Indian Academy of Pediatrics Presidential Action Plan 2006 Pediatric Hematology–Oncology Chapter

Reference Manual for

National Training Project

Practical

Pediatric Hematology Second Edition Editor

Anupam Sachdeva Associate Editor

SP Yadav

National Coordinator National Training Project - Practical Pediatric Hematology

National Advisory Committee SC Arya (Delhi) VP Choudhury (Delhi) SK Sood (Delhi) Panna Choudhury (Delhi) MR Lokeshwar (Mumbai) Bharat Agarwal (Mumbai) Z Currimbhoy (Mumbai) Mamta Manglani (Mumbai) Rashmi Dalvi (Mumbai) RK Marwaha (Chandigarh) ®

JAYPEE BROTHERS MEDICAL PUBLISHERS (P) LTD New Delhi • Panama City • London

®

Jaypee Brothers Medical Publishers (P) Ltd. Headquarter Jaypee Brothers Medical Publishers (P) Ltd 4838/24, Ansari Road, Daryaganj New Delhi 110 002, India Phone: +91-11-43574357 Fax: +91-11-43574314 Email: [email protected] Overseas Offices J.P. Medical Ltd., 83 Victoria Street London SW1H 0HW (UK) Phone: +44-2031708910 Fax: +02-03-0086180 Email: [email protected]

Jaypee-Highlights Medical Publishers Inc. City of Knowledge, Bld. 237, Clayton Panama City, Panama Phone: 507-317-0160 Fax: +50-73-010499 Email: [email protected]

Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2012, Anupam Sachdeva All rights reserved. No part of this book may be reproduced in any form or by any means without the prior permission of the publisher. Inquiries for bulk sales may be solicited at: [email protected] This book has been published in good faith that the contents provided by the contributors contained herein are original, and is intended for educational purposes only. While every effort is made to ensure accuracy of information, the publisher and the editors specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work. If not specifically stated, all figures and tables are courtesy of the editors. Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device. Practical Pediatric Hematology First Edition: 2006 Second Edition: 2012 ISBN 978-93-5025-921-4

Printed at Repro India Limited

Indian Academy of Pediatrics Presidential Action Plan 2006 Pediatric Hematology–Oncology Chapter

Office Bearers PHO Chapter 2005-2006 Chairman Bharat R Agarwal Immediate Past Chairman RK Marwaha Honorary Secretary Anupam Sachdeva Honorary Treasurer Jagdish Chandra Organizing Secretary PHOCON 2005 Pradeep Sihare Organizing Secretary PHOCON 2006 Leni Grace Mathews Chief Editor Rashmi Dalvi National Coordinator: NTP-PPO Purna A Kurkure Webmaster Shailesh A Kanvinde Central Zone Archana Kumar East Zone Ashish Mukhopadhyay

West Zone Mamta V Manglani

North Zone Deepak Bansal

South Zone Major ATK Rau Co-opted Members Nalin Kant Pati Anupama S Borker

Indian Academy of Pediatrics Presidential Action Plan 2006 Pediatric Hematology–Oncology Chapter

The Executive Board of Central lAP 2005 President lAP (2005) Raju C Shah President lAP (2006) Nitin K Shah President lAP (2004) MKC Nair Vice President lAP (2005) Anoop Kumar Verma Secretary General Bharat R Agarwal Treasurer Deepak Ugra Editor-in-Chief, IP Panna Choudhury Editor-in-Chief, IJPP A Balachandran Joint Secretary AK Dutta

Santosh T Soans P Venkateshwara Rao V Ram Narsimha Reddy Garima Saikia Radha Krishna Sinha RK Marwaha Ajay Gambhir Anupam Sachdeva Satish V Pandya Baldev S Prajapati Dinesh Khosla Brij Bhushan Sahni M Govindaraj

BD Gupta TM Ananda Kesavan MA Mathew TU Sukumaran MI Agnihotri Chandra Has Sharma KSH Chourjit Singh Pramod Jog Sandeep Bapu Kadam Rajendra V Kulkarni Yashwant Patil Gadadhar Sarangi Harmesh Singh

