479 results on '"George R. Buchanan"'
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2. Slide Over Here: The Various Adjacencies of Co-borrowed Ebooks.
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Dana McKay and George R. Buchanan 0001
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- 2017
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- View/download PDF
3. The Heat is On: A Temperature Display for Conveying Affective Feedback.
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Jordan Tewell, Jon Bird, and George R. Buchanan 0001
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- 2017
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4. Heat-Nav: Using Temperature Changes as Navigation Cues.
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Jordan Tewell, Jon Bird, and George R. Buchanan 0001
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- 2017
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- View/download PDF
5. Barriers and facilitators of risk‐based health care for adult survivors of childhood cancer: A report from the Childhood Cancer Survivor Study
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Joanne F. Chou, Ann C. Mertens, Melissa M. Hudson, Stephanie M. Smith, Jennifer S. Ford, Emily S. Tonorezos, Kevin C. Oeffinger, Jacqueline Casillas, Barbara M. Foster, George R. Buchanan, Chaya S. Moskowitz, and Leslie L. Robison
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Adult ,Male ,Risk ,Cancer Research ,medicine.medical_specialty ,Adolescent ,Childhood cancer ,Childhood Cancer Survivor Study ,Article ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Cancer Survivors ,Neoplasms ,Surveys and Questionnaires ,Outcome Assessment, Health Care ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Child ,Cancer survivor ,business.industry ,Cancer ,medicine.disease ,Confidence interval ,Oncology ,Child, Preschool ,030220 oncology & carcinogenesis ,Relative risk ,Family medicine ,Female ,Educational interventions ,business - Abstract
Background Optimal risk-based survivor health care includes surveillance for late effects and education targeted at reducing or preventing risky health behaviors. Understanding the reasons for a lack of risk-based follow-up care is essential. Methods Adult participants from the Childhood Cancer Survivor Study were surveyed about having a cancer-related visit in the past 2 years and the likelihood of having a cancer-related visit in the future. Additional factors thought to be related to the primary outcomes were also assessed. Results Nine hundred seventy-five survivors completed the survey. Twenty-seven percent (95% confidence interval [CI], 24%-30%) had a cancer-related medical visit in the previous 2 years, and 41% (95% CI, 38%-44%) planned to have such a visit within the next 2 years. The likelihood of having had a cancer-related visit within the last 2 years was higher among survivors assigning greater importance to these visits (relative risk [RR], 1.2; 95% CI, 1.1-1.3), perceiving greater susceptibility to health problems (RR, 1.2; 95% CI, 1.1-1.3), having a moderate to life-threatening chronic health problem related to their cancer (RR, 2.1; 95% CI, 1.7-2.7), seeing a primary care provider for a cancer-related problem (RR, 1.3; 95% CI, 1.0-1.6), having a cancer treatment summary (RR, 1.3; 95% CI, 1.0-1.6), and endorsing greater confidence in physicians' abilities to address questions and concerns (RR, 1.2; 95% CI, 1.0-1.3). Conclusions Educational interventions improving awareness of treatment history and susceptibility to cancer-related late effects and corresponding risk-based care are likely to be beneficial for survivors of childhood cancers.
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- 2019
6. Physician decision making in selection of second-line treatments in immune thrombocytopenia in children
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Carolyn M. Bennett, Amy Geddis, Kristin A. Shimano, Vicky R. Breakey, James B. Bussel, Alexis A. Thompson, Kristina M. Haley, Ellis J. Neufeld, Jennifer A. Rothman, Adonis Lorenzana, Rachael F. Grace, Michael Jeng, George R. Buchanan, Kerry Hege, Shelley E. Crary, Jenny M. Despotovic, Michelle Neier, Cindy E. Neunert, Robert J. Klaassen, Yves D. Pastore, Melissa J. Rose, Travis Brown, Michele P. Lambert, and Peter W. Forbes
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Male ,Pediatrics ,medicine.medical_specialty ,Side effect ,medicine.medical_treatment ,Clinical Decision-Making ,Decision Making ,Splenectomy ,MEDLINE ,Eltrombopag ,Physician Decision ,Article ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Pharmacotherapy ,Physicians ,hemic and lymphatic diseases ,medicine ,Humans ,Child ,Purpura, Thrombocytopenic, Idiopathic ,business.industry ,Hematology ,chemistry ,030220 oncology & carcinogenesis ,Female ,Observational study ,Rituximab ,business ,Immunosuppressive Agents ,030215 immunology ,medicine.drug - Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune bleeding disorder which presents with isolated thrombocytopenia and risk of hemorrhage. While most children with ITP promptly recover with or without drug therapy, ITP is persistent or chronic in others. When needed, how to select second-line therapies is not clear. ICON1, conducted within the Pediatric ITP Consortium of North America (ICON), is a prospective, observational, longitudinal cohort study of 120 children from 21 centers starting second-line treatments for ITP which examined treatment decisions. Treating physicians reported reasons for selecting therapies, ranking the top three. In a propensity weighted model, the most important factors were patient/parental preference (53%) and treatment-related factors: side effect profile (58%), long-term toxicity (54%), ease of administration (46%), possibility of remission (45%), and perceived efficacy (30%). Physician, health system, and clinical factors rarely influenced decision-making. Patient/parent preferences were selected as reasons more often in chronic ITP (85.7%) than in newly diagnosed (0%) or persistent ITP (14.3%, P = .003). Splenectomy and rituximab were chosen for the possibility of inducing long-term remission (P < .001). Oral agents, such as eltrombopag and immunosuppressants, were chosen for ease of administration and expected adherence (P < .001). Physicians chose rituximab in patients with lower expected adherence (P = .017). Treatment choice showed some physician and treatment center bias. This study illustrates the complexity and many factors involved in decision-making in selecting second-line ITP treatments, given the absence of comparative trials. It highlights shared decision-making and the need for well-conducted, comparative effectiveness studies to allow for informed discussion between patients and clinicians.
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- 2018
7. Iron Deficiency Anemia in Adolescents Who Present with Heavy Menstrual Bleeding
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Amanda G. Cooke, George R. Buchanan, Jacquelyn M. Powers, and Timothy L. McCavit
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Male ,medicine.medical_specialty ,Pediatrics ,Blood transfusion ,Adolescent ,Anemia ,Iron ,medicine.medical_treatment ,030204 cardiovascular system & hematology ,Menstruation ,Hemoglobins ,03 medical and health sciences ,0302 clinical medicine ,hemic and lymphatic diseases ,030225 pediatrics ,medicine ,Humans ,Blood Transfusion ,Ferrous Compounds ,Child ,Menorrhagia ,Retrospective Studies ,Anemia, Iron-Deficiency ,business.industry ,Medical record ,Obstetrics and Gynecology ,Retrospective cohort study ,General Medicine ,Emergency department ,medicine.disease ,Texas ,Surgery ,Hospitalization ,Contraceptives, Oral, Combined ,Iron-deficiency anemia ,Concomitant ,Pediatrics, Perinatology and Child Health ,Female ,Emergency Service, Hospital ,business - Abstract
Study Objective To assess the clinical severity and initial treatment of iron deficiency anemia (IDA) in female adolescents with heavy menstrual bleeding (HMB) in our center. Design Retrospective cohort study of electronic medical records via search of administrative records using International Classification of Diseases Ninth Revision codes for IDA or unspecified anemia and disorders of menstruation. Setting Children's Medical Center in Dallas, Texas. Participants One hundred seven patients with HMB and concomitant IDA (median age, 14.4 years) who presented to the outpatient, emergency department, and/or inpatient settings. Results The median initial hemoglobin concentration for all patients (n = 107) was 7.4 g/dL, and most (74%, n = 79) presented to the emergency department or via inpatient transfer. Symptomatic IDA was treated with blood transfusion in 46 (43%, n = 46). Ferrous sulfate was the most commonly prescribed oral iron therapy. Seven patients received intravenous iron therapy either initially or after oral iron treatment failure. Combined oral contraceptives were commonly prescribed for abnormal uterine bleeding, yet 10% of patients (n = 11) received no hormonal therapy during their initial management. Evaluation for underlying bleeding disorders was inconsistent. Conclusion Severe anemia because of IDA and HMB resulting in urgent medical care, including hospitalization and blood transfusion, is a common but underemphasized problem in adolescent girls. In addition to prevention and early diagnosis, meaningful efforts to improve initial management of adolescents with severe HMB and IDA are necessary.
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- 2017
8. American Society of Hematology 2019 guidelines for immune thrombocytopenia
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Hayley Shimanek, Keith R. McCrae, Rachael F. Grace, Barbara Pruitt, Cindy Neunert, James N. George, Adam Cuker, Wendy Lim, Sara K. Vesely, Deirdra R. Terrell, Jenny M. Despotovic, Douglas B. Cines, Thomas Kühne, George R. Buchanan, Nichola Cooper, David J. Kuter, and Donald M. Arnold
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medicine.medical_specialty ,Consensus ,MEDLINE ,030204 cardiovascular system & hematology ,History, 21st Century ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Bone Marrow ,Multidisciplinary approach ,law ,Internal medicine ,Health care ,medicine ,Humans ,Grading (education) ,Intensive care medicine ,Purpura, Thrombocytopenic, Idiopathic ,Hematology ,business.industry ,Guideline ,Middle Aged ,Thrombocytopenia ,United States ,030220 oncology & carcinogenesis ,Rituximab ,business ,Clinical Guidelines ,medicine.drug - Abstract
Background:Despite an increase in the number of therapies available to treat patients with immune thrombocytopenia (ITP), there are minimal data from randomized trials to assist physicians with the management of patients.Objective:These evidence-based guidelines of the American Society of Hematology (ASH) are intended to support patients, clinicians, and other health care professionals in their decisions about the management of ITP.Methods:In 2015, ASH formed a multidisciplinary guideline panel that included 8 adult clinical experts, 5 pediatric clinical experts, 2 methodologists with expertise in ITP, and 2 patient representatives. The panel was balanced to minimize potential bias from conflicts of interest. The panel reviewed the ASH 2011 guideline recommendations and prioritized questions. The panel used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, including evidence-to-decision frameworks, to appraise evidence (up to May 2017) and formulate recommendations.Results:The panel agreed on 21 recommendations covering management of ITP in adults and children with newly diagnosed, persistent, and chronic disease refractory to first-line therapy who have non–life-threatening bleeding. Management approaches included: observation, corticosteroids, IV immunoglobulin, anti-D immunoglobulin, rituximab, splenectomy, and thrombopoietin receptor agonists.Conclusions:There was a lack of evidence to support strong recommendations for various management approaches. In general, strategies that avoided medication side effects were favored. A large focus was placed on shared decision-making, especially with regard to second-line therapy. Future research should apply standard corticosteroid-dosing regimens, report patient-reported outcomes, and include cost-analysis evaluations.
