Haematological symptoms

Diagnostics of haematological symptoms

DO NOT

Do diagnostics unless it has important therapeutic implications without undue burden on the child.

Provide information on causes, symptoms, treatment options and disease course of anaemia, increased bleeding tendency and thrombosis.
In children in the palliative phase, always weigh the benefits of treating haematological conditions against the disadvantages and risks.
At risk of life-threatening bleeding:
- Discuss the possible impact of a life-threatening (pulmonary) haemorrhage with parent(s) and/or child.
- Discuss what to do in case of acute severe life-threatening bleeding.
- Provide dark towels in the home.
- Have an emergency kit at home for acute life-threatening bleeding with instructions on how to act and what medication to administer.

Consider

In case of wish activities/fulfilment consider active intervention, which is temporarily effective, such as erythrocyte transfusion, platelet transfusion or Fresh Frozen Plasma (FFP) transfusion to reduce the risk of severe bleeding.

DO NOT

DO NOT

Give vitamins and nutritional supplements in anaemia if life expectancy is short.

In children with long-term anaemia with bone marrow failure (e.g., MDS) in the palliative phase, adopt an individual transfusion policy based on perceived quality of life.
In hematologic children with anaemia based on bone marrow failure, give erythrocyte transfusion on an individual basis at an Hb between 4.3-5.0 mmol/L or with symptoms of anaemia.

DO	Adhere to the platelet limits from the national transfusion guideline in palliative procedures (such as placement of an epidural catheter).
Consider	In children with thrombocytopenia due to production disorder, consider adhering to the transfusion limits from your national transfusion guideline. Before a particular physical activity with risk of bleeding, consider a platelet transfusion.

Treat nasal bleeding with local adrenaline, xylometazoline, spongostan or possibly local coagulation by ENT physician.
Consult with a paediatric surgeon when local bleeding cannot be easily stopped.

Consider

In bleeding due to thrombocytopathy, consider desmopressin (DDAVP).
For persistent or severe bleeding tendency due to coagulation factor deficiency, consider vitamin K, FFP and/or recombinant factor VII.
In thrombocytopenia and mucosal bleeding (nasal, gum bleeding, menorrhagia) anti-fibrinolytic medication to reduce bleeding tendency. Do not give fibrinolytic drugs in haematuria.
If bleeding occurs, consider platelet transfusion: see section on platelet transfusion.

Consider

Consider

Evaluate the effect and side effects of the instituted treatment at the appropriate time, and adjust treatment as needed. Involve child and family in this process.