A retrospective chart review of 40 patients with sickle cell anemia (SCA) between the ages of 5-19 years who were seen within a 1-year period was performed to determine clinical and laboratory correlates for microalbuminuria and proteinuria. Age, sex, height, body mass index (BMI), serum creatinine [and estimated glomerular filtration rate (eGFR) by Schwartz and MDRD formulas], type of SCA, hemoglobin (Hb) level [total Hb and hemoglobin F percentage (HbF%)], lactate dehydrogenase (LDH) level, reticulocyte count, blood pressure, history of splenectomy, history of hydroxyurea use, and history of transfusions were correlated with microalbuminuria and proteinuria by univariate and multivariate regression analysis. The prevalence of microalbuminuria and proteinuria among these patients was 15 and 5%, respectively. Univariate analyses revealed a significant correlation between LDH level and microalbuminuria (Pearson r=0.47, p=0.04) and between LDH level and proteinuria (Pearson r=0.48, p=0.035). Multivariate analysis revealed a significant correlation between microalbuminuria and LDH level (p = 0.04) when controlled for age, sex, eGFR, Hb level, HbF%, type of SCA, BMI, history of transfusions, and reticulocyte count. In this pediatric SCA population, LDH was found to correlate with the presence of microalbuminuria and proteinuria. Further studies are needed to confirm LDH as an early marker for the risk of kidney involvement among SCA patients.

Objective Advances in medical care have resulted in nearly 95% of all children with sickle cell disease (SCD) living to adulthood. There is a lack of effective transition programming, contributing to high rates of mortality and morbidity among adolescents and young adults (AYAs) during the transition from pediatric to adult healthcare. This nonrandomized study evaluated the feasibility, acceptability, and preliminary outcomes of a novel medical student mentor intervention to improve transition outcomes. Methods Eligible participants were ages 18–25 years, either preparing for transition or had transferred to adult care within the past year. Twenty-four AYA with SCD (Mage = 20.3, SD = 2.6) enrolled in the program and were matched with a medical student mentor. Feasibility and acceptability of the intervention was assessed through enrollment rates, reasons for refusal, retention rates, engagement with the intervention, satisfaction, and reasons for drop-out. Dependent t-tests were used to evaluate the preliminary effects of the intervention on patient transition readiness, health-related quality of life, self-efficacy, SCD knowledge, medication adherence, and health literacy. Results Participants (N = 24) demonstrated adequate retention (75.0%), adherence to the intervention (M = 5.3 of 6 sessions), and satisfaction with the intervention. Participants demonstrated significant improvements in transition readiness (p = .001), self-efficacy (p = .002), medication adherence (p = .02), and health literacy (p = .05). Conclusions A medical student mentor intervention to facilitate transition from pediatric to adult care for AYA with SCD is both feasible and acceptable to patients and medical students. Preliminary results suggest benefits for patients, warranting a larger efficacy study.

Three examples of non-syphilitic paroxysmal cold haemoglobinuria (PCH) in children are described which occurred, within a period of 16 days, in association with a febrile illness. No definite viral aetiology or obvious epidemiological association could be established. A Donath-Landsteiner antibody of anti-P specificity was demonstrated in all three patients. The serological aspects of PCH are critically discussed.

The purpose of this study, a secondary analysis of a publicly available database, was to identify racial and ethnic disparities in the risk of severe sepsis facing children undergoing the intensive therapy necessary to treat acute myeloid leukemia (AML). The sample consisted of 1,913 hospitalizations of children, younger than 21 years, in the United States during the year 2016 with documentation of both AML and at least one infectious complication. Binary logistic regression models were used to examine the association between race/ethnicity and severe sepsis in children with AML and infection. We found that, after controlling for potential confounding variables, the odds of developing severe sepsis were significantly increased for Hispanic children compared with White children. There were no significant differences in the likelihood of the development of sepsis in Black, Asian, or other race children. The increased risk of severe sepsis for Hispanic children may contribute to the disparate rates of overall survival in this group. This inequitable rate of severe sepsis was evident despite the generally accepted practice of retaining children in the hospital throughout recovery of blood counts following AML therapy. Nurses are in a position to identify and eliminate modifiable risk factors contributing to this disparity.

Background There have been remarkable advances in overall survival following the diagnosis of acute lymphoblastic leukemia in childhood, but toxicities, including pancreatitis, remain a concern. Pancreatitis occurs early in therapy, before extensive exposure to the chemotherapy agents associated with its development, indicating there are underlying risk factors for some children. The role of race/ethnicity in treatment-related pancreatitis has not been well established. Objective The aim of this study was to examine the relationship between race/ethnicity and pancreatitis in children hospitalized with acute lymphoblastic leukemia in the United States in 2016. Methods This was an analysis of a nationally representative database of pediatric hospitalizations. The sample consisted of 21 775 records with documentation of the diagnosis of acute lymphoblastic leukemia. Statistical methods included descriptive statistics, bivariate analyses using the χ 2 test, and multilevel logistic regression models. Results Pancreatitis was documented in 1.6% of hospital discharges. Compared with white children, Hispanic children were at increased risk of pancreatitis during hospitalization (P = .002). There were no differences among black (P = .469), Asian (P = .364), or other-race children (P = .937). Conclusions Hispanic children hospitalized with acute lymphoblastic leukemia are at greater risk of pancreatitis than white children. Reasons for this disparity are likely due to both genetic and social factors. Implications for Practice Nurses must be active participants in the research process with the goal of enrolling patients with diverse backgrounds in clinical trials. Inclusive research will provide increased understanding of a holistic toxicity risk profile.