CareTalk Blog: Nemours Center for Cancer and Blood Disorders

CareTalk: Blog for Cancer and Blood Disorders

Get insights and inspiration from Nemours’ experts in Hematology/Oncology.

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Lymphoma

Lymphomas are cancers that start in a child's lymphatic system — the part of the body that works with the immune system to help fight infections and diseases.

There are two types of pediatric lymphoma:
  • Non-Hodgkin’s lymphoma (also called NHL, non-Hodgkin’s disease, or just non-Hodgkin’s, for short) is the most common type of pediatric lymphoma. This type of cancer develops when there are too many white blood cells in the lymph nodes, bone marrow, spleen, and other areas. Non-Hodgkin’s lymphoma is usually diagnosed in children between the ages of 7 and 11, but older kids and adults can have it, too.
  • Hodgkin’s lymphoma (also called Hodgkin’s disease) develops when abnormal B cells (called Reed-Sternberg cells) start to form in the lymph nodes, spleen, and other areas of the body. Although associated with progressive swelling in the lymph nodes (or glands), Hodgkin’s lymphoma is often hard to diagnosis because symptoms can seem like the flu. Most kids with Hodgkin’s lymphoma are diagnosed around age 15.
 
Signs and Symptoms of Lymphoma in Children

Each individual child’s symptoms can vary, but common signs and symptoms of pediatric lymphoma may include:

  • swelling (typically where lymph nodes are found such as the neck, chest, abdomen, underarms, and groin areas)
  • fever
  • sore throat
  • bone and joint pain 
  • night sweats
  • fatigue (more tired than usual)
  • sudden and increased weight loss
  • burning and itching skin

IMPORTANT NOTE: These signs and symptoms together or on their own do not automatically mean that a child has lymphoma. Any or all of these could be a sign of something else. And not all need be present to indicate lymphoma or any other kind of cancer.

 
Diagnosing Pediatric Lymphoma

Our pediatric cancer care experts will conduct a complete exam of your child and a medical history evaluation. Other diagnostic tests for pediatric lymphoma may include:

  • X-rays
  • blood and urine tests
  • lymph node biopsy (taking a sample of cells or tissues for examination)
  • CAT scan (which stands for computed tomography) — a painless test that uses a special X-ray machine to take black-and-white pictures of the lungs, heart, blood vessels, airway passages, ribs, and lymph nodes
  • PET scan (which stands for positron emission tomography) — an imaging test that helps doctors see how the organs and tissues inside your child’s body are functioning
  • lumbar puncture (also called a spinal tap – when a thin needle is placed in the lower-back area of the spinal cord so we can take and then examine a sample of spinal fluid)

We know that tests can be scary – for you and your child. Whatever kind of tests your child might need, know that your Nemours pediatric cancer care team will do everything we can to make the experience as comfortable as possible – physically and emotionally. We’ll give sedation or anesthesia as needed and offer support and guidance at every step.

Learn more about what to expect with certain medical tests »

 
Treating Lymphoma in Children

Depending on your child’s age, overall health, extent of the disease, and other factors, pediatric lymphoma treatment may include one or a combination of
the following:

  • chemotherapy
  • radiation therapy   
  • blood or bone marrow transplant (also sometimes called a BMT, BBMT, stem cell transplant, or cord blood transplant)
  • medications/antibiotics
  • blood transfusions
  • surgery
  • antibiotics

At Nemours, we know that getting a cancer diagnosis can be very frightening and overwhelming for your whole family. That’s why Nemours’ board-certified pediatric hematologists-oncologists, specialty nurses, cancer researchers, and other cancer experts are focused on helping not only your child, but your family, too.

From diagnosis to treatment (and beyond) we’ll be here to help guide your family through your lymphoma journey – and to strive and hope, with you, for a better tomorrow.

Blood Transfusions

A blood transfusion is a relatively simple medical procedure during which a patient receives whole blood or one of its parts through an intravenous line, or IV. This is a tiny tube that is inserted into a vein using a small needle.

While patients are likely to notice a brief pinch of the needle, a blood transfusion is relatively painless. Still, any procedure that involves a needle is likely to cause some anxiety for a child, so it helps to understand how a transfusion is done. That way you can feel confident about what is happening and help put your child at ease.

About Blood Transfusions

Blood is like the body's transportation system. As blood circulates, it delivers oxygen and nutrients throughout the body. It also collects waste products and carries them to the organs responsible for making sure the wastes leave the body.Blood Transfusions_sidebar

Whole blood is a mixture of cells and liquid, and each part has a specific job:

  • Red blood cells carry oxygen to the body's tissues and remove carbon dioxide.
  • White blood cells help defend the body against infection by producing antibodies, which help destroy foreign germs in the body.
  • Platelets, the smallest blood cells, help to clot the blood and control bleeding.
  • Plasma is the liquid part of whole blood and contains a mixture of water, proteins, electrolytes, carbohydrates, cholesterol, hormones, and vitamins.

A blood transfusion can make up for a loss of blood or any part of the blood. Although whole blood can be transfused, it is rarely used. Instead, more specific parts of blood are transfused as needed. Red blood cells, the most commonly transfused part, are used to increase the blood's ability to carry oxygen and prevent fatigue and other complications.

Transfusions take 1 to 4 hours, depending on how much blood and what type is given, and no special recovery time is needed.

Most transfusions are done in a hospital, but can be done elsewhere when necessary. In most cases, the blood comes from volunteer donors. The blood of the donor, which is carefully screened to ensure its safety, must match the blood of the person receiving it.

Why Blood Transfusions Are Performed

The three main reasons why a child may need a blood transfusion are:

  1. Loss of blood during surgery or from an injury or an illness.
  2. An inability to make enough blood. Some illnesses and treatments can impair the bone marrow's ability to make blood (e.g., chemotherapy decreases production of new blood cells).
  3. To prevent complications from an existing blood or bleeding disorder, such as sickle cell disease, thalassemia, or anemia caused by kidney disease, hemophilia, or von Willebrand disease.

Where the Blood Comes From

Since there's no manmade substitute for blood, the blood supply used for transfusion must be donated. The three types of blood donation are:

  1. Autologous blood donation. Sometimes, when people know in advance that they are going to need a transfusion (for a planned surgery, for example), they may donate their own blood beforehand. In general, kids don't donate their own blood until they are over age 12.
  2. Directed donation. This is when a family member or friend with a compatible blood type donates blood specifically for use by a designated patient.
  3. Volunteer donation. Since there's no medical evidence that blood from directed donors is any safer than blood from volunteer donors, most patients receive blood donated through blood drives, which are often run by independent collection agencies like the American Red Cross.

Some people worry about getting diseases from infected blood, but the United States has one of the safest blood supplies in the world. Many organizations, including community blood banks and the federal government, work hard to ensure that the blood supply is safe.

The risk of contracting a disease like HIV or hepatitis is extremely low in the United States today because of very stringent blood screening. Also, the needles and other equipment used are sterile and they're used only on one person and then thrown away.

Preparing for a Blood Transfusion

If your child needs a blood transfusion, the doctor will speak with you about the procedure. If you have questions, be sure to ask. When you feel comfortable with the information and your questions have been fully answered, you'll be asked to sign an informed consent form, stating that you understand the procedure and its risks, and give your permission for your child to have the blood transfusion.