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- 2019
9. Disorders of Iron Metabolism: New Diagnostic and Treatment Approaches to Iron Deficiency
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Jacquelyn M, Powers and George R, Buchanan
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Male ,Adolescent ,Anemia, Iron-Deficiency ,Hepcidins ,Child, Preschool ,Iron ,Humans ,Infant ,Anemia ,Female - Abstract
Iron deficiency anemia is the leading cause of anemia worldwide and affects many young children and adolescent girls in the United States. Its signs and symptoms are subtle despite significant clinical effects. Iron deficiency anemia is diagnosed clinically by the presence of risk factors and microcytic anemia. Improvement following a trial of oral iron therapy is confirmative. An array of iron laboratory tests is available with variable indications. Clinical trial and iron absorption data support a shift to lower-dose oral iron therapy. Intravenous iron should be considered in children who fail oral iron or who have more complex disorders.
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- 2019
10. Navigating your career path in pediatric hematology/oncology: On and off the beaten track
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Linda C. Stork, Judy Felgenhauer, Rima Jubran, Kathleen M. Sakamoto, Caroline Hastings, Patrick A. Zweidler-McKay, Judith F. Margolin, Mona D. Shah, Janet Franklin, Suman Malempati, Jacqueline Casillas, George R. Buchanan, Mary Jane Staba Hogan, Joanne M. Hilden, Sarah R. Vaiselbuh, Vandy Black, James Harper, and Nita L. Seibel
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medicine.medical_specialty ,business.industry ,Track (disk drive) ,Pediatric Hematology/Oncology ,Career path ,Hematology ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,medicine ,Medical physics ,Intensive care medicine ,business ,030215 immunology - Published
- 2016
11. Occult hemorrhage in children with severe ITP
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George R. Buchanan and Adolfo Flores
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medicine.medical_specialty ,Urinalysis ,medicine.diagnostic_test ,business.industry ,Urinary system ,Fecal occult blood ,Physical examination ,Hematology ,030204 cardiovascular system & hematology ,Gastroenterology ,Surgery ,03 medical and health sciences ,Purpura ,0302 clinical medicine ,Hemosiderin ,Internal medicine ,Medicine ,medicine.symptom ,Microscopic hematuria ,business ,Prospective cohort study ,030217 neurology & neurosurgery - Abstract
Little is known about the frequency and significance of clinically unapparent or occult hemorrhage in ITP. Therefore, we prospectively explored the sites and frequency of occult bleeding in children with severe ITP at diagnosis or upon symptomatic relapse in a prospective, single-institution cohort study of patients ≤ 18 years of age and a platelet count ≤ 10,000/mm(3) . Data collected included bleeding severity assessment, urinalysis, fecal occult blood testing, and non-contrast brain MRI. Stool and urine samples were tested within 7 days of diagnosis or symptomatic relapse. Three months after diagnosis or relapse a noncontrast brain MRI evaluated hemosiderin deposits resulting from prior localized hemorrhage. Fifty-two ITP patients were enrolled with a mean platelet count of 4,000/mm(3) . A significant occurrence of occult hemorrhage was identified in the urine (27%) compared with clinically overt hematuria (0.91%, P
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- 2016
12. Severe bleeding events in adults and children with primary immune thrombocytopenia: a systematic review
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Donald M. Arnold, Jennifer K Goy, Geoffrey R. Norman, George R. Buchanan, Cindy E. Neunert, Nastaran Noroozi, Ishac Nazi, and John G. Kelton
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Adult ,Severe bleeding ,medicine.medical_specialty ,Pediatrics ,Intracranial Hemorrhages ,MEDLINE ,Hemorrhage ,macromolecular substances ,030204 cardiovascular system & hematology ,Risk Assessment ,Severity of Illness Index ,Article ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,immune system diseases ,hemic and lymphatic diseases ,medicine ,Humans ,Platelet ,Child ,Cerebral Hemorrhage ,Purpura, Thrombocytopenic, Idiopathic ,Platelet Count ,business.industry ,Age Factors ,Hematology ,biochemical phenomena, metabolism, and nutrition ,Prognosis ,Immune thrombocytopenia ,3. Good health ,Surgery ,Purpura ,030220 oncology & carcinogenesis ,bacteria ,medicine.symptom ,business - Abstract
The burden of severe bleeding in adults and children with immune thrombocytopenia (ITP) has not been established.To describe the frequency and severity of bleeding events in patients with ITP, and the methods used to measure bleeding in ITP studies.We performed a systematic review of all prospective ITP studies that enrolled 20 or more patients. Two reviewers searched Medline, Embase, CINAHL and the Cochrane registry up to May 2014. Overall weighted proportions were estimated using a random effects model. Measurement properties of bleeding assessment tools were evaluated.We identified 118 studies that reported bleeding (n = 10 908 patients). Weighted proportions for intracerebral hemorrhage (ICH) were 1.4% for adults (95% confidence interval [CI], 0.9-2.1%) and 0.4% for children (95% CI, 0.2-0.7%; P0.01), most of whom had chronic ITP. The weighted proportion for severe (non-ICH) bleeding was 9.6% for adults (95% CI, 4.1-17.1%) and 20.2% for children (95% CI, 10.0-32.9%; P0.01) with newly-diagnosed or chronic ITP. Methods of reporting and definitions of severe bleeding were highly variable in primary studies. Two bleeding assessment tools (Buchanan 2002 for children; Page 2007 for adults) demonstrated adequate inter-rater reliability and validity in independent assessments.ICH was more common in adults and tended to occur during chronic ITP; other severe bleeds were more common in children and occurred at all stages of disease. Reporting of non-ICH bleeding was variable across studies. Further attention to ITP-specific bleeding measurement in clinical trials is needed to improve standardization of this important outcome for patients.
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- 2015
13. Management of iron deficiency anemia: A survey of pediatric hematology/oncology specialists
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George R. Buchanan, Timothy L. McCavit, and Jacquelyn M. Powers
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medicine.medical_specialty ,Pediatrics ,Hematology ,medicine.diagnostic_test ,Anemia ,Cross-sectional study ,business.industry ,Pediatric Hematology/Oncology ,Complete blood count ,Iron sucrose ,medicine.disease ,Oncology ,Iron-deficiency anemia ,hemic and lymphatic diseases ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Toddler ,business ,medicine.drug - Abstract
Background Iron deficiency anemia (IDA) is the most common hematologic condition in children and adolescents in the United States (US). No prior reports have described the management of IDA by a large cohort of pediatric hematology/oncology specialists. Procedure A 20-question electronic survey that solicited responses to two hypothetical cases of IDA was sent to active members of the American Society of Pediatric Hematology/Oncology (ASPHO) in the US. Results Of 1,217 recipients, 398 (32.7%) reported regularly treating IDA and completed the survey. In a toddler with nutritional IDA, 15% (N = 61) of respondents reported ordering no diagnostic test beyond a complete blood count. Otherwise, wide variability in laboratory testing was reported. For treatment, most respondents would prescribe ferrous sulfate (N = 335, 84%) dosed at 6 mg/kg/day (N = 248, 62%) divided twice daily (N = 272, 68%). The recommended duration of iron treatment after resolution of anemia and normalized serum ferritin varied widely from 0 to 3 months. For an adolescent with heavy menstrual bleeding and IDA, most respondents recommended ferrous sulfate (N = 327, 83%), with dosing based on the number of tablets daily. For IDA refractory to oral treatment, intravenous iron therapy was recommended most frequently, 48% (N = 188) using iron sucrose, 17% (N = 68) ferric gluconate, and 15% (N = 60) low molecular weight iron dextran. Conclusion The approach to diagnosis and treatment of IDA in childhood was widely variable among responding ASPHO members. Given the lack of an evidence base to guide clinical decision making, further research investigating IDA management is needed. Pediatr Blood Cancer 2015;62:842–846. © 2015 Wiley Periodicals, Inc.
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- 2015
14. Long‐term use of the thrombopoietin‐mimetic romiplostim in children with severe chronic immune thrombocytopenia (ITP)
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Melissa Eisen, Kimo C. Stine, James B. Bussel, Ram Kalpatthi, Loan Hsieh, Kun Nie, David J. Gnarra, George R. Buchanan, and Richard H. Ho
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Blood Platelets ,Male ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Longitudinal data ,Recombinant Fusion Proteins ,Receptors, Fc ,Humans ,Medicine ,Platelet ,Longitudinal Studies ,Child ,Research Articles ,Thrombopoietin ,Purpura, Thrombocytopenic, Idiopathic ,Romiplostim ,Platelet Count ,business.industry ,autoimmunity ,Infant ,Hematology ,bleeding ,Immune thrombocytopenia ,Surgery ,Treatment Outcome ,Oncology ,Child, Preschool ,Chronic Disease ,platelets ,Pediatrics, Perinatology and Child Health ,Female ,business ,Receptors, Thrombopoietin ,medicine.drug - Abstract
Background Treatment of chronic severe pediatric ITP is not well studied. In a phase 1/2 12–16-week study, 15/17 romiplostim-treated patients achieved platelet counts ≥50 × 109/L, and romiplostim treatment was well tolerated. In a subsequent open-label extension (≤109 weeks), 20/22 patients received romiplostim; all achieved platelet counts >50 × 109/L. Twelve patients continued in a second extension (≤127 weeks). Longitudinal data from start of romiplostim treatment through the two extensions were evaluated to investigate the safety and efficacy of long-term romiplostim treatment in chronic severe pediatric ITP. Procedure Patients received weekly subcutaneous romiplostim, adjusted by 1 µg/kg/week to maintain platelet counts (50–200 × 109/L, maximum dose 10 µg/kg). Bone marrow examinations were not required. Results At baseline, patients were median age 10.0 years; median ITP duration 2.4 years; median platelet count 13 × 109/L; 73% were male; and 36% had prior splenectomy. Median romiplostim treatment duration was 167 weeks (Q1, Q3: 78,227 weeks), and median average weekly dose was 5.4 µg/kg (Q1, Q3: 4.3, 8.0 µg/kg). Seven patients discontinued treatment: four withdrew consent, two were noncompliant, and one received alternative therapy. None withdrew because of adverse events (AEs). After the first 12 weeks, median platelet counts remained >50 × 109/L. Eight (36.4%) patients received rescue medication, and 14 (63.6%) used concurrent ITP therapy. Seven patients (31.8%) reported serious AEs, and two (9.1%) reported life-threatening AEs (both thrombocytopenia); there were no serious AEs attributed to treatment and no fatalities. Conclusions Long-term romiplostim treatment in this small cohort increased and maintained platelet counts for over 4 years in children with ITP with good tolerability and without significant toxicity. Pediatr Blood Cancer 2015;62:208–213. © 2014. The Authors. Pediatr Blood & Cancer published by Wiley Periodicals, Inc.
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- 2014
15. Deficiencies in the Management of Iron Deficiency Anemia During Childhood
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George R. Buchanan, Timothy L. McCavit, Catherine Daniel, and Jacquelyn M. Powers
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Pediatrics ,medicine.medical_specialty ,business.industry ,nutritional and metabolic diseases ,Medication adherence ,Retrospective cohort study ,Hematology ,Emergency department ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Oncology ,Iron-deficiency anemia ,hemic and lymphatic diseases ,030225 pediatrics ,030220 oncology & carcinogenesis ,Pediatrics, Perinatology and Child Health ,medicine ,Etiology ,ANEMIA IRON DEFICIENCY ,business - Abstract
Limited high-quality evidence supports the management of iron deficiency anemia (IDA). To assess our institutional performance in this area, we retrospectively reviewed IDA treatment practices in 195 consecutive children referred to our center from 2006 to mid-2010. The majority of children were ≤4 years old (64%) and had nutritional IDA (74%). In 11- to 18-year-old patients (31%), the primary etiology was menorrhagia (42%). Many were referred directly to the emergency department and/or prescribed iron doses outside the recommended range. Poor medication adherence and being lost-to-follow-up were common. Substantial improvements are required in the management of IDA.
