Warriors and Survivors

Children Cancer Stories by Rukh Yusuf - Blog # 10

I am Rukh Yusuf, Clinical Pharmacist, also specialized in Total Parenteral Nutrition and Bone Marrow Transplant. I have been working in Pediatric Oncology unit of a public hospital for several years. The mission of this blog is to bring to you the real-life stories of child patients suffering from cancer. Cancer is still a difficult disease to handle and treat. However, when it strikes the children, some so young that they cannot even speak, their agony is beyond expression and words. Let us pray especially for children suffering from cancer for early and complete remission. May Allah shower His Merciful Blessings upon them. Aameen.

Couple of days ago during my routine work at hospital, I met a very cute healthy looking five years old Asad, who seemed to be angry in first impression but later I found a lovely friendly child who loved tattoos and candies.

When he was four, he put a bead in his ear somehow, He had to go to OR to remove the bead. He was kept NPO (food was not allowed) since 12 midnight to remove bead under anesthesia. Asad fainted at once when he was having juices and eatables after bead removal. He was treated in emergency and got better for the time. After few months he fainted again and along with treatment he needed blood transfusion this time.

Asad’s mother took him to civil hospital for checkup, after many diagnostics tests, Asad was diagnosed as a case of EVANS SYNDROME.

Evans syndrome is an autoimmune disorder in which antibodies attack red blood cells, which deliver oxygen to body tissues, platelets, and/or neutrophils. The disorder resembles a combination of autoimmune hemolytic anemia , thrombocytopenia, and neutropenia. These may occur simultaneously or one may follow the other.

The current cause for Evans syndrome is unknown. There is no known genetic cause of Evans syndrome, and occurrences in families are rare. It is considered a chronic disease, with periods of remission and exacerbation. Thrombocytopenia recurs in about 60 percent of patients, while autoimmune hemolytic anemia (AIHA) recurs in about 30 percent.

The symptoms of Evans syndrome may be similar in nature to leukemia and lymphoma; these illnesses must be ruled out before a diagnosis is made. If a child has a low red blood cell (RBC) count, symptoms may include: jaundice, dark brown urine, pale Skin, weakness, fatigue and shortness of breath. If a child has a low platelet count, symptoms may include: increased bruising, petechia – tiny red dots under the skin that are a result of very small bleeds into the skin and increased bleeding symptoms, such as a bloody nose or heavy menses.  If a child has a low neutrophil count, symptoms may include: fevers, mouth sores, increased bacterial infections.

Diagnosis may involve Complete blood count, Coombs test, Reticulocyte count. Other tests may include bone marrow aspiration and biopsy and flow cytometry.

The first-line treatments for Evans syndrome are corticosteroid, such as prednisone, and intravenous immunoglobulin, which help to control acute episodes. Most children respond to this treatment, but relapses frequently occur. Other treatments include: immunosuppressive drugs, such as 6-mercaptopurine and Mycophenolate mofetil, removal of the spleen to improve blood counts, which may be short-lived , Rituximab, a monoclonal antibody or stem cell transplant, for severe, difficult-to-treat cases and the best chance for a long-term cure.  

For children with Evans syndrome, recurrences of thrombocytopenia, anemia, and also neutropenia are common. It can sometimes remain well controlled on long-term immunosuppressant therapy and occasionally patients have spontaneous complete resolution of the condition.

Asad is under treatment and Alhumdolillah is responding well, he had jaundice some time back and had to be admitted for few days for treatment, He comes for follow up but Asad do not like to stay in hospital.

He belongs to lower middle class family from Gujranwala, He has a younger sister, his elder sister had died at age of six due to electric shock.  Asad’s mother is alone breadwinner for  the family, Brave lady is not only managing her son’s treatment all the way coming from outstation but is also a working lady and taking care of her two young lads.

Lack of health care facilities is a grave issue that affects patients and their treatment. Patients and their families have to reach to big cities and hospitals to get treatment of their loved ones that adds to their suffering. It becomes very difficult for a family to travel out stations for the treatment of the chronic diseases of their family members, it is not only a financial burden but also a painstaking period each time when they have to approach health care facility. I shall write on this issue in coming blogs as well.

We pray for the eventless recovery of Asad and ease for her mother. Aameen.

 

Note: names have been changed to protect identity.