-7764