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- 2016
16. Effect of Low-Dose Ferrous Sulfate vs Iron Polysaccharide Complex on Hemoglobin Concentration in Young Children With Nutritional Iron-Deficiency Anemia: A Randomized Clinical Trial
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George R. Buchanan, Ang Gao, Jacquelyn M. Powers, Timothy L. McCavit, Song Zhang, and Leah Adix
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Male ,medicine.medical_specialty ,Anemia ,Iron ,Gastroenterology ,Child Nutrition Disorders ,Ferrous ,law.invention ,Medication Adherence ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,Double-Blind Method ,law ,Polysaccharides ,030225 pediatrics ,Internal medicine ,Medicine ,Humans ,Ferrous Compounds ,Lost to follow-up ,Adverse effect ,Mean corpuscular volume ,Original Investigation ,medicine.diagnostic_test ,Anemia, Iron-Deficiency ,business.industry ,Infant ,Hemoglobin A ,General Medicine ,medicine.disease ,Surgery ,Treatment Outcome ,Iron-deficiency anemia ,030220 oncology & carcinogenesis ,Child, Preschool ,Ferritins ,Female ,Lost to Follow-Up ,Hemoglobin ,business ,Iron Compounds - Abstract
Iron-deficiency anemia (IDA) affects millions of persons worldwide, and is associated with impaired neurodevelopment in infants and children. Ferrous sulfate is the most commonly prescribed oral iron despite iron polysaccharide complex possibly being better tolerated.To compare the effect of ferrous sulfate with iron polysaccharide complex on hemoglobin concentration in infants and children with nutritional IDA.Double-blind, superiority randomized clinical trial of infants and children aged 9 to 48 months with nutritional IDA (assessed by history and laboratory criteria) that was conducted in an outpatient hematology clinic at a US tertiary care hospital from September 2013 through November 2015; 12-week follow-up ended in January 2016.Three mg/kg of elemental iron once daily as either ferrous sulfate drops or iron polysaccharide complex drops for 12 weeks.Primary outcome was change in hemoglobin over 12 weeks. Secondary outcomes included complete resolution of IDA (defined as hemoglobin concentration11 g/dL, mean corpuscular volume70 fL, reticulocyte hemoglobin equivalent25 pg, serum ferritin level15 ng/mL, and total iron-binding capacity425 μg/dL at the 12-week visit), changes in serum ferritin level and total iron-binding capacity, adverse effects.Of 80 randomized infants and children (median age, 22 months; 55% male; 61% Hispanic white; 40 per group), 59 completed the trial (28 [70%] in ferrous sulfate group; 31 [78%] in iron polysaccharide complex group). From baseline to 12 weeks, mean hemoglobin increased from 7.9 to 11.9 g/dL (ferrous sulfate group) vs 7.7 to 11.1 g/dL (iron complex group), a greater difference of 1.0 g/dL (95% CI, 0.4 to 1.6 g/dL; P .001) with ferrous sulfate (based on a linear mixed model). Proportion with a complete resolution of IDA was higher in the ferrous sulfate group (29% vs 6%; P = .04). Median serum ferritin level increased from 3.0 to 15.6 ng/mL (ferrous sulfate) vs 2.0 to 7.5 ng/mL (iron complex) over 12 weeks, a greater difference of 10.2 ng/mL (95% CI, 6.2 to 14.1 ng/mL; P .001) with ferrous sulfate. Mean total iron-binding capacity decreased from 501 to 389 μg/dL (ferrous sulfate) vs 506 to 417 μg/dL (iron complex) (a greater difference of -50 μg/dL [95% CI, -86 to -14 μg/dL] with ferrous sulfate; P .001). There were more reports of diarrhea in the iron complex group than in the ferrous sulfate group (58% vs 35%, respectively; P = .04).Among infants and children aged 9 to 48 months with nutritional iron-deficiency anemia, ferrous sulfate compared with iron polysaccharide complex resulted in a greater increase in hemoglobin concentration at 12 weeks. Once daily, low-dose ferrous sulfate should be considered for children with nutritional iron-deficiency anemia.clinicaltrials.gov Identifier: NCT01904864.
- Published
- 2017
17. Potential for Improved Screening, Diagnosis, and Treatment for Iron Deficiency and Iron Deficiency Anemia in Young Children
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George R. Buchanan and Jacquelyn M. Powers
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medicine.medical_specialty ,Anemia, Iron-Deficiency ,Anemia ,business.industry ,Iron ,Infant ,Iron deficiency ,medicine.disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Iron-deficiency anemia ,030225 pediatrics ,030220 oncology & carcinogenesis ,Internal medicine ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Ferritins ,medicine ,Humans ,Mass Screening ,business ,Child ,Mass screening - Published
- 2017
18. Diagnosis and Management of Iron Deficiency Anemia
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Jacquelyn M. Powers and George R. Buchanan
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medicine.medical_specialty ,Anemia, Iron-Deficiency ,Anemia ,business.industry ,Disease Management ,nutritional and metabolic diseases ,Hematology ,medicine.disease ,Optimal management ,Clinical trial ,Oral iron preparation ,Treatment success ,Oncology ,Iron-deficiency anemia ,hemic and lymphatic diseases ,medicine ,Physical therapy ,Humans ,Dosing ,Intensive care medicine ,business ,Iron therapy - Abstract
Iron deficiency anemia (IDA) is a common hematologic condition, affecting a substantial proportion of the world's women and young children. Optimal management of IDA requires an accurate diagnosis, identification and correction of the underlying cause, provision of medicinal iron therapy, and confirmation of treatment success. There are limited data to support current treatment approaches regarding oral iron preparation, dosing, monitoring, and duration of therapy. New intravenous iron agents have improved safety profiles, which may foster their increased utilization in the treatment of patients with IDA. Clinical trials focused on improving current treatment standards for IDA are sorely needed.
- Published
- 2014
19. Blood pressure abnormalities in children with sickle cell anemia
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Amy M. Becker, Chul Ahn, George R. Buchanan, Michael Henson, Liyue Tong, Michel Baum, and Jordan H. Goldberg
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medicine.medical_specialty ,Ambulatory blood pressure ,business.industry ,Hematology ,medicine.disease ,Sickle cell nephropathy ,Sickle cell anemia ,Diabetic nephropathy ,Endocrinology ,Blood pressure ,Oncology ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Medicine ,Microalbuminuria ,Risk factor ,business ,Kidney disease - Abstract
Background Kidney disease is an important cause of morbidity and mortality in patients with sickle cell anemia (SCA). The factors that affect progression of renal disease are unknown, especially in children and adolescents. Alterations in blood pressure, including hypertension and lack of the normal nocturnal dip in blood pressure, are important determinants of diabetic nephropathy and other renal diseases and may play a role in sickle cell nephropathy. Our primary hypothesis was that children with SCA who have microalbuminuria will demonstrate less nocturnal dipping of blood pressure compared to patients without microalbuminuria. We also investigated other potential factors associated with microalbuminuria. Procedure This prospective study of 52 adolescents with SCA followed in the Children's Medical Center Dallas Comprehensive Sickle Cell Center characterized 24-hour ambulatory blood pressure profiles and presence of microalbuminuria. Stepwise logistic regression was performed to identify significant independent factors that are associated with microalbuminuria. Results Thirty-five percent of patients were identified as having previously unrecognized hypertension, and 17% had pre-hypertension (blood pressure greater than the 90th percentile but less than the 95th percentile). Fifty-six percent of patients lacked the normal nocturnal dip in blood pressure. In addition, 21% had microalbuminuria, and their percent nocturnal dip was significantly less than those without microalbuminuria (P = 0.01). Conclusions Blood pressure abnormalities are common in adolescents with SCA and are a possible modifiable risk factor in the progression of sickle cell nephropathy. Pediatr Blood Cancer 2014;61:518–522. © 2013 Wiley Periodicals, Inc.
- Published
- 2013
20. Treatment of Relapsed Precursor-B Acute Lymphoblastic Leukemia With Intensive Chemotherapy
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Eric Sandler, Xiaomin Lu, Michael E. Kelly, George R. Buchanan, Alan Homans, Mark L. Bernstein, Thomas C. Abshire, Meenakshi Devidas, Bruce M. Camitta, and Amy L. Billett
- Subjects
Male ,Oncology ,medicine.medical_specialty ,Asparaginase ,Adolescent ,medicine.medical_treatment ,Antineoplastic Agents ,Article ,chemistry.chemical_compound ,Recurrence ,Precursor B-Cell Lymphoblastic Leukemia-Lymphoma ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Idarubicin ,B Acute Lymphoblastic Leukemia ,Child ,Etoposide ,Chemotherapy ,Ifosfamide ,business.industry ,Remission Induction ,Infant ,Hematology ,medicine.disease ,Surgery ,Leukemia ,Treatment Outcome ,chemistry ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Cytarabine ,Female ,business ,medicine.drug - Abstract
Pediatric patients who experience a bone marrow relapse of precursor-B acute lymphoblastic leukemia are cured < 50% of the time. This study was designed to determine if intensification of therapies with known activity in this disease would improve the cure rates for patients with relapsed acute lymphoblastic leukemia. Patients were treated with intensive asparaginase during induction followed by repeated cycles of ifosfamide/etoposide and cytarabine/idarubicin. Patients with well-matched related donors were encouraged to undergo hematopoietic stem cell transplant as consolidation. The results of this study demonstrate no significant difference in disease-free survival in patients who received chemotherapy alone (45%) or chemotherapy followed by allogeneic stem cell transplant (50%). Furthermore, results from this study show no significant difference in event-free survival (39.9% ± 6.2%) or overall survival (41.6% ± 6.1%) at 8 years when compared with previous studies using less intensive regimens. Our results suggest that alternative therapies are needed to improve cure rates for pediatric patients with relapsed leukemia.
- Published
- 2013
21. Sports Participation in Children and Adolescents with Immune Thrombocytopenia (ITP)
- Author
-
Michele P. Lambert, Manjusha Kumar, Robert J. Klaassen, Kerri Nottage, George R. Buchanan, Michelle Neier, Pamela Kempert, Vicky R. Breakey, Ellis J. Neufeld, and Cindy E. Neunert
- Subjects
Pediatrics ,medicine.medical_specialty ,Benign disease ,business.industry ,Hematology ,Affect (psychology) ,Immune thrombocytopenia ,Oncology ,Quality of life ,Pediatrics, Perinatology and Child Health ,Physician perception ,Medicine ,business ,human activities - Abstract
We surveyed 278 pediatric hematologists/oncologists regarding how children with immune thrombocytopenia (ITP) are counseled for participation in sports. Results show substantial variation in physician perception of contact risk for different sports, and the advice offered about restriction of sport activities of affected children. Many physicians recommend restriction of sports when platelet counts are under 50 × 10(9) /L. Such restriction may affect the child's quality of life despite their having an overall benign disease.
