Acute Myelogenous Leukemia

Acute myelogenous leukemia (AML} results from damage to the DNA of a single myeloid stem cell in the bone marrow. This cell then produces other abnormal cells called leukemic blasts, and in time these leukemia cells crowd out the production of healthy red blood cells, platelets, and white cells.

Who Gets AML:

AML is most common in people older than 50, but AML does account for 15% of diagnosed acute childhood leukemia cases, making it one of the most common types of leukemia.

How AML is Treated:

Because AML progresses quickly, treatment is generally initiated very quickly after diagnosis. Very intense chemotherapy is the first treatment of choice for most patients. Because of the intensity of the chemotherapy required, AML patients are usually admitted to the hospital for their first cycle of chemotherapy, called induction therapy. The goal of induction therapy is to eliminate any signs of leukemic blast cells in the blood and bone marrow. After AML patients have achieved remission, they will require hospitalization for maintenance chemotherapy at regular intervals to rid the body of any remaining leukemic cells.

Another important option for patients in remission is bone marrow transplantation. An autologous stem cell transplantation involves wiping out the patient's bone marrow with very intense chemotherapy and then infusing the patient with his or her own stem cells, harvested after remission was achieved and frozen for later use. An allogeneic stem cell transplantation involves the harvesting of healthy stem cells from a matched donor. The patient's bone marrow is obliterated through intense chemotherapy and the donor cells are infused. A graft-versus-leukemia effect occurs in which the healthy donor marrow recognizes and wipes out all remaining leukemic cells. A less intense option with more gradual beneficial effects is the "mini" tranplant which uses a less intense regimen of conditioning with radiation and chemotherapy; the process of the donor marrow taking over happens more gradually due to the lighter conditioning, over two to four weeks from the time of transplant.

When To Call Your Pediatrician for a Fever

When To Call Your Pediatrician for a Fever

Q. My question is when is a fever in a toddler a concern? My son is 2 years old and used to have a normal temp around 98.7 when not ill. In the last 4 months his temp is always in the 99.5-100.3 range with the exception of a few days here and there where it is 98.7 or so. I first noticed this because he feels hot to the touch when his temp is elevated and I knew that was not normal for him. He also has had occasional days with a fever of 102 or higher when not obviously ill. Is this something to be concerned about?

A. In general, you should call your Pediatrician or seek medical attention for fever when:

* an infant under two to three months old has a temp at or above 100.4 degrees Fahrenheit (38.1 degrees Celsius)
* an infant that is three to six months old has a temp at or above 101 degrees Fahrenheit (38.3 degrees Celsius)
* an infant six to twelve months old has a temp at or above 103 degrees Fahrenheit (39.4 degrees Celsius)
* a child over twelve months old has a temp at or above 103 degrees Fahrenheit (39.4 degrees Celsius) and the fever does not improve with home remedies and a fever reducer

Remember that how high a fever is doesn't necessarily tell you how sick your child is. Whatever your child's temperature, even if your child doesn't have a fever, if your child is very irritable and doesn't have some playful moments or is not eating and sleeping well, you should still call your Pediatrician.

It is important to keep in mind that children normally have higher temperatures than adults, so a rectal temperature under 100.4 is often considered to be normal in a child under age 3 years. And it is hard to believe that he would have regular fevers for 4 months without any other symptoms.

If you really think he is having regular fevers, especially if it is sometimes 102 or higher, you likely should see your Pediatrician for an evaluation. You might also consider using a different method to check his temperature. Especially if you are checking his temperature using an axillary (under the arm) thermometer, you might confirm it with a rectal temperature the next time you think he has a fever.

Chicken Pox - A Preventable Childhood Illness

Chicken pox is a highly contagious illness that should become much less a part of childhood as more children are given the Varivax or chicken pox vaccine. Chicken pox is caused by the varicella zoster virus and occurs most commonly in late winter or early spring. Unvaccinated children usually develop symptoms about ten to twenty-one days after being exposed to someone with chicken pox (incubation period).

Chicken pox is spread by both direct contact with an infected person and through air borne spread of respiratory secretions. Since infected persons are contagious for 1-2 days before they even develop a rash, your child may have been exposed to someone with chicken pox without knowing. You can also get chicken pox after having direct contact with someone who has shingles or herpes zoster, a reactivation of chicken pox.

Symptoms begin with a low grade fever, loss of appetite and decreased activity. About two days later, your child will develop an itchy rash consisting of small red bumps that start on the scalp, face and trunk and then spread to the arms and legs (but may also occur in the mouth and genitalia). The bumps then become blisters with clear and then cloudy fluid, and then become open sores and finally crust over within about twenty four hours, but your child will continue to get new bumps for about four more days.

All of the chicken pox lesions should be crusted over after about six days at which time your child will no longer be contagious. It may take another one to two weeks before all of the scabs finally heal. Once your child has had chicken pox he should have lifelong immunity.

There is no effective treatment for children who develop uncomplicated chicken pox, but if your child is given the Varivax vaccine within 72 hours (and sometimes up to five days) of being exposed to someone with chicken pox, it may help prevent him from becoming infected.

The usual treatments are aimed at making your child more comfortable, and can include pain relievers, plenty of fluids, oatmeal baths, calamine lotion, and oral Benadryl for severe itchiness. Also keep your child's fingernails cut short and allow him to wear loose fitting clothing.

Treatment with acyclovir, an antiviral medication that can help to decrease the symptoms of chicken pox, should be considered for children at risk of developing a severe case of chicken pox. This includes children with pulmonary disorders, on steroid medications, or with immune system problems.

Another medication, Varicella Zoster Immune Globulin (VZIG), can be given as a preventative medication to children at high risk for developing a severe case of chicken pox as soon as they are exposed to someone with chicken pox (and within 96 hours) to help prevent them from getting infected. High risk children who are considered candidates for VZIG include those with immune system problems, pregnant women who have never had chicken pox and newborns whose mother developed chicken pox within 5 days before delivery or two days after delivery.

You should call your doctor if your child has chicken pox and the blisters become very red and tender, drain pus, if your child has high fever for more than 3-4 days or is unconsolable, has swollen and tender glands or if he is unable to drink and is becoming dehydrated.

You should keep your child out of the sun while he has chicken pox and while the lesions are healing. Being in the sun can cause your child to become overheated and sweaty, which may make him more uncomfortable and increase his itching. Also, the areas where chickpox lesions are healing are also more prone to sunburn until they have totally healed and they are more likely to permanently scar if exposed to too much direct sunlight.