The pediatric hematology team at Duke offers state-of-the-art care for infants, children, adolescents, and young adults with a wide variety of blood disorders.

We diagnose and treat children with a number of blood disorders including:

• Hemoglobinopathies (sickle cell disease, thalassemia)
• Bleeding disorders (hemophilia, von Willebrand disease, platelet function disorders)
• Clotting disorders (deep vein thrombosis, post-thrombotic syndrome, thrombophilia, and stroke)
• General hematologic conditions affecting red blood cells, white blood cells, and platelets

Patients are given compassionate, coordinated care with treatments delivered by dedicated physicians, nurse practitioners, physician assistants, social workers, pharmacists, psychologists, and a genetic counselor.

Treatments for pediatric hematology patients cover the full spectrum of inpatient and outpatient clinical services related to blood disorders.

Duke's pediatric hematology physicians are devoted to improving the care of children with blood disorders. They hold leadership positions in ongoing local and national clinical research studies in an effort to provide the best care possible for our patients.

Hemoglobinopathies

Sickle Cell Disease

The Pediatric Sickle Cell Center, under the direction of Courtney Thornburg, MD, MS, is dedicated to the care of approximately 500 children with sickle cell disease.

Children are given comprehensive care from birth to 18 years of age including education about age-related sickle cell disease complications and genetic counseling. Adolescents participate in a program to prepare for transition to adult care.

Preventive medicine is provided including antibiotics and immunizations for the prevention of bacterial sepsis, hydroxyurea for the prevention of vaso-occlusive pain and acute chest syndrome, and transcranial Doppler ultrasound screening to identify children who may benefit from chronic red cell transfusions to prevent stroke.

In addition, children who are eligible for bone marrow transplantation are referred to the Duke Pediatric Blood and Marrow Transplantation program.

Pediatric hematologists provide in-patient and out-patient management of acute illnesses. Subspecialists are also available for consultation related to a variety of sickle cell disease complications including neurocognitive deficits, stroke, pulmonary hypertension, retinopathy, and avascular necrosis.

Pediatric surgeons are available for surgical management of various sickle cell disease complications including splenic sequestration, cholelithiasis, and obstructive sleep apnea.

The Pediatric Sickle Cell Center participates in a clinical trial studying hydroxyurea in young children and is a participating center in the Sickle Cell Disease Clinical Research Network. The Division of Blood and Marrow Transplantation participates in clinical trials of transplantation for sickle cell disease.

Thalassemia

The pediatric hematology team provides comprehensive care for children with beta thalassemia major including a chronic blood transfusion program. In addition, children who are eligible for bone marrow transplantation are referred to the Duke Pediatric Blood and Marrow Transplantation program.

Genetic counseling is available regarding alpha and beta thalassemia as well as other types of thalassemia.

Bleeding and Clotting Disorders

The Pediatric Hemostasis and Thrombosis Clinic, under the direction of Courtney Thornburg, MD, MS, is part of the Duke Comprehensive Hemostasis and Thrombosis Center and provides care for children with bleeding and clotting disorders.

Children evaluated in the clinic are eligible to participate in the Center for Disease Control Prevention Thrombosis and Hemostasis Patient Research Registry.

The clinic also participates in an NIH-sponsored Transfusion Medicine/Hemostasis Clinical Trials Network, the Hemophilia Inhibitor Genetics study, and a multi-center study of warfarin pharmacogenetic testing in children.

Bleeding Disorders

Pediatric hematologists at Duke evaluate children with easy bruising, severe epistaxis, menorrhagia, and other abnormal bleeding.

Pre-operative evaluation for children with abnormal bleeding tests, histories of bleeding, and family histories of bleeding disorders is also available.

Comprehensive care is available for children with bleeding disorders such as hemophilia, von Willebrand disease, and platelet function disorders.

Treatments include clotting factor replacement, adjuvant medical therapy, physical therapy, and orthopedic services.

Clotting Disorders

Comprehensive care is available for children with venous thrombosis, post-thrombotic syndrome, and arterial thrombosis including stroke.

Consultation regarding thrombophilia testing is available for children with a personal or family history of thrombosis.

Treatments include anticoagulant management.

General Hematology

Duke's pediatric hematologists/oncologists evaluate, diagnose, and treat children with a variety of other blood disorders, including the following:

• Anemia
• Polycythemia
• Leukopenia
• Leukocytosis
• Thrombocytopenia
• Thrombocythemia

Two areas of interest include hereditary spherocytosis and ITP.

Courtney Thornburg, MD, and Henry Rice, MD, are conducting research related to the use of partial splenectomy for the treatment of congenital hemolytic anemias such as hereditary spherocytosis.

Children with acute and chronic immune thrombocytopenic purpura (ITP) are evaluated and treated in the pediatric hematology clinics. Children with chronic ITP may be eligible to participate in the North American Chronic ITP Registry.

Physicians

Physicians offering this service include:

• Armstrong, Michael B.
  • Pediatrics / Hematology-Oncology
• Barfield, Ray C.
  • Pediatrics / Hematology-Oncology
• Hwang, Eugene I.
  • Pediatrics / Hematology-Oncology
• Linardic, Corinne M.
  • Pediatrics / Hematology-Oncology
• Rosoff, Philip M.
  • Pediatrics / Hematology-Oncology
• Thornburg, Courtney D.
  • Pediatrics / Hematology-Oncology
• Wechsler, Daniel S.
  • Pediatrics / Hematology-Oncology