Childhood autoimmune hemolytic anemia: A scoping review.

BACKGROUND AND OBJECTIVE: Autoimmune hemolytic anemia (AIHA) is a rare but important cause of morbidity in pediatric hematology patients. Given its rarity, there is little high-quality evidence on which to base the investigation and management of pediatric AIHA. This scoping review aims to summarize the current evidence and highlight key gaps to inform future studies. METHODS: This review searched MEDLINE and the Cochrane CENTRAL Trials Register from 2000 to November 03, 2023. Experimental and observational studies reporting AIHA diagnostic criteria, laboratory workup, or treatment/management in populations with at least 20% of patients ≤18 years were included. RESULTS: Forty-three studies were included, with no randomized controlled trials identified. AIHA diagnostic criteria, diagnostic tests, and treatments were highly variable. First-line treatment approaches include corticosteroids, intravenous immunoglobulin, or both. Approaches to AIHA resistance to first-line therapy were widely variable between studies, but most commonly included rituximab and/or cyclosporine. CONCLUSIONS: We identify a heterogenous group of observational studies into this complex, immune-mediated disorder. Standardized definitions and classifications are needed to guide collaborative efforts needed to study this rare disease. The work done by the CEREVANCE group provides an important paradigm for future studies.

Ten-Year Review of the Postpartum Maternal Health Clinic at the Kingston Health Sciences Centre.

OBJECTIVES: The postpartum Maternal Health Clinic (MHC) sees patients who have experienced pregnancy complications identified as pregnancy-related cardiovascular disease (CVD) risk indicators (hypertensive disorders of pregnancy, gestational diabetes, placental abruption, idiopathic preterm delivery, and intrauterine growth restriction) at 6 months postpartum for CVD risk screening. This project aimed to summarise the past 10 years of the MHC and identify trends in patient characteristics, patient CVD risk assessments, and clinic attendance over time. METHODS: Patients included in this study have experienced 1 or more pregnancy-related CVD risk indicator(s) and have delivered between April 2011 and April 2021. MHC patient data and the Better Outcomes Registry Network database were utilised to compare eligible and participating patient data during clinically significant time periods. RESULTS: The clinic has seen 1030 patients in the last 10 years and their characteristics have remained largely consistent. However, there has been an increase in the proportion of patients seen because of a hypertensive disorder and an increase in the proportion of patients with obesity, abnormal total cholesterol, and elevated fasting glucose. Additionally, CVD risk scores and the prevalence of metabolic syndrome have remained consistent over the years. Regarding the clinic's outreach, patient eligibility for the MHC has been increasing while attendance has been decreasing over time. CONCLUSIONS: Overall, there remains a need to screen these patients for CVD risk and counsel them on risk reduction. There is also an opportunity to increase patient recruitment to improve attendance and to address the increased need for CVD risk screening and counselling in the community.

Families' perceptions of consumer-grade, inexpensive oxygen saturation monitors.

OBJECTIVES: We evaluated what proportion of families have a consumer-grade pulse oximeter, why they bought one, and how they choose to use it. WORKING HYPOTHESIS: We hypothesized that children followed in cardiorespiratory clinics would be more likely to have an oximeter than children attending a more general clinic. STUDY DESIGN AND SUBJECT SELECTION: We carried out a cross-sectional study using a convenience sample of children attending a respirology, cardiology, or gastroenterology clinic at a children's hospital. Consenting guardians completed a survey. RESULTS: Two-hundred families completed the survey. Fifty-three (26.5%; 53/200) had an oximeter at home. The proportion of children attending a cardiorespiratory clinic who had an oximeter was higher than another clinic (p = 0.08), but 15.5% of children attending the latter also had access to one. Of devices not funded by government insurance, over 80% of devices were "fingertip" clamp-style oximeters, and 50% were purchased online. Most devices were used only when the child was ill (83.7%; 36/43). Only about 1/3 of families had received education about using an oximeter, and a similar proportion had compared their oximeter to a medical-grade device. Only 2.4% (1/42) respondents did not feel that their device was "somewhat" or "very" accurate. The oxygen saturation that would prompt seeking emergency care was similar to most pediatric acute care guidelines. CONCLUSIONS: Many children, particularly those with cardiorespiratory conditions, have access to consumer-grade pulse oximeters. Asking about the presence of an oximeter should be part of the pediatric history, and families responding affirmatively should be offered education.