Hematologic Problems of the Neonate, 1e

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9780721677279: Hematologic Problems of the Neonate, 1e

Introducing an up-to-date reference on causes and treatments of hematologic conditions in newborn infants. The book provides definitive coverage of hematopoiesis and hematopoietic growth factors solving hematologic problems of neonates. The authors are well known respected authorities.

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From The New England Journal of Medicine:

Justification for the existence of pediatrics and the many pediatric subspecialties is based on the belief that infants and children warrant specialized care and that pediatric diseases are sufficiently different from those in adults to warrant specialized treatment. Furthermore, not only is the age-related spectrum of diseases different, but the physiology of young children varies considerably from that of adults. In no area of pediatrics are these differences more apparent than in neonatal medicine. As a consequence, subspecialists who practice neonatology, of necessity, become super-subspecialized, acquiring knowledge and developing skills that are fairly specific, if not unique, to neonatal medicine. Hematologic Problems of the Neonate, edited by Christensen with contributions from multiple knowledgeable collaborators, is a testimony to the unique hematologic problems in neonates and to the special therapeutic considerations in the care of soon-to-be-born and newborn infants.

As a pediatric hematologist, I was consistently surprised and pleased by the breadth of physiologic detail in chapters on fetal and neonatal hematopoiesis, the developing immune system, and developmental aspects of the complement and coagulation systems and the processes that regulate these systems. Particularly helpful are the tables throughout the text, which present normal fetal and neonatal hematologic values, including comparisons with values in older children and adults. The coverage of diseases is comprehensive, yet not overwhelming. Particularly worthy of comment are the reviews of several conditions unique to the neonate: erythroblastosis fetalis and the related problem of maternal-fetal ABO incompatibility, the anemias of prematurity and of bronchopulmonary dysplasia, the effect of fetomaternal hemorrhage and of twin-to-twin transfusion on the neonate, the assessment and treatment of erythrocytosis, the impact of pregnancy-induced hypertension and the HELLP syndrome (hemolysis, elevated liver enzymes, and a low platelet count in association with preeclampsia) on the fetus, and the infectious, immune, metabolic, and drug-related hematologic disorders that may develop as a consequence of the obligate relationship between the mother and her fetus.

The discussion of disorders of erythrocyte metabolism and shape is comprehensive and nicely complemented by relevant biochemical and ultrastructural details and figures. Disorders of hemostasis and neonatal platelet disorders (both quantitative and qualitative) are thoroughly reviewed in separate chapters, with helpful tables and figures included; the chapter on hemostasis offers up-to-date coverage of inherited thrombotic disorders and options for treating thrombosis. Leukocyte function and disorders are reviewed concisely, with a focus on quantitative abnormalities of neutrophils, the use of hematopoietic growth factors, and the contributions of monocytes and macrophages, dendritic cells, and T and B lymphocytes to the immunologic defenses of the neonate. Hemoglobin synthesis and the regulation of hemoglobin switching are reviewed in an understandable, straightforward fashion; this chapter provides valuable insights into the oxygen affinities of various types of hemoglobin and into the common hemoglobinopathies and disorders of unstable hemoglobin.

The bone marrow-failure syndromes are reviewed, with a clear focus on genetic disorders for which detection in the neonatal period is either likely or possible. The roles of various laboratory tests in facilitating the diagnosis of infection, sepsis, or both in the neonate are reviewed in detail. Finally, a comprehensive discussion of transfusional and blood-banking considerations rounds out this book. Guidelines are provided for the use of red-cell, platelet, neutrophil, and plasma transfusions; additional valuable insights are provided in reviews of alternatives to red-cell transfusion, the use of leukocyte removal from cellular blood products to reduce the risk of cytomegalovirus infection, and the use of blood-product irradiation to prevent graft-versus-host disease.

In spite of its virtues, this book is not without flaws. There are minor, occasional redundancies and occasional typographic errors, omissions, and inconsistencies. Most are of little consequence, but a few should be mentioned. In the chapter on anemia in the neonate, the doses of oral iron are listed in milligrams per kilogram of body weight per day, but a statement specifying that these doses are to be calculated in milligrams of elemental iron, rather than of ferrous sulfate, is missing. Although this omission is not dangerous, the failure to calculate in milligrams of elemental iron will lead to underdosing of neonates with deficiency and a longer time to recovery. In the same chapter, the statement that patients with Fanconi's anemia have a steroid-responsive hypoplastic anemia may be strictly true, but it is to anabolic steroids and not corticosteroids that they respond. In the discussion on factor IX deficiency in the chapter on hemostasis, the final statement about prenatal diagnosis and in utero treatment deals with factor VIII deficiency and factor VIII replacement -- a potentially confusing misplaced statement for someone reading selectively about factor IX deficiency.

In addition, there is inconsistency in discussing the use of intramuscular vitamin K for the prevention of bleeding due to vitamin K deficiency. Initially, it is stated that vitamin K should be given subcutaneously or intravenously, rather than intramuscularly, to avoid severe hematoma formation; yet it is subsequently stated that compliance is better with intramuscular than with oral vitamin K administration; the implication is that intramuscular administration is the preferred route. In the review of qualitative platelet disorders, the presentation of data on bleeding-time results obtained with an automated incision device indicates that 97 percent of the subjects had bleeding times of less than 3.5 seconds; surely, this must be less than 3.5 minutes. In general however, these flaws do not detract from the overwhelmingly positive effect of this book.

Raymond J. Hutchinson, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

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Robert D. Christensen MD
Editorial: Saunders (2000)
ISBN 10: 0721677274 ISBN 13: 9780721677279
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Christensen MD, Robert D.
Editorial: Saunders (2000)
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Robert D. Christensen MD
Editorial: Saunders (2000)
ISBN 10: 0721677274 ISBN 13: 9780721677279
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