D Gunasingh K Meer Mustafa Hussain P Velusamy Ashok Kumar Rai Vineet K Saxena VN Tripathi Debasis Biswas Sukanta Chatterjee Col MK Behera Rajesh Mehta (President’s Sp. Rep.) Tanmay Amladi (AAA)

Indian Academy of Pediatrics Presidential Action Plan 2006 Pediatric Hematology–Oncology Chapter The Executive Board of Central lAP 2006 President lAP Nitin K Shah President Elect, lAP Naveen Thacker Immediate Past President, lAP Raju C Shah Secretary General, lAP Deepak Ugra Treasurer, lAP Rohit C Agrawal Editor-in-Chief, IP Panna Choudhury Editor-in-Chief, IJPP A Balachandran Joint Secretary, lAP Bharat R Agarwal

K Umamaheswara Rao

R Nisarga

Prem Prakash Gupta

P Venkateshwara Rao

Santosh T Soans

Ashok Gupta

P Sudershan Reddy

Guhan Balraj

MP Jeyapaul

Arati Deka

TU Sukumaran

K Nedunchelian

Sachidanand Thakur

MA Mathew

K Chandrasekaran

Pradeep Sihare

Mukesh Kumar Khare

Vineet K Saxena

Sunil Gomber

CP Bansal

VN Tripathi

Ajay Gambhir

Anand K Shandilya

Mahesh Kumar Goel

Baldev S Prajapati

Yashwant Patil

Nabendu Choudhuri

Satish V Pandya

Tanmay Amladi .

Sutapa Ganguly

VN Mehendiratta

Vijay Yewale

Col MK Behera

Subhash Singh Slathia

KSH Chourjit Singh

Anupam Sachdeva

Bijay Prasad

BK Bhuyan

(President’s Sp Rep.)

M Govindaraj

Kul Bhushan Sharda

Kamlesh Shrivastava (AAA)

Dedicated to The stalwarts of Pediatric Hematology in our Country

Contributors

Anshul Gupta MD Department of Pediatric Hematology and Oncology and Bone Marrow Transplantation Rajiv Gandhi Cancer Institute and Research Centre Delhi, India

Biju George DM Professor Department of Hematology Christian Medical College Vellore, Tamil Nadu, India

Anupam Sachdeva Director Pediatric Hematology and Oncology and Bone Marrow Transplantation Chairman Department of Academics and Convenor Research Sir Ganga Ram Hospital New Delhi, India

Deepak Bansal MD DNB Additional Professor Hematology/Oncology Unit Advanced Pediatric Center Postgraduate Institute of Medical Education and Research, Chandigarh, India [email protected]

AP Dubey Professor-Director and Head Department of Pediatrics Sir Ganga Ram Hospital New Delhi, India Archana Kumar Professor Department of Pediatrics Chhatrapati Shahuji Maharaj Medical University Lucknow, Uttar Pradesh, India Arun Soni Consultant Neonatologist Institute for Child Health Sir Ganga Ram Hospital New Delhi, India ATK Rau Pediatric Hematologist and Oncologist Professor and Head Department of Pediatrics MS Ramaiah Medical College Bengaluru, Karnataka, India [email protected] Bharat R Agarwal Consultant Pediatric Head Department of Hematology and Oncology BJ Wadia Hospital Mumbai, Maharashtra, India

