#include ./header_include.iphtml 

      <P align="center"><B><font color="#0c2d83" size="+2">Article Reviews &amp; 
        Commentary</font></B> 

<P>
      <P><font size="2"><b>Article Reviews by Thomas J. Mancuso, MD, FAAP </b></font>
      <P> 












      <P><FONT COLOR="#0c2d83" SIZE="+1">Health Supervision for Children with Sickle 
        Cell Disease. <br>
        </FONT><font size="2">Section on Hematology/Oncology, Committee on 
        Genetics <I>Pediatrics 2002:109;526-535</I> </font>
      <P> 
      <P><font size="2">This statement from the AAP is intended to provide general 
        pediatrician and subspecialty practitioners with an overview of the genetics, 
        diagnosis, clinical manifestations and treatment of Sickle Cell Disease 
        (SCD). The description of the illness, SCD, captures in one sentence the 
        varied clinical picture seen in children afflicted and the extent the 
        illness affects their lives. &quot;&#133;SCD describes a group of complex, 
        chronic disorders characterized by hemolysis, unpredictable acute complications 
        that can rapidly become life-threatening, and the variable development 
        of chronic organ damage.&quot; The statement goes on to distinguish the 
        various forms of SCD such as SS, SC and the 2 sickle-thalassemias. The 
        genetics and diagnostic test for the various forms as well as the protean 
        clinical manifestations are reviewed. </font>
      <P> 
      <P><font size="2">The importance of adequate, comprehensive pain treatment 
        is mentioned in the section dealing with acute illnesses in these children. 
        The section devoted to health maintenance includes discussions of immunizations, 
        prophylactic antibiotics and innovative therapies for SCD. However, the 
        statement does not mention the importance of outpatient analgesia in the 
        care of these children. </font>
      <P> 
      <P><font color="#0c2d83" size="2"><b>Commentary</b></font> 
      <P><font size="2">This document is a useful reference on SCD, including 
        many references and mention of new, innovative therapies becoming available 
        for these children in addition to a discussion of routine medical, psychosocial, 
        and family care of children with SCD. A glaring absence is perioperative 
        management of these patients, many of whom will come to the OR for procedures. 
        For example, most children with SCD, a hemolytic anemia, have gallstones. 
        I will now get on my soapbox and encourage the members of SPA to become 
        advocates for children with SCD and educate their primary caregivers about 
        the issues surrounding anesthesia and surgery for these patients as well 
        as the contributions we can make to their pain management.
      <P> 
      <P><font color="#0c2d83">The interested reader 
        should review the following paper wihch evaluated various preop transfusion 
        regimens for patients with sickle-cell disease.</font><br>
        Vichinsky EP. &#160;Haberkern CM. &#160;Neumayr L et al. 
        <I>New England Journal of Medicine</I>. 333(4):206-13, 1995 Jul 27, comment 
        333(4):251-2 </font>


#include ./footer_include.iphtml