Hematology and Oncology in Critical Illness

  • Leonardo R. Brandão
  • Scott C. Howard
  • Kenneth W. Gow
  • Surender Rajasekaran
  • Robert F. Tamburro


This chapter will focus on a variety of hematologic issues pertinent to the care of critically ill children. This is an area of intense research with the pathophysiology underlying these clinical conditions becoming progressively better understood. This improved understanding has resulted in new therapeutic strategies that are being assessed in multicenter clinical trials. The chapter will begin by describing the incidence and pathophysiologic significance of anemia in the pediatric intensive care unit (PICU) providing a differential diagnosis of the many conditions that may present with anemia in this setting. The chapter will next consider disseminated intravascular coagulation (DIC) focusing on the pathophysiology of a condition that has been associated with much morbidity and mortality. The underlying conditions predisposing to DIC will be detailed as well as a number of treatment options that have been implemented in clinical trials. In addition to DIC, thrombocytopenia may be caused by a number of other clinical conditions important to the pediatric critical care provider. The clinical and prognostic significance of thrombocytopenia will be addressed and a focused differential diagnosis will be provided. Thrombotic disorders are becoming increasingly recognized in children and are a particular concern for the pediatric intensivist. The epidemiology of thromboembolism in children will be reviewed focusing on the conditions most commonly associated with these thromboses. Finally, a chapter on hematologic issues in the critically ill child would not be complete without a discussion of sickle cell disease. Acute chest syndrome, one of the most frequent complications of sickle cell disease resulting in the need for intensive care services, will be discussed in detail.


Hematopoietic Stem Cell Transplantation Sickle Cell Disease Pediatric Intensive Care Unit Disseminate Intravascular Coagulation Hemolytic Uremic Syndrome 
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Copyright information

© Springer-Verlag London Limited 2012

Authors and Affiliations

  • Leonardo R. Brandão
    • 1
  • Scott C. Howard
    • 2
  • Kenneth W. Gow
    • 3
  • Surender Rajasekaran
    • 4
  • Robert F. Tamburro
    • 5
  1. 1.Hematology/Oncology, Department of PediatricsUniversity of Toronto, The Hospital for Sick ChildrenTorontoCanada
  2. 2.Leukemia/Lymphoma, Department of OncologyUniversity of Tennessee, St. Jude Children’s Research HospitalMemphisUSA
  3. 3.Pediatric General and Thoracic Surgery, Department of SurgeryUniversity of Washington, Seattle Children’s HospitalSeattleUSA
  4. 4.Pediatric Critical Care Medicine, Department of PediatricsMichigan State University, Helen DeVos Children’s HospitalGrand RapidsUSA
  5. 5.Pediatric Critical Care Medicine, Department of PediatricsPenn State College of Medicine, Penn State Hershey Children’s HospitalHersheyUSA

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