BRONX-LEBANON HOSPITAL CENTER

Edwin Robins, M.D.

GOALS & OBJECTIVES

Residents  do  a  one-month  elective  rotation  in  Pediatric Hematology-Oncology at Montefiore Medical Center. The program is designed to train individuals who plan to pursue  a  full time  career  in  Pediatric  Hematology/Oncology as well as provide a broad clinical experience for pediatric house-officers and medical students.  Special research interest, whether clinical or in basic science, are met  through the resources of the entire Montefiore Medical Center as well as those of the Division. 

Primary Goals for this Rotation

Prevention, Counseling and Screening

Understand the role of the pediatrician in preventing Hematologic or Oncologic conditions, and in counseling and screening individuals at risk for these diseases.

Provide routine preventive counseling about hematology to all patients and families, addressing:

1.       Adequate diet and iron intake to prevent iron deficiency.

2.        Signs and symptoms of malignant disease.

Normal Versus Abnormal

Distinguish normal from pathologic states of the hematologic and lymphatic systems.

Describe the changes that occur over time in the hematologic indices of the normal infant and child (e.g., hemoglobin, hematocrit, MCV).

Explain the findings on clinical history and examination that suggest a hematologic or oncologic disease that requires further evaluation and treatment.

Explain the interpretation of a bone marrow aspirate.

Undifferentiated Signs and Symptoms

Evaluate, treat, and/or refer patients with presenting signs and symptoms that may indicate a Hematologic or Oncologic disease process.

Develop a strategy to determine if the following presenting signs and symptoms are caused by a hematology/oncology disease process and determine if the patient needs treatment or referral.

1.       Fatigue/malaise

2.       Fever

3.       Bruising/bleeding

4.       Headache

5.       Limb pain/limp

6.       Seizure

7.       Lymphadenopathy

8.       Hepatomegaly and/or splenomegaly

9.       Weight loss

10.    Abdominal pain

11.    Vomiting

12.    Dizziness and gait disturbances

13.     Nevi

Common Malignancies

Discuss the presentation, pathophysiology, and prognosis of important malignancies in children and adolescents.

Discuss the common late complications of childhood cancer treatment that may present in childhood or adolescence. These include: learning disabilities, endocrine suppression, and second cancers.

Iron Disorders

Discuss the appropriate methods of diagnosis and management of a patient with iron disorders.

Describe the normal requirements, absorption, and metabolism of iron from birth through adolescence.

Identify the common causes and features of iron deficiency (including anemia) in all age groups and compare and contrast with anemia caused by chronic inflammation.

Describe the diagnosis and treatment of iron deficiency, and discuss the follow-up necessary to assure success in treatment.

Develop a treatment and education plan for managing iron deficiency. This should include: dietary management, replacement therapy, parent education, and follow-up.

Blood Products

Understand indications for and complications related to the use of blood products

Sickle Cell Disease

Understand the general pediatrician's role in the diagnosis and management of patients with sickle cell disease.

Explain the findings on clinical history, examination, and laboratory tests (including newborn screening) that suggest a diagnosis of sickle cell disease.

Develop a preventive care plan for a patient with a sickle disease. These should include use of folate, prophylactic antibiotics, immunizations, prompt evaluation of febrile episodes and stroke screening.

Identify the indicators for a hematology referral in a child with sickle cell disease.