Dhiren Gupta Consultant Pediatric Intensive Care Unit Institute of Child Health Sir Ganga Ram Hospital New Delhi, India Gauri Kapoor Department of Pediatric Hematology and Oncology and Bone Marrow Transplantation Rajiv Gandhi Cancer Institute and Research Centre Delhi, India Himani Manchanda Fellow in Pediatric Hematology and Oncology Institute of Child Health Sir Ganga Ram Hospital New Delhi, India IC Verma Center of Medical Genetics Sir Ganga Ram Hospital New Delhi, India Jagdish Chandra Director, Professor Department of Pediatrics Lady Hardinge Medical College Kalawati Saran Children’s Hospital New Delhi, India Leni Mathew MD Professor Department of Pediatrics Christian Medical College Vellore, Tamil Nadu, India

x

Practical Pediatric Hematology

LS Arya MD DCH Senior Consultant Indraprastha Apollo Hospital Sarita Vihar New Delhi, India

Nivedita Dhingra Fellow in Pediatric Hematology and Oncology Institute of Child Health Sir Ganga Ram Hospital New Delhi, India

Mammen Chandy MD FRACP FRCPA FRCP Director Tata Medical Center Kolkata, West Bengal, India

Panna Choudhury Consultant Pediatrician and President IAP 2009 New Delhi, India

MB Agarwal Consultant Hematologist Bombay Hospital Mumbai, Maharashtra, India

R Parakh Chairman Division of Peripheral Vascular and Endovascular Sciences Medanta-The Medicity Gurgaon, Haryana, India

Mir Sadaqat Hassan Zafar Fellow in Hematology Sir Ganga Ram Hospital New Delhi, India Mohammed Ramzan Fellow in Pediatric Hematology and Oncology Institute of Child Health Sir Ganga Ram Hospital New Delhi, India MR Lokeshwar Consultant, Pediatrician Lilavati Hospital Mumbai, Maharashtra, India Neha Rastogi Fellow in Pediatric Hematology and Oncology Institute of Child Health Sir Ganga Ram Hospital New Delhi, India Nirmalya Roy Moulik Senior Resident Department of Pediatrics Chhatrapati Shahuji Maharaj Medical University Lucknow, Uttar Pradesh, India Nitin K Shah Consultant Pediatrician PD Hinduja Hospital, Mumbai Hon. Hematologist Oncologist BJ Wadia Hospital for Children Mumbai, Maharashtra, India President Indian Academy of Pediatrics, 2006 Fellow Indian Society of Hematology and Transfusion Medicine

RK Marwaha Professor of Pediatric Hematology and Oncology Advanced Pediatric Center Postgraduate Institute of Medical Education and Research Chandigarh, India [email protected] R Saxena Professor and Head Department of Hematology All India Institute of Medical Sciences New Delhi, India Roma Kumar Clinical Psychologist Institute of Child Health Sir Ganga Ram Hospital New Delhi, India Sachin Thakur Consultant Neonatologist USA Samridh Nagar Consultant Neonatologist Australia Shirish Kumar Consultant Hematologist Geneva, Switzerland Shruti Patil Assistant Professor Department of Pediatrics MS Ramaiah Medical College Bengaluru, Karnataka, India

Contributors SP Yadav Consultant Pediatric Hematologist and Oncologist Department of Pediatrics Institute of Child Health Sir Ganga Ram Hospital New Delhi, India Sunil Gomber Professor of Pediatrics University College of Medical Sciences and Guru Teg Bahadur Hospital New Delhi, India Sunil Narain Consultant Pediatrician New Delhi, India Trupti Dongre Consultant Pediatrician Mumbai, Maharashtra, India Ushma Singh Fellow in Pediatric Hematology and Oncology and Bone Marrow Transplantation Institute of Child Health Sir Ganga Ram Hospital New Delhi, India Vaishnavi Reddy Center of Medical Genetics Sir Ganga Ram Hospital New Delhi, India