- Published
- 2015
22. Evidence gaps in the management of sickle cell disease: A summary of needed research
- Author
-
Paula Tanabe, Lanetta B. Jordan, Russell E. Ware, Kathryn L. Hassell, Jonathan C. Goldsmith, William J. Savage, Barbara P. Yawn, Eduardo Ortiz, Samir K. Ballas, Andra H. James, Araba Afenyi-Annan, Joylene John-Sowah, M. Hassan Murad, George R. Buchanan, Richard Lottenberg, and Sophie Lanzkron
- Subjects
Pathology ,medicine.medical_specialty ,Text mining ,medicine.anatomical_structure ,business.industry ,Cell ,medicine ,Hematology ,Disease ,business ,Intensive care medicine - Published
- 2015
23. Drug-induced thrombocytopenia in children
- Author
-
Jessica A. Reese, Deirdra R. Terrell, Sara K. Vesely, Loan P. Nguyen, Brian R. Curtis, George R. Buchanan, and James N. George
- Subjects
medicine.medical_specialty ,Drug Induced Thrombocytopenia ,biology ,business.industry ,Hematology ,Evidence-based medicine ,Blood cancer ,Oncology ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Immunology ,biology.protein ,Medicine ,Antibody ,Adverse effect ,business - Abstract
Background Acute, immune-mediated thrombocytopenia may be caused by many different approved drugs as well as by other substances including vaccines, complementary and alternative medicines, herbal remedies, nutritional supplements, foods and beverages. All causes are described as drug-induced thrombocytopenia (DITP). Often the cause is not recognized, resulting in recurrent thrombocytopenia and inappropriate treatments. Systematic analysis of children (age less than 18 years) with suspected DITP has not been previously reported. Procedures (1) We searched 15 databases to identify articles describing children with thrombocytopenia as an adverse effect of drugs and other substances. Articles were reviewed to assign levels of evidence for an association of the suspected substance with thrombocytopenia. (2) Data from the BloodCenter of Wisconsin were reviewed to identify reports of drug-dependent, platelet-reactive antibodies in children with suspected DITP. Results Of 2,191 articles identified, 242 were selected for review. Seventy-two articles reporting 74 individual patients and nine groups of patients had evaluable data. Eleven individual patients and one group had definite evidence and 40 patients and three groups had probable evidence for an association of the suspected substance with thrombocytopenia. Thirty-two substances had a definite or probable association with thrombocytopenia. During 2008–2012, sera from 91 children with suspected DITP were tested and 21 had drug-dependent, platelet-reactive antibodies involving six substances. Conclusions Drugs and other substances must be considered as potential causes of thrombocytopenia. Evidence from published reports and data for drug-dependent, platelet-reactive antibodies can help clinicians evaluate of children with unexpected thrombocytopenia. Pediatr Blood Cancer 2013;60:1975–1981. © 2013 Wiley Periodicals, Inc.
- Published
- 2013
24. Splenectomy in Children With 'Mild' Hereditary Spherocytosis
- Author
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Shelley E. Crary, Sani M. Roy, and George R. Buchanan
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,medicine.medical_treatment ,Splenectomy ,Spherocytosis, Hereditary ,Disease ,Hemoglobin levels ,Hereditary spherocytosis ,Hemoglobins ,Reticulocyte Count ,Disease severity ,Quality of life ,Reticulocyte count ,medicine ,Humans ,Child ,Retrospective Studies ,business.industry ,Hematology ,medicine.disease ,Oncology ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Hemoglobin ,business - Abstract
Splenectomy is considered the treatment of choice for patients with "symptomatic" hereditary spherocytosis (HS). Published guidelines offering recommendations for splenectomy in HS categorize patients primarily based on hemoglobin concentration. We performed a retrospective review of 64 children having splenectomy for HS at Children's Medical Center Dallas. On the basis of hemoglobin concentration alone, 16 children (25%) had mild, 38 (59%) moderate, and 10 (16%) severe HS. However, when reticulocyte count was used to categorize disease severity, only 3 patients (5%) having splenectomy would be considered mild, 17 (27%) moderate, and 42 (66%) severe. Despite otherwise having "mild" disease defined by near-normal hemoglobin levels, many children with nontraditional or subjective signs and symptoms related to hemolytic rate received a splenectomy, and, therefore, reticulocyte count might be a more reliable laboratory marker suggesting consideration of splenectomy. A validated assessment tool incorporating quality of life indicators in addition to the traditional medical indications for splenectomy in HS would be valuable in assessing indications for the procedure.
- Published
- 2013
25. Bleeding from the eyes and through intact skin: Physiologic, structural, spiritual, or faked?
- Author
-
George R. Buchanan and Stephanie K. Bezner
- Subjects
medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,General surgery ,Signs and symptoms ,Physical examination ,Hematology ,Intact skin ,Teaching hospital ,Test (assessment) ,medicine.anatomical_structure ,Scalp ,medicine ,Spontaneous hemorrhage ,Hematologist ,Psychiatry ,business - Abstract
Patients with an apparent bleeding disorder can usually be diagnosed by a careful history, physical examination, and screening laboratory tests. However, at times the constellation of bleeding signs and symptoms fail to be explained by test results and/or our current understanding of hemostatic mechanisms. One such patient is the subject of the current report. She is a 13-year-old female with a history of striking bleeding manifestations, including spontaneous hemorrhage from her eyes, scalp, hands, and feet. She was evaluated by one of the authors at a teaching hospital in Mumbai, India in March 2009 during the filming of a National Geographic Channel documentary characterizing puzzling medical disorders encountered in India. Given her unusual bleeding manifestations, she received international media attention at the time. National Geographic and a film company in the United Kingdom subsequently expressed interest in highlighting the patient to document her seemingly rare hematologic disorder and contacted the American Society of Hematology to identify an American hematologist to further investigate the case. With consent of the family and collaboration with a hematologist practicing at a teaching hospital in Mumbai, filming commenced during March 2009 in an attempt to capture the patient's diagnosis and the cultural and medical milieu in which the bleeding events occurred. Am. J. Hematol. 88:713–716, 2013. © 2013 Wiley Periodicals, Inc.
- Published
- 2013
26. Intravenous low molecular weight iron dextran in children with iron deficiency anemia unresponsive to oral iron
- Author
-
Ellen S. Plummer, George R. Buchanan, Timothy L. McCavit, and Shelley E. Crary
- Subjects
medicine.medical_specialty ,business.industry ,Anemia ,Hematology ,Iron deficiency ,medicine.disease ,Gastroenterology ,Hematologic Response ,Surgery ,Oncology ,Iron-deficiency anemia ,Internal medicine ,Pediatrics, Perinatology and Child Health ,Medicine ,Hematinic ,Iron Dextran Complex ,business ,Adverse effect ,Complete Hematologic Response - Abstract
Background Iron deficiency anemia (IDA) in children is usually treated with oral iron, yet many respond poorly. Intravenous low molecular weight iron dextran (LMWID) offers the opportunity of employing a single outpatient infusion to correct the anemia and reduce the overall burden of treatment, but its use in children has been limited due to concerns of serious adverse effects. In this study we report our initial experience using LMWID in children with iron deficiency in whom oral iron was ineffective. Methods We performed a case series of LMWID treatment of children with IDA of diverse etiologies who were poorly responsive to oral iron therapy with the aim of measuring its efficacy and adverse effects. LMWID was administered as a total dose infusion over 60 minutes in the outpatient setting. Results Thirty-one patients age 11 months to 18 years received intravenous LMWID, and 24 were evaluable for hematologic response. Median hemoglobin increments were respectively 3.5, 1.9, and 1.8 g/dl in patients with IDA due to poor nutrition (n = 11), chronic blood loss (n = 13), and miscellaneous causes (n = 7). Two thirds of evaluable patients had a complete hematologic response. Nine of the patients (29%) had mild non-specific adverse effects upon initiation of the LMWID infusion. Conclusions LMWID as a total dose infusion was well tolerated and effective in a heterogeneous group of children and adolescents with IDA who were refractory to oral iron therapy. Transient reactions were common but not serious. Pediatr Blood Cancer 2013;60:1747–1752. © 2013 Wiley Periodicals, Inc.
- Published
- 2013
27. Bleeding manifestations and management of children with persistent and chronic immune thrombocytopenia: data from the Intercontinental Cooperative ITP Study Group (ICIS)
- Author
-
George R. Buchanan, Leah Adix, Victor S. Blanchette, Sara K. Vesely, Cindy E. Neunert, Thomas Kühne, Paula H. B. Bolton-Maggs, Ellis J. Neufeld, Carolyn M. Bennett, Paul Imbach, and Ozsahin, Ayse Hulya
- Subjects
Male ,Pediatrics ,medicine.medical_specialty ,Blood transfusion ,medicine.medical_treatment ,Immunology ,Splenectomy ,Hemorrhage ,Platelet Transfusion ,Severity of Illness Index ,Biochemistry ,Steroids/therapeutic use ,Interquartile range ,Severity of illness ,bleeding ,children ,persistent ,chronic ,immune thrombocytopenia ,medicine ,Immunoglobulins, Intravenous/therapeutic use ,Humans ,Hemorrhage/immunology/therapy ,Prospective Studies ,Registries ,Child ,Prospective cohort study ,Purpura, Thrombocytopenic, Idiopathic/immunology/therapy ,Retrospective Studies ,Purpura, Thrombocytopenic, Idiopathic ,ddc:618 ,Platelet Count ,business.industry ,Remission Induction ,Registries/statistics & numerical data ,Immunoglobulins, Intravenous ,Infant ,International Agencies ,Retrospective cohort study ,Cell Biology ,Hematology ,Combined Modality Therapy ,Purpura ,Platelet transfusion ,Child, Preschool ,Acute Disease ,Chronic Disease ,Female ,Steroids ,medicine.symptom ,business ,Follow-Up Studies - Abstract
Long-term follow-up of children with immune thrombocytopenia (ITP) indicates that the majority undergo remission and severe thrombocytopenia is infrequent. Details regarding bleeding manifestations, however, remain poorly categorized. We report here long- term data from the Intercontinental Cooperative ITP Study Group Registry II focusing on natural history, bleeding manifestations, and management. Data on 1345 subjects were collected at diagnosis and at 28 days, 6, 12, and 24 months thereafter. Median platelet counts were 214 × 10(9)/L (interquartile range [IQR] 227, range 1-748), 211 × 10(9)/L (IQR 192, range 1-594), and 215 × 10(9)/L (IQR 198, range 1-598) at 6, 12, and 24 months, respectively, and a platelet count
- Published
- 2013
28. Barriers to Hematopoietic Cell Transplantation Clinical Trial Participation of African American and Black Youth With Sickle Cell Disease and Their Parents
- Author
-
Richard J. Labotka, Nancy A. Omondi, Navneet S. Majhail, Ellen M. Denzen, J. Douglas Rizzo, Ann E. Haight, Stacy Stickney Ferguson, George R. Buchanan, and Elizabeth Murphy
- Subjects
Adult ,Male ,Parents ,Health Knowledge, Attitudes, Practice ,congenital, hereditary, and neonatal diseases and abnormalities ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Anemia ,medicine.medical_treatment ,MEDLINE ,Anemia, Sickle Cell ,Disease ,Hematopoietic stem cell transplantation ,Health Services Accessibility ,Article ,hemic and lymphatic diseases ,medicine ,Humans ,Child ,Clinical Trials as Topic ,Hematopoietic cell ,business.industry ,Hematopoietic Stem Cell Transplantation ,Hematology ,Focus Groups ,medicine.disease ,Focus group ,Black or African American ,Clinical trial ,Transplantation ,Oncology ,Child, Preschool ,Family medicine ,Pediatrics, Perinatology and Child Health ,Female ,business - Abstract
African-Americans and Blacks have low participation rates in clinical trials and reduced access to aggressive medical therapies. Hematopoietic cell transplantation (HCT) is a high-risk investigational but potentially curative therapy for sickle-cell disease (SCD), a disorder predominantly seen in African-Americans. We conducted focus groups to better understand participation barriers to HCT clinical trials for SCD. Nine focus groups of youth with SCD (n=10) and parents (n=41) were conducted at three sites representing the Midwest, South Atlantic and West South Central US. Main barriers to clinical trial participation included gaps in knowledge about SCD, limited access to SCD/HCT trial information and mistrust of medical professionals. For education about SCD/HCT trials, participants highly preferred one-on-one interactions with medical professionals and electronic media as a supplement. Providers can engage with sickle cell camps to provide information on SCD/HCT clinical trials to youth and local health fairs for parents/families. Youth reported learning about SCD via computer games; investigators may find this medium useful for clinical trial/HCT education. African-Americans affected by SCD face unique barriers to clinical trial participation and have unmet HSCT clinical studies education needs. Greater recognition of these barriers will allow targeted interventions in this community to increase their access to HCT.
