TT whaaa??

Posted by Christine Rabah at Friday, September 09, 2011

So before we know it, rotation #1 one is over, and we're 2 weeks into rotation #2. I really enjoyed my Drug Information rotation at Beaumont and will miss all of the people I met there.

I am currently on rotation at Mott in Pediatric Hematology/Oncology with Dr. Erika Howle. I'm not gonna lie, I was terrified going into this rotation. I know next to nothing about peds, let alone pediatric oncology. It was also a big change to just complete a Drug Information rotation that had zero patient interaction to the complete opposite of the spectrum.

My typical day starts off by getting to the hospital around 7-7:30am to check on my patients before rounds at 9. Rounds last about 1.5-2 hours depending on how many patients we have on our service at the moment. Rounds include an attending, 2 interns (1st year residents), 1 senior resident, a fellow, a couple of med students, sometimes a dietician, and us. It's typical to see patients discharged for a few days then come back for chemo, so we follow the same patients throughout the month whenever they are readmitted. Each of our cancer patients are on a certain chemo protocol (as Melanie described a few posts down) which we have to follow. We also have to be very conscious of their supportive therapy (for pain, nausea/vomiting, neutropenic fever, etc) and make sure it's appropriate.

After rounds, my preceptor, fellow pharmacy student, PGY-2 Oncology resident, and myself discuss our patients. We then get some time for lunch, and lastly, attend boot camp. All 5 of the pharmacy students on oncology rotations (whether they are adult or peds) attend "boot camp" topic discussions about different things that can affect cancer patients. As Melanie described below, the first week consisted of topics on pain, nausea/vomiting, and neutropenic fever. During the second week, we talked about anemia, colony stimulating factors, and tumor lysis syndrome.

We also have smaller topic discussion as a peds heme/onc group on common pediatric cancers/heme disorders such as acute lymphoblastic leukemia (ALL), acute myeloid leukemia (AML), sickle cell disease, the 3 sarcomas (osteosarcoma, rhabdomyosarcoma, Ewing sarcoma), and neuroblastoma. Dr. Howle was sure to give each of us a wide range of patients so we could learn about their diseases. Currently I have a patient with pre-B cell ALL, one with osteosarcoma, and one with TTP. Now, day 1 of this rotation when the team kept throwing around this acronym "TTP", all I could think was "what the heck are they talking about??" Of course, I had to LOOK IT UP!

TTP stands for thrombotic thrombocytopenic purpura. It is a blood disorder that occurs when the body is deficient or lacking (this is rare) a certain enzyme called ADAMST-13, or if the body has developed antibodies to this enzyme. This enzyme breaks down a protein called von Willebrand factor which clumps together with platelets to form blood clots. When you are deficient in this enzyme, all of your platelets are getting stuck to the von Willebrand factor causing tiny blood clots all over your body (and shows up as tiny purple spots under your skin, called purpura), and are not free elsewhere in the body to do their job. This is why patients with this disorder have a very very low platelet count. To fix this, patients get a treatment called plasma exchange where blood is removed, the plasma is separated and the antibodies against the enzyme are removed. More plasma with the enzyme is added and it goes back into the patient's body.

So far, my favorite part of this rotation is getting to see the kids. A couple of them have already stolen my heart. I have also learned more than I ever thought I would about pediatric cancers in just 2 weeks, and am looking forward to learning much more. Previous to this rotation, anything having to do with pediatrics was not on my radar but now it just might be :)