Vasant Chinnabhandar Fellow in Pediatric Hematology and Oncology Institute of Child Health Sir Ganga Ram Hospital New Delhi, India Vikas Dua Fellow in Pediatric Hematology and Oncology Institute of Child Health Sir Ganga Ram Hospital New Delhi, India Vikram Mathews Professor of Hematology Christian Medical College Vellore, Tamil Nadu, India Vinita Jain Consultant Pediatrician Aastha Medical Center New Delhi, India VP Choudhary Ex-Professor and Head Hematology All India Institute of Medical Sciences Consultant Hematologist Sunflag Hospital Faridabad, Haryana, India

xi

From the President, IAP 2006

Dear Colleagues Evidence-based medicine is the need of the hour. Every pediatrician strives for perfection in his or her practice. While the avenue to learn decrease after one leaves the medical school, the science keeps on evolving. It is impossible to keep pace with what is happening in the field of pediatrics in general and hence the need to specialize is now felt even by the pediatricians. It is still some time before some centers would start providing a postgraduate diploma or degree in various pediatric subspecialties. The only avenue left for learning a specialty then is through regular updates and seminars. Keeping this in mind, Indian Academy of Pediatrics (IAP) has envisaged starting specialty training under its plan of action 2006. IAP-Pediatric Hematology and Oncology (PHO) Chapter is the first to respond to the call of IAP by starting this year the IAP PHO Training in Hematology. After the grand success of the Pediatric Oncology training workshops, the need to start similar program in Pediatric Hematology was felt by many. This combined with the enthusiasm and hard work put in by Dr Anupam Sachdeva, Dr Bharat R Agarwal and their team has resulted in this dream come true in the form of these workshops. The whole concept is well thought, well conceived, well planned and well executed. The case-based discussion while teaching the skills and the hands on experience are two unique features of this workshop. The icing on the cake is the beautiful and picturesque manual for the delegates to carry back home. I am sure that the manual will be a good desk companion for the delegates while solving the mysteries of Pediatric Hematology cases. I am sure that the delegates will be better empowered to deal with pediatric hematology cases after attending the workshop. Please do give your feedback so that we can improve on the quality from time to time. Nitin K Shah President IAP 2006

From the Chairman, Pediatric Hematology–Oncology Chapter, IAP

Dear Colleagues These are exciting times for Pediatric Hematology and Oncology. Major advances during the past decade in the field have enhanced our understanding and significantly influenced the management and outcome of many of these chronic and fatal diseases affecting children. Achieving the gold standard of care for children patients should be our goal. Given the realistic situation under which we function, and due to the major sociocultural and economic hurdles this ideal may seem a utopian goal. Nevertheless, I strongly believe that we can achieve together much more than we alone can do. There are many novel adaptations that we could adopt in our clinic practice and management guidelines that would benefit a large chunk of patients. Training, I think, is the cornerstone for this progress! The PHO Chapter of IAP has been in the forefront of IAP activities leading in many ways—publication on anemia in children, pediatric hematology and oncology; parent education booklet on ALL, hemophilia, thalassemia; publishing management guidelines on sickle cell disease, ITP, blood component therapy national training programs on pediatric oncology; publication of PHO newsletter; promoting subspecialty fellowship training; preparing teaching slide sets on CD; Pediatric Hematology and Oncology, website—phoindia.org, etc. Training in Practical Pediatric Hematology (NTP-PPH) is the latest venture of PHO chapter program for training in practical pediatric hematology will be kicked off in January 2006 at Gurgaon, Haryana, India. This will be a 2 days course in intensive practical training for pediatricians and postgraduates. The launch of this program has been a dream come true for many of us who have waited for long to make this happen. This unique idea and process of training pediatricians in practical aspects of Pediatric Hematology will instantly raise the standards of care provided to children suffering with hematological disorders throughout the country. I take this opportunity to thank Dr Nitin K Shah, President IAP 2006, to adopt this program under the IAP Action Plan 2006 and provide us this important platform to spread our message with very wide visibility also acknowledge the massive contributions of our dynamic honorary secretary and the National Co-ordinator of NTP-PPH, Dr Anupam Sachdeva. Hope you enjoy reading this interesting manual and send us your feedback for its improvement in the future.

Bharat R Agarwal Chairman PHO Chapter of IAP and Head Department of Pediatric Hematology and Oncology BJ Wadia Hospital for Children Parel, Mumbai, Maharashtra, India