- Published
- 2013
29. Chemotherapy for Initial Induction Failures in Childhood Acute Lymphoblastic Leukemia
- Author
-
Michael Joyce, Bruce M. Camitta, Bradley H Pollock, George R. Buchanan, and Meenakshi Devidas
- Subjects
Adult ,Male ,Oncology ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Hydrocortisone ,medicine.medical_treatment ,Article ,Young Adult ,Acute lymphocytic leukemia ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,Young adult ,Child ,Childhood Acute Lymphoblastic Leukemia ,Teniposide ,Chemotherapy ,business.industry ,Remission Induction ,Cytarabine ,Infant ,Hematology ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,medicine.disease ,Methotrexate ,Treatment Outcome ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,business ,medicine.drug - Abstract
Children with acute lymphocytic leukemia who fail to enter remission have a poor prognosis. In a previous study, 9 of 14 children with induction failure entered remission after teniposide (VM26) plus cytosine arabinoside (Ara-C). We attempted to confirm these results. Twenty children received teniposide (200 mg/m/day IV) for 3 days and cytosine arabinoside (100 mg/m/day continuous IV infusion) for 7 days. There were 3 complete and 3 partial responses. Two additional patients achieved a complete response after a second, shorter course of the same agents. Although VM26 plus Ara-C is an active combination for treatment of acute lymphocytic leukemia induction failure, it does not appear as effective as in the initial report. Better treatments for this problem are needed.
- Published
- 2013
30. Bleeding severity as an important outcome in childhood immune thrombocytopenia
- Author
-
George R. Buchanan and Adolfo Flores
- Subjects
Purpura, Thrombocytopenic, Idiopathic ,medicine.medical_specialty ,Platelet Count ,business.industry ,Surrogate endpoint ,MEDLINE ,Immunoglobulins, Intravenous ,Hemorrhage ,Hematology ,Immune thrombocytopenia ,Surgery ,Pharmacotherapy ,Oncology ,Disease severity ,immune system diseases ,hemic and lymphatic diseases ,Pediatrics, Perinatology and Child Health ,medicine ,Humans ,Child ,business ,Intensive care medicine ,Biomarkers - Abstract
Over the years pediatric hematologists have continued to debate whether pharmacotherapy or clinical observation should be employed as initial management in childhood immune thrombocytopenia (ITP). Delineating the fundamental elements of heterogeneity in bleeding manifestations in childhood ITP has proven to be a complicated task. Efforts to classify the impact of hemorrhage in ITP based on platelet count have been problematic. Factors beyond relying on a laboratory measurement as a surrogate marker of disease severity need to be considered. What is needed to better guide therapeutic decision-making is a clinically relevant and evidence-based measure of bleeding severity. In this special supplement, the history of therapeutic management in ITP and prior attempts to grade or quantify hemorrhage will be reviewed.
- Published
- 2012
31. Intravenous Ferric Carboxymaltose in Children with Iron Deficiency Anemia Who Respond Poorly to Oral Iron
- Author
-
Jacquelyn M. Powers, George R. Buchanan, Mark Shamoun, Timothy L. McCavit, and Leah Adix
- Subjects
Male ,medicine.medical_specialty ,Pediatrics ,Adolescent ,Iron ,Administration, Oral ,030204 cardiovascular system & hematology ,Inflammatory bowel disease ,Ferric Compounds ,FERRIC CARBOXYMALTOSE ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Refractory ,medicine ,Humans ,Adverse effect ,Child ,Infusions, Intravenous ,Maltose ,Retrospective Studies ,Anemia, Iron-Deficiency ,business.industry ,Infant ,Retrospective cohort study ,medicine.disease ,Hematologic Response ,Surgery ,Treatment Outcome ,Iron-deficiency anemia ,030220 oncology & carcinogenesis ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Female ,Hemoglobin ,business - Abstract
Objective To assess the benefits and risks of intravenous (IV) ferric carboxymaltose (FCM) in children with iron deficiency anemia (IDA). Study design In a retrospective cohort study of patients seen at our center, we identified all FCM infusions in children with IDA over a 12-month period through a query of pharmacy records. Clinical data, including hematologic response and adverse effects, were extracted from the electronic medical record. Results A total of 116 IV FCM infusions were administered to 72 patients with IDA refractory to oral iron treatment (median age, 13.7 years; range, 9 months to 18 years). Median preinfusion and postinfusion hemoglobin values were 9.1 g/dL and 12.3 g/dL, respectively (at 4-12 weeks after the initial infusion; n = 53). Sixty-five patients (84%) experienced no adverse effects. Minor transient complications were encountered during or immediately after 7 infusions. Conclusion FCM administered as a short IV infusion without a test dose proved to be safe and highly effective in a small yet diverse population of infants, children, and adolescents with IDA refractory to oral iron therapy.
- Published
- 2016
32. Occult hemorrhage in children with severe ITP
- Author
-
Adolfo, Flores and George R, Buchanan
- Subjects
Male ,Purpura, Thrombocytopenic, Idiopathic ,Adolescent ,Platelet Count ,Child, Preschool ,Humans ,Infant ,Female ,Hemorrhage ,Prospective Studies ,Child ,Intracranial Hemorrhages ,Magnetic Resonance Imaging - Abstract
Little is known about the frequency and significance of clinically unapparent or occult hemorrhage in ITP. Therefore, we prospectively explored the sites and frequency of occult bleeding in children with severe ITP at diagnosis or upon symptomatic relapse in a prospective, single-institution cohort study of patients ≤ 18 years of age and a platelet count ≤ 10,000/mm(3) . Data collected included bleeding severity assessment, urinalysis, fecal occult blood testing, and non-contrast brain MRI. Stool and urine samples were tested within 7 days of diagnosis or symptomatic relapse. Three months after diagnosis or relapse a noncontrast brain MRI evaluated hemosiderin deposits resulting from prior localized hemorrhage. Fifty-two ITP patients were enrolled with a mean platelet count of 4,000/mm(3) . A significant occurrence of occult hemorrhage was identified in the urine (27%) compared with clinically overt hematuria (0.91%, P 0.0005). CNS microbleeding in the superficial cortex of the left frontal lobe was identified in one child with occult bleeding in the urinary tract. There was no relationship between occult hemorrhage and bleeding manifestations on physical examination. Occult hemorrhage was not a harbinger of subsequent bleeding. Our findings suggest that occult hemorrhage occurs with greater frequency than overt bleeding in children with severe ITP. CNS microbleeding is a potential risk in this patient population. Assessment of brain microbleeds and microscopic hematuria in this patient population require additional study.
- Published
- 2015
33. Polyethylene Glycol-conjugated L-asparaginase Versus Native L-asparaginase in Combination With Standard Agents for Children With Acute Lymphoblastic Leukemia in Second Bone Marrow Relapse
- Author
-
George R. Buchanan, Bradley H Pollock, Mark L. Bernstein, Joanne Kurtzberg, Barbara L. Asselin, and Bruce M. Camitta
- Subjects
Male ,Asparaginase ,Adolescent ,macromolecular substances ,Polyethylene glycol ,Pharmacology ,Conjugated system ,medicine.disease_cause ,Antibodies ,Article ,Polyethylene Glycols ,Drug Hypersensitivity ,chemistry.chemical_compound ,Bone Marrow ,Recurrence ,Antineoplastic Combined Chemotherapy Protocols ,PEG ratio ,medicine ,Humans ,Child ,Escherichia coli ,Group study ,biology ,business.industry ,Escherichia coli Proteins ,technology, industry, and agriculture ,Infant ,Hematology ,Precursor Cell Lymphoblastic Leukemia-Lymphoma ,Treatment Outcome ,medicine.anatomical_structure ,Oncology ,chemistry ,Vincristine ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Immunology ,biology.protein ,Prednisone ,Female ,Bone marrow ,Antibody ,business - Abstract
Administration of L-asparaginase is limited by hypersensitivity reactions mediated by anti-asparaginase antibodies. To overcome this problem, native Escherichia coli L-asparaginase was conjugated to polyethylene glycol (PEG) to formulate PEG-L-asparaginase, a preparation with decreased immunogenicity and increased circulating half-life. In early trials, PEG-L-asparaginase was tolerated by patients known to be hypersensitive to the native E. coli product.The Pediatric Oncology Group conducted a phase II, randomized trial to compare the efficacy and toxicity of PEG-L-asparaginase compared with native E. coli asparaginase in children with acute lymphoblastic leukemia in second bone marrow relapse. All patients (n=76) received standard doses of vincristine and prednisone. Nonhypersensitive patients (n=34) were randomized to receive either PEG-L-asparaginase of 2500 IU/m/dose intramuscularly on days 1 and 15 (treatment I) or native E. coli asparaginase of 10,000 IU/m/dose intramuscularly on days 1, 3, 5, 8, 10, 12, 15, 17, 19, 22, 24, and 26 (treatment II). Patients with a clinical history of an allergic reaction to unmodified asparaginase were directly assigned to treatment with PEG-L-asparaginase (n=42). Asparaginase levels and anti-asparaginase antibody titers were monitored in all patients. Response and toxicity were scored using conventional criteria.The complete response rate for the total study population was 41%. There was no difference in complete response between patients randomized to PEG (47%) and native asparaginase (41%). PEG was well tolerated even in patients with prior allergic reactions to native asparaginase. PEG half-life was shorter in patients with prior allergy.PEG asparaginase is a useful agent in patients with allergic reactions to native asparaginase.
