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A 3-year-old girl was being treated for acute lymphoblastic leukaemia (ALL) on the paediatric oncology ward. She had required numerous red cell and platelet transfusions during induction chemotherapy. She was the youngest of four siblings, two of which suffered from beta-thalassaemia. Her mother wanted to know why her daughter was not on treatment to reduce the iron from all the blood transfusions like her other two daughters.
Structured clinical question
In children being treated for cancer, is transfusional iron overload (IO) a risk? When should treated clinicians screen and how should IO be managed and monitored?
Search strategy and outcome
The Ovid MEDLINE database was used, searching both Embase and MEDLINE (1946 to present) in December 2015. The search was restricted to studies conducted on humans and limited to publications in the English language. The following terms were used: (malignan*, neoplas*, cancer*, oncol*MesH terms cancer/neoplasms/medical oncology or oncology Service, hospital) AND (child*, p?ediatr*, MesH terms child/pediatric) AND (transfus*, packed adj red adj cell*, MesH blood transfusion/erythrocyte infusion) AND (iron, iron adj overload, chelat*,MesH iron/iron overload). This search yielded 123 results, of which 15 studies were relevant. Three more studies were identified through references of relevant articles. After review, a total of 14 relevant papers were identified, 11 of which had similar methods of quantifying IO and …
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