they should not be given if they are not needed. In the HSCT setting, getting more transfusions can increase the chance of your child rejecting the bone marrow. WBCs help fight infection. Although children with aplastic anemia often have very low WBC counts, WBC transfusions are rarely given because WBCs only live a few hours, and serious side effects may develop. In certain situations, usually if there is evidence of a life-threatening infection, WBC transfusions may be recommended. Growth Factors Growth factors are medications that are given to help increase the body’s own production of various blood cells. They are generally given as a subcutaneous (under the skin) injection or as an IV infusion. WBC growth factors are the most commonly used and include granulocyte colony stimulating factor (G- CSF) or filgastrim (Neupogen), pegfilgastrim (Neulasta), and granulocyte macrophage stimulating factor (GM-CSF). These medications help decrease the risk of infection by increasing the ANC and the body’s ability to fight bacterial infections. Common side effects can include pain or redness at the injection site, bone pain, headache, and nausea. There are growth factors that can stimulate RBC and platelet production. These are typically not used to treat children with aplastic anemia. Your child’s healthcare team will discuss these options with you, if indicated. Infection Children with aplastic anemia are at risk for infection. The lower the ANC, the greater the child’s risk of infection. Children with an ANC less than 500 are at a high risk for infection, and those with an ANC of less than 200 are at very high risk for infection. Children with aplastic anemia will have their ANC monitored closely. Those with a low ANC may require growth factors to increase their ANC. If your child develops a fever with a low ANC, he or she requires prompt medical evaluation no matter what time of the day or night. Medical evaluation includes labora- tory tests, such as blood tests, exams, and other tests to determine the source of the fever. If a bacterial infection is suspected, your child needs to be started on antibiotics and may need to be admitted to the hospital for close observation. Children with aplastic anemia also may require prophylactic or preventative medications to decrease their
risk of developing an infection. Medication to prevent a specific type of pneumonia, called pneumocystic jirovecii pneumonia (PCP), is often needed. Although sulfamethoxazole/trimethoprim (Bactrim) is the best medication to prevent PCP pneumonia, a side effect of the medication is lower blood cell counts; therefore, it is not recommended in children with aplastic anemia. The use of this medication should be discussed with your healthcare provider. Other medications that may be used are pentamidine (given via aerosol or injection) or Dapsone (given orally). Children also may require medication to prevent fungal infections. Flucon- azole (Diflucan) is a commonly used oral medication.
Iron Overload
8
Powered by FlippingBook