- Published
- 2011
34. Tapered oral dexamethasone for the acute chest syndrome of sickle cell disease
- Author
-
Ashok Raj, Lewis L. Hsu, Kim Smith-Whitley, Suba Krishnan, Frans A. Kuypers, Lori Styles, Yamaja Setty, Charles T. Quinn, Karen Kesler, Marie J. Stuart, George R. Buchanan, Nigel S. Key, Seungshin Rhee, Winfred C. Wang, Theodore Wun, and Kenneth I. Ataga
- Subjects
medicine.medical_specialty ,Sickle cell trait ,biology ,business.industry ,medicine.drug_class ,Anemia ,C-reactive protein ,Hematology ,medicine.disease ,Placebo ,Gastroenterology ,Acute chest syndrome ,Surgery ,Internal medicine ,medicine ,biology.protein ,Corticosteroid ,Biomarker (medicine) ,business ,Dexamethasone ,medicine.drug - Abstract
Tapered oral dexamethasone for acute chest syndrome (ACS) in sickle cell anaemia was studied using a novel ACS assessment tool and investigational biomarkers. Twelve participants were randomized (mean age 17·3 years) before early study termination. Dexamethasone decreased duration of hospitalization for ACS by 20·8 h compared to placebo (P = 0·024). Rebound pain occurred in both groups (3 dexamethasone versus 1 placebo). Overall, dexamethasone decreased the leucocyte activation biomarker, sL-selectin; however, participants with rebound pain had higher sL-selectin within 24 h of treatment (dexamethasone or placebo). This ACS assessment tool was feasibly applied, and sL-selectin is a promising biomarker of ACS therapy.
- Published
- 2011
35. A randomized, double-blind study of romiplostim to determine its safety and efficacy in children with immune thrombocytopenia
- Author
-
Kun Nie, James B. Bussel, David J. Gnarra, Lisa Bomgaars, George R. Buchanan, Diane J. Nugent, Victor S. Blanchette, Yow Ming Wang, and Susie Jun
- Subjects
Male ,medicine.medical_specialty ,Pediatrics ,Randomization ,Adolescent ,Injections, Subcutaneous ,Recombinant Fusion Proteins ,Immunology ,Receptors, Fc ,Placebo ,Biochemistry ,Thrombopoiesis ,law.invention ,Double-Blind Method ,Randomized controlled trial ,Pharmacokinetics ,law ,Internal medicine ,medicine ,Humans ,Child ,Adverse effect ,Purpura, Thrombocytopenic, Idiopathic ,Romiplostim ,Hematology ,business.industry ,Infant ,Cell Biology ,Surgery ,Treatment Outcome ,Thrombopoietin ,El Niño ,Child, Preschool ,Female ,business ,Receptors, Thrombopoietin ,medicine.drug - Abstract
Romiplostim, a thrombopoietin-mimetic peptibody, increases and maintains platelet counts in adults with immune thrombocytopenia (ITP). In this first study of a thrombopoietic agent in children, patients with ITP of ≥ 6 months' duration were stratified by age 1:2:2 (12 months-< 3 years; 3-< 12 years; 12-< 18 years). Children received subcutaneous injections of romiplostim (n = 17) or placebo (n = 5) weekly for 12 weeks, with dose adjustments to maintain platelet counts between 50 × 109/L and 250 × 109/L. A platelet count ≥ 50 × 109/L for 2 consecutive weeks was achieved by 15/17 (88%) patients in the romiplostim group and no patients in the placebo group (P = .0008). Platelet counts ≥ 50 × 109/L were maintained for a median of 7 (range, 0-11) weeks in romiplostim patients and 0 (0-0) weeks in placebo patients (P = .0019). The median weekly dose of romiplostim at 12 weeks was 5 μg/kg. Fourteen responders received romiplostim for 4 additional weeks for assessment of pharmacokinetics. No patients discontinued the study. There were no treatment-related, serious adverse events. The most commonly reported adverse events in children, as in adults, were headache and epistaxis. In this short-term study, romiplostim increased platelet counts in 88% of children with ITP and was well-tolerated and apparently safe. The trial was registered with http://www.clinicaltrials.gov as NCT00515203.
- Published
- 2011
36. Response to steroids predicts response to rituximab in pediatric chronic immune thrombocytopenia
- Author
-
Michael Recht, Alexis A. Thompson, Robert J. Klaassen, Michele P. Lambert, Leslie A. Kalish, Courtney D. Thornburg, Ellis J. Neufeld, Margaret Heisel Kurth, Michael Jeng, A. Kim Ritchey, George R. Buchanan, Michelle Neier, Rachael F. Grace, Kimo C. Stine, Carolyn M. Bennett, Diane J. Nugent, Victor Blanchette, and Manjusha Kumar
- Subjects
Male ,Logistic regression ,Biochemistry ,Cohort Studies ,Antibodies, Monoclonal, Murine-Derived ,immune system diseases ,Prednisone ,hemic and lymphatic diseases ,Longitudinal Studies ,Prospective Studies ,Child ,Prospective cohort study ,Univariate analysis ,biology ,Incidence (epidemiology) ,Immunoglobulins, Intravenous ,Hematology ,Treatment Outcome ,Oncology ,Child, Preschool ,Monoclonal ,Female ,Rituximab ,Antibody ,medicine.drug ,Cohort study ,medicine.medical_specialty ,Evans syndrome ,Adolescent ,Uterine fibroids ,Immunology ,Antineoplastic Agents ,Article ,Refractory ,Internal medicine ,medicine ,Humans ,Immunologic Factors ,Glucocorticoids ,Retrospective Studies ,Platelet Count ,business.industry ,Infant, Newborn ,Infant ,Retrospective cohort study ,Cell Biology ,medicine.disease ,Thrombocytopenia ,Chronic Disease ,Pediatrics, Perinatology and Child Health ,biology.protein ,business ,Follow-Up Studies - Abstract
Abstract 3681 Background: Pediatric Immune Thrombocytopenia (ITP) has an incidence of 4–6/100,000 with 1/3 of cases becoming chronic. Treatment choice is arbitrary, because few studies are powered to identify predictors of therapy response. Increasingly, rituximab is becoming a treatment of choice in those refractory to other therapies (Neunert CE, et al. Pediatr Blood Cancer 2008; 51(4):513). Previous studies in ITP have not examined predictors of response to rituximab or whether response to prior treatments predicts response. Objective: To evaluate univariate and multivariable predictors of platelet count response to rituximab. Methods: After local IRB approval, 550 patients with chronic ITP enrolled in the longitudinal, North American Chronic ITP Registry (NACIR) between January 2004 and June 2010. Eligibility included: ages 6 months-18 years at ITP diagnosis, clinical diagnosis of ITP, and ITP duration >6 months. Primary ITP was defined as isolated thrombocytopenia without associated conditions. Secondary ITP included those patients with immune thrombocytopenia associated with other immune-mediated medical conditions, including Evans Syndrome. Treatment response was defined as a post-treatment platelet count ≥50,000/uL within 16 weeks of rituximab and within 14 days of steroids. Steroids were prescribed as 1–4 mg/kg prednisone or adult equivalent over 4–14 days with or without taper. The NACIR captured treatment responses both retrospectively prior to enrollment and then prospectively, and both periods were included in this analysis. The multivariable logistic regression modeling process utilized SAS 9.1 using binary variables which were either significant in the univariate analysis or clinically important. A backwards elimination procedure was used to select the final model. Results: Seventy-six (13.8%) patients were treated with rituximab. Demographics of the patients treated with rituximab include: 42% male; 81% Caucasian, 17% Black, and 2% Asian. The mean age at diagnosis of ITP was 8.4 ± SD 5.1 years. The median platelet count at diagnosis of acute ITP was 10,000/uL (IQR 5,000-20,000/uL). 19 (25%) patients had secondary ITP or Evans syndrome. Treatment with rituximab had an overall response rate of 63.2% (48/76). Univariate predictors of response to rituximab are shown in Table I. The strongest univariate predictor of response to rituximab was response to steroids. Gender, ethnicity, and race were not predictive of response to rituximab. Furthermore, other variables which did not predict rituximab response include: history of a bleeding score ≥3 (Buchanan and Adix, J Pediatr 2002; 141: 683), symptoms ≥1 month prior to ITP diagnosis, older age (age >5 years), platelets ≥20,000/uL at acute ITP diagnosis, and a positive ANA. In multivariable analysis, response to steroids remained a strong predictor of response to rituximab with an OR 6.2 (95% CI 1.8–21.3, p=0.004). Secondary ITP also remained a strong a predictor of a positive response to rituximab with an OR 5.9 (95% CI 1.2–33.3, p=0.03). Conclusion: In the NACIR, response to steroids and secondary ITP were strong predictors of response to rituximab, a finding not previously reported in children or adults. Although this finding requires further validation, this result may provide evidence that rituximab should be most considered in patients previously responsive to steroids. Disclosures: Off Label Use: Rituximab for chronic ITP. Lambert:Cangene: Membership on an entity's Board of Directors or advisory committees. Klaassen:Novartis: Research Funding; Cangene: Research Funding. Neufeld:Novartis, Inc: Research Funding.
- Published
- 2011
37. Immune Thrombocytopenia during Childhood: New Approaches to Classification and Management
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George R. Buchanan
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Male ,Purpura, Thrombocytopenic, Idiopathic ,business.industry ,Recombinant Fusion Proteins ,Receptors, Fc ,Bioinformatics ,Benzoates ,Immune thrombocytopenia ,Hydrazines ,Text mining ,Thrombopoietin ,Pediatrics, Perinatology and Child Health ,Humans ,Pyrazoles ,Medicine ,Female ,business - Published
- 2014
38. Burden of diagnostic radiation exposure in children with sickle cell disease
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George R. Buchanan, Charles T. Quinn, and Courtney L. Vetter
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Pediatrics ,medicine.medical_specialty ,business.industry ,Radiography ,Cancer ,Retrospective cohort study ,Hematology ,Disease ,Limiting ,medicine.disease ,Radiation exposure ,Tomography x ray computed ,Increased risk ,Oncology ,Pediatrics, Perinatology and Child Health ,Medicine ,business - Abstract
Children with sickle cell disease (SCD) are repeatedly exposed to diagnostic radiation. We identified 938 children with SCD who had 9,246 radiographic tests. Mean number of tests/patient was 9.9 (95% CI: 8.9–10.9) over 8,817 patient-years. Mean rate was 1.5 tests/year (95% CI: 1.3–1.6). On average, a child with SCD will have 26.7 (95% CI: 24.1–29.3) radiographic tests by 18 years of age, and 5% will have ≥100 tests. Six percent have ≥3 CT scans, which may be associated with an increased risk of cancer. Strong consideration should be given to limiting the exposure of children with SCD to radiation.
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- 2014
39. Intravenous iron sucrose for children with iron deficiency failing to respond to oral iron therapy
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Katherine Hall, George R. Buchanan, and Shelley E. Crary
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medicine.medical_specialty ,business.industry ,Anemia ,Hematology ,Iron deficiency ,Iron sucrose ,medicine.disease ,Gastroenterology ,Surgery ,Parenteral nutrition ,Oncology ,Refractory ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Hemoglobin ,Hematinic ,business ,Adverse effect ,medicine.drug - Abstract
Background For decades, parenteral iron has been used in patients with iron deficiency unresponsive to oral iron therapy and in hemodialysis-dependent patients receiving erythropoietin. Newer intravenous (IV) iron formulations such as iron sucrose have replaced high-molecular weight iron (HMW) dextran in dialysis patients; however, the use of parenteral iron in children without renal disease has not been well defined. Procedure Pharmacy records were reviewed on children (≤18 years of age) who received IV iron sucrose at Children's Medical Center Dallas between January 1, 2004 and June 30, 2009. Patients who received iron sucrose for chronic renal disease were excluded from analysis. Results Thirty-eight children received iron sucrose for non-renal indications, 13 with iron deficiency refractory to oral iron therapy, 13 with iron malabsorption or dependence on parenteral nutrition, 7 for chronic gastrointestinal blood loss, and 5 for miscellaneous indications. Among these 38 children, who received a total of 510 doses of IV iron sucrose, there were only six adverse reactions. Patients in all categories had a good response to the iron sucrose, with a median hemoglobin rise of 1.9–3.1 g/dl depending on the indication. Conclusions Parenteral iron is a safe and effective means to treat iron deficiency in children who cannot receive or do not respond to oral iron due to intolerance, poor adherence, or iron malabsorption. Pediatr Blood Cancer 2011;56:615–619. © 2010 Wiley-Liss, Inc.
- Published
- 2010
40. Traditional laboratory measures of cardiovascular risk in hereditary spherocytosis
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George R. Buchanan, Naveed Ahmad, Sarah B. Troendle, and Shelley E. Crary
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Adult ,Male ,medicine.medical_specialty ,Adolescent ,Homocysteine ,Anemia ,medicine.medical_treatment ,Spherocytosis ,Splenectomy ,Spherocytosis, Hereditary ,Gastroenterology ,Article ,Hereditary spherocytosis ,chemistry.chemical_compound ,Internal medicine ,White blood cell ,Humans ,Medicine ,Prospective Studies ,Child ,Aged ,medicine.diagnostic_test ,biology ,business.industry ,C-reactive protein ,Complete blood count ,Bilirubin ,Cholesterol, LDL ,Hematology ,Middle Aged ,medicine.disease ,Lipids ,Blood Cell Count ,C-Reactive Protein ,Cross-Sectional Studies ,medicine.anatomical_structure ,Oncology ,chemistry ,Cardiovascular Diseases ,Child, Preschool ,Pediatrics, Perinatology and Child Health ,Immunology ,biology.protein ,Female ,business - Abstract
Background Individuals who have undergone splenectomy may be at an increased risk of arterial and venous thrombosis. We sought to determine if splenectomy affects surrogate laboratory measures of cardiovascular risk in persons with hereditary spherocytosis (HS). Procedure We conducted a prospective cross-sectional study of 21 children and 36 adults with HS. Fasting blood samples were collected for complete blood count and plasma lipid panel, homocysteine, lipoprotein (a), C-reactive protein, and fibrinogen. The variables were compared between the groups with and without prior splenectomy by Mann–Whitney tests. Results Subjects with prior splenectomy had higher hemoglobin, white blood cell and platelet counts and lower reticulocyte counts and total serum bilirubin concentrations (P
- Published
- 2010
41. Improved survival of children and adolescents with sickle cell disease
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Timothy L. McCavit, Charles T. Quinn, George R. Buchanan, and Zora R. Rogers
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Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Time Factors ,Adolescent ,Clinical Trials and Observations ,Anemia ,Immunology ,Anemia, Sickle Cell ,Biochemistry ,Sepsis ,medicine ,Humans ,Young adult ,Child ,Survival rate ,Quality of Health Care ,Cause of death ,business.industry ,Incidence ,Incidence (epidemiology) ,Age Factors ,Infant, Newborn ,Infant ,Cell Biology ,Hematology ,medicine.disease ,Texas ,Sickle cell anemia ,Acute chest syndrome ,Survival Rate ,Child, Preschool ,Cohort ,Female ,business ,Follow-Up Studies - Abstract
The survival of young children with sickle cell disease (SCD) has improved, but less is known about older children and adolescents. We studied the Dallas Newborn Cohort (DNC) to estimate contemporary 18-year survival for newborns with SCD and document changes in the causes and ages of death over time. We also explored whether improvements in the quality of medical care were temporally associated with survival. The DNC now includes 940 subjects with 8857 patient-years of follow-up. Most children with sickle cell anemia (93.9%) and nearly all children with milder forms of SCD (98.4%) now live to become adults. The incidence of death and the pattern of mortality changed over the duration of the cohort. Sepsis is no longer the leading cause of death. All the recent deaths in the cohort occurred in patients 18 years or older, most shortly after the transition to adult care. Quality of care in the DNC has improved over time, with significantly more timely initial visits and preventive interventions for young children. In summary, most children with SCD now survive the childhood years, but young adults who transition to adult medical care are at high risk for early death.
- Published
- 2010
42. Thrombocytopenic Purpura after Measles-Mumps-Rubella Vaccination: A Systematic Review of the Literature and Guidance for Management
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Evangelia Farmaki, George R. Buchanan, and Elpis Mantadakis
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Pediatrics ,medicine.medical_specialty ,Measles-Mumps-Rubella Vaccine ,Thrombotic thrombocytopenic purpura ,MMR vaccine ,complex mixtures ,Rubella ,Measles ,Risk Factors ,immune system diseases ,hemic and lymphatic diseases ,medicine ,Humans ,business.industry ,Incidence ,Vaccination ,medicine.disease ,Thrombocytopenic purpura ,digestive system diseases ,Purpura, Thrombocytopenic ,Immunization ,Practice Guidelines as Topic ,Pediatrics, Perinatology and Child Health ,Immunology ,business - Abstract
Objective To determine the incidence of immune thrombocytopenic purpura (ITP) after measles-mumps-rubella (MMR) immunization compared with natural measles and rubella, its clinical course and outcome, and the risk of recurrence after repeat MMR vaccination. Study design We performed a systematic review of the Ovid MEDLINE (1950 to present) bibliographic database. We selected studies that reported cases of thrombocytopenia in a known number of children who were immunized with MMR vaccine before development of ITP. We also extracted data from the same and other studies regarding bleeding manifestations and the resolution of MMR-associated thrombocytopenia or thrombocytopenic purpura within 6 months. Finally, we studied the risk of ITP recurrence after MMR immunization or reimmunization. Results On the basis of 12 studies, the incidence of MMR-associated ITP ranged from 0.087 to 4 (median 2.6) cases per 100 000 vaccine doses. Severe bleeding manifestations were rare, and MMR-associated thrombocytopenia resolved within 6 months from diagnosis in 93% of the children. MMR vaccination of unimmunized patients with ITP and revaccination of patients with prior ITP did not lead to recurrence of thrombocytopenia. Conclusions MMR-associated ITP is rare, self-limited, and non-life threatening, and susceptible children with ITP should be immunized with MMR at the recommended ages.
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- 2010
43. Free vibration of a paraboloidal shell of revolution including shear deformation and rotary inertia
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George R. Buchanan and Omar J. Al-Khatib
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Engineering ,business.industry ,Mechanical Engineering ,media_common.quotation_subject ,Shell (structure) ,Geometry ,Rotary inertia ,Building and Construction ,Mechanics ,Inertia ,Curvature ,Finite element method ,Vibration ,Normal mode ,Physics::Atomic and Molecular Clusters ,Boundary value problem ,business ,Civil and Structural Engineering ,media_common - Abstract
The governing strain-displacement and curvature-displacement equations for paraboloidal shells including shear deformation and rotary inertia are solved for free vibration of closed shells. The finite element method is used to obtain three-dimensional frequency of vibration solutions for a variety of boundary conditions, free, fixed and simply supported. Assumptions concerning the circumferential vibrational behavior are incorporated that reduce the analysis to a single coordinate and the element shape function is formulated using the meridional coordinate. The results for frequency of vibration compare favorably with the available literature. Selected results for frequency of vibration are presented in tabular form for several shell parameters, including free, pinned and fixed boundary conditions. Representative mode shapes are plotted for a fixed boundary condition.
- Published
- 2010
44. Severe Sickle Cell Disease—Pathophysiology and Therapy
- Author
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Lakshmanan Krishnamurti, Elliott Vichinsky, Shalini Shenoy, and George R. Buchanan
- Subjects
medicine.medical_specialty ,Chronic transfusion therapy ,Anemia ,medicine.medical_treatment ,MEDLINE ,Hematopoietic stem cell transplantation ,Disease ,Anemia, Sickle Cell ,030204 cardiovascular system & hematology ,Article ,03 medical and health sciences ,0302 clinical medicine ,Medicine ,Humans ,Intensive care medicine ,Transplantation ,business.industry ,Sickle cell disease ,Hematopoietic Stem Cell Transplantation ,Hematology ,medicine.disease ,Prognosis ,Pathophysiology ,3. Good health ,Surgery ,Bone transplantation ,Bone marrow transplant ,030220 oncology & carcinogenesis ,business ,Psychosocial - Abstract
Over 70,000 people live with sickle cell disease (SCD) in the United States and multitudes worldwide. About 2000 afflicted babies are born in this country each year. In African countries such as Nigeria, over 100,000 babies are born with the disease each year. Great strides have been made in the conservative management of SCD. However, the medical and psychosocial cost of supporting patients with this chronic illness is enormous and spans a lifetime. Hematopoietic stem cell transplantation (HSCT) can abrogate SCD manifestations, and is the best option for cure today. Yet, this treatment modality is underutilized as less than 500 transplants are reported in the Center for International Blood and Marrow Transplant Research (CIBMTR) database because of its significant risk of morbidity and mortality. There is growing understanding of the pathophysiology of the disease, and this, coupled with advances in transplantation and new approaches to therapy, continue to improve care of patients with SCD both in children and during adulthood. Continuing investigation seeks to predict the course of the disease and to determine timing and modality of therapy in order to optimize outcomes.
- Published
- 2010
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45. Health Related Quality of Life and Fatigue Improve on Second Line Treatments in Pediatric Immune Thrombocytopenia (ITP)
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James B. Bussel, Carolyn M. Bennett, Vicky R. Breakey, Kristina M. Haley, Ellis J. Neufeld, Rachael F. Grace, Jenny M. Despotovic, George R. Buchanan, Amy E. Geddis, Robert J. Klaassen, Rukhmi Bhat, Michael Jeng, Peter W. Forbes, Kristin A. Shimano, Cindy Neunert, Kerry Hege, Jennifer A. Rothman, Shelley E. Crary, Melissa J. Rose, Michele P. Lambert, Michelle Neier, Yves D. Pastore, Nolan Neu, and Adonis Lorenzano
- Subjects
Health related quality of life ,Pediatrics ,medicine.medical_specialty ,Romiplostim ,business.industry ,medicine.medical_treatment ,Immunology ,Splenectomy ,Eltrombopag ,Cell Biology ,Hematology ,030204 cardiovascular system & hematology ,Dapsone ,Biochemistry ,Rho(D) immune globulin ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Second line ,chemistry ,medicine ,Rituximab ,business ,030215 immunology ,medicine.drug - Abstract
Background: The impact of second line therapies on health related quality of life (HRQoL) and fatigue in pediatric patients with ITP is not well studied. Objective: To describe the impact of second line therapies on HRQoL and fatigue in North American pediatric patients with ITP. Methods: A longitudinal observational cohort of 120 children with ITP starting second line treatments was enrolled from 2013-2015 at 21 ICON centers. Enrollment requirements included age 1-17y and starting a second line treatment (not IVIG, corticosteroids or anti-D immunoglobulin) as monotherapy. HRQoL (Kids ITP Tool - KIT) and fatigue (Hockenberry Fatigue Scale - FS) surveys were completed prior to starting treatment (baseline) and 1 and 12 months after starting treatment by patient/caregiver. KIT is scored from 0 (worst) to 100 (best), and the FS scores were re-scaled so that 0 is no fatigue and 100 is highest fatigue. At the same time points as the patient/caregiver surveys, physicians assessed the perceived effect of treatment on patient HRQoL using a 7-point scale. ANOVA was used to compare the baseline means of the treatment groups. This study specifically compared change from baseline to 1 month in the KIT and FS using paired t-tests within each treatment group. The 12 month timepoint was not used in the paired analysis of individual treatments due to attrition between 1 and 12 months. Results: The median age at enrollment was 11.3 y (1.2-17.8), and 16% (19/120) had newly diagnosed ITP, 31% (37/120) had persistent ITP, and 53% (64/120) had chronic ITP. The median number of prior treatments was 3 (range: 1-9). Fifty-eight (48%) patients had received at least one prior second line treatment. Treatments selected for second line treatment included: rituximab (n=43), romiplostim (n=31), eltrombopag (n=20), oral immunosuppressants (n=19), splenectomy (n=4), and dapsone (n=3). The child and parent proxy KIT scores significantly improved on rituximab (p As previously described, at enrollment, physicians reported that ITP had impacted the patients' HRQoL severely in 15%, significantly in 45%, moderately in 38%, and almost not at all in 3%. Physicians reported that HRQoL improved in 68% (range: 64-75%) of patients while on treatment from baseline to 1 month with no significant difference by treatment group (p=0.46). The physician's assessment of the patient's baseline HRQoL significantly correlated with the child and parent proxy KIT report (p At enrollment, the median FS-Child score (n=54) was 18.5 (range 0-85), the median FS-Adolescent score (n=42) was 20.2 (0-73), and the median FS-Parent (n= 100) score was 35 (7-81). One month FS-Child improved for those who were treated with rituximab (p=0.03); there was no significant change in fatigue on the other treatments. One month FS-Parent significantly improved for those treated with rituximab (p=0.015) and eltrombopag (p=0.009). Conclusions: In this pediatric cohort, all second line treatments appear to significantly improve HRQoL in ITP. Rituximab had the greatest impact in decreasing fatigue at one month. Physician assessment of patient HRQoL did not correlate well with patient assessment after treatment was started, suggesting there may be challenges in ascertaining the effect of treatment on HRQoL. Future analysis of ICON1 will consider the impact of treatment on HRQoL and fatigue while also accounting for the treatment effect on bleeding and platelet count. Disclosures Grace: Agios: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding. Klaassen: Amgen: Consultancy; Hoffman-La Roche LTD: Consultancy; Octapharma: Honoraria; Baxalta: Honoraria; Biogen Canada LTD: Consultancy; Agios Pharmaceuticals: Consultancy. Despotovic: Sanofi: Consultancy; Schell Cooley LLP: Other: Expert witness. Bussel: Protalex: Membership on an entity's Board of Directors or advisory committees, Research Funding; Momenta: Membership on an entity's Board of Directors or advisory committees; Rigel: Membership on an entity's Board of Directors or advisory committees, Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding; Amgen: Membership on an entity's Board of Directors or advisory committees, Research Funding. Rothman: Pfizer: Consultancy; Agios Pharmaceuticals: Honoraria. Haley: Genentech: Honoraria; Baxalta: Honoraria; CSL Behring: Honoraria. Neufeld: Octapharma: Consultancy, Honoraria; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Lambert: Educational Concepts in Medicine: Honoraria; Novartis: Honoraria; AstraZeneca: Research Funding.
- Published
- 2017
46. Effect of Different Iron Preparations for Young Children With Iron-Deficiency Anemia—Reply
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George R. Buchanan, Jacquelyn M. Powers, and Timothy L. McCavit
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business.industry ,Anemia ,IRON PREPARATIONS ,Physiology ,General Medicine ,Iron deficiency ,medicine.disease ,03 medical and health sciences ,0302 clinical medicine ,Iron-deficiency anemia ,030220 oncology & carcinogenesis ,medicine ,030212 general & internal medicine ,ANEMIA IRON DEFICIENCY ,business - Published
- 2017
47. Acute silent cerebral infarction in children with sickle cell anemia
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Charles T. Quinn, Zora R. Rogers, Michael M. Dowling, and George R. Buchanan
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medicine.medical_specialty ,business.industry ,Cerebral infarction ,Anemia ,Hematology ,medicine.disease ,Sickle cell anemia ,Diffusion-Weighted Magnetic Resonance Imaging ,Surgery ,Neurologic injury ,Blood cancer ,Oncology ,Internal medicine ,Pediatrics, Perinatology and Child Health ,medicine ,Cardiology ,Focal neurologic deficits ,business ,Stroke - Abstract
Silent cerebral infarctions (SCI) occur in up to 35% of children with sickle cell anemia (HbSS) but are rarely recognized during the initial 10–14 days when diffusion weighted magnetic resonance imaging (MRI) can differentiate acute infarctions from remote events. We report acute SCI in seven children with HbSS who had areas of restricted diffusion on MRI without persistent focal neurologic deficits. Four had acute SCI identified following acute anemic events. Our observations suggest that SCI are detectible in the acute phase, present with subtle neurologic symptoms, result in permanent neurologic injury, and may be caused by acute anemic events. Pediatr Blood Cancer 2010;54:461–464. © 2009 Wiley-Liss, Inc.
- Published
- 2009
48. Vascular complications after splenectomy for hematologic disorders
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George R. Buchanan and Shelley E. Crary
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medicine.medical_specialty ,medicine.medical_treatment ,Immunology ,Splenectomy ,Review Article ,Biochemistry ,Postoperative Complications ,Hematologic disorders ,Internal medicine ,Correspondence ,medicine ,Humans ,In patient ,Vascular Diseases ,Intensive care medicine ,Adverse effect ,Hematology ,Extramural ,business.industry ,Incidence (epidemiology) ,Cell Biology ,medicine.disease ,Hematologic Diseases ,Thrombosis ,Surgery ,Surgical asplenia ,business ,Complication ,Thrombotic complication - Abstract
The most widely recognized long-term risk of splenectomy is overwhelming bacterial infection. More recently, thrombosis has become appreciated as another potential complication of the procedure. Because of these long-term risks, the indications for and timing of splenectomy are debated in the medical community. Accordingly, the adverse effects and benefits of splenectomy for hematologic disorders and other conditions demand further study. This comprehensive review summarizes the existing literature pertaining to vascular complications after splenectomy for hematologic conditions and attempts to define the potential pathophysiologic mechanisms involved. This complex topic encompasses diverse underlying conditions for which splenectomy is performed, diverse thrombotic complications, and multiple pathophysiologic mechanisms.
- Published
- 2009
49. Possible lower rate of chronic ITP after IVIG for acute childhood ITP an analysis from registry I of the Intercontinental Cooperative ITP Study Group (ICIS)
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Marrie C. A. Bruin, George R. Buchanan, Willi Berchtold, Thomas Kühne, Rienk Y. J. Tamminga, and Faculteit Medische Wetenschappen/UMCG
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Male ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Immunoglobulin E ,law.invention ,Randomized controlled trial ,immune system diseases ,law ,Internal medicine ,hemic and lymphatic diseases ,intravenous immunoglobulin ,medicine ,Humans ,chronic immune thrombocytopenic purpura ,Intercontinental Cooperative ITP Study Group ,REGULATORY T-CELLS ,Prospective cohort study ,Child ,ORAL PREDNISONE ,childhood ,Purpura, Thrombocytopenic, Idiopathic ,Hematology ,biology ,business.industry ,Potential effect ,Immunoglobulins, Intravenous ,Infant ,MEGADOSE METHYLPREDNISOLONE ,PLATELET COUNT ,medicine.disease ,Thrombocytopenic purpura ,RANDOMIZED-TRIAL ,Treatment Outcome ,El Niño ,Multicenter study ,ANTIINFLAMMATORY ACTIVITY ,IDIOPATHIC-THROMBOCYTOPENIC-PURPURA ,Child, Preschool ,Chronic Disease ,biology.protein ,IMMUNOGLOBULIN-G ,Female ,business ,INTRAVENOUS IMMUNE GLOBULIN ,DOSE METHYLPREDNISOLONE - Abstract
P>In children, one-third of immune thrombocytopenic purpura (ITP) patients follow a chronic course. The present study investigated whether treatment with intravenous immunoglobulin (IVIG) at the time of diagnosis of ITP is of prognostic significance, using data from 1984 children entered in Registry I of the Intercontinental Cooperative ITP Study Group. A matched pairs analysis compared children with thrombocytopenia (platelet count = 50 x 10(9)/l at that time point, the former group was less often treated with IVIG than with steroids (P = 0 center dot 02). Prospective studies are required to further explore this potential effect of IVIG.
- Published
- 2009
50. Academic promotion and tenure: a user’s guide for junior faculty members
- Author
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George R. Buchanan
- Subjects
Faculty, Medical ,Universities ,ComputingMilieux_THECOMPUTINGPROFESSION ,business.industry ,Process (engineering) ,media_common.quotation_subject ,Prestige ,Aspirations, Psychological ,Organizational culture ,Timeline ,Hematology ,Plan (drawing) ,Public relations ,Organizational Culture ,Career Mobility ,Promotion (rank) ,Political science ,Institution ,Humans ,Position (finance) ,business ,Schools, Medical ,media_common - Abstract
Securing a junior faculty position is an important early step in an academic career in hematology. Shortly thereafter one should begin to plan for eventual promotion and possible tenure. The process is not straightforward, as the “rules of the road” regarding academic positions, academic tracks, assessment and evaluation metrics, and timelines vary immensely from one institution to another. It is critically important, therefore, for the new junior faculty member to become knowledgeable about the institutional policies and “culture” regarding this process. This understanding includes the definition of and criteria for achieving tenure, the academic tracks and the policies for advancement on each track, and the process by which the institutional committee responsible for promotion and tenure conducts its activities. Learning the rules and successfully navigating the academic pathway will help ensure success by achieving the desired promotion and the self-satisfaction, prestige, and financial awards that may accompany it.
- Published
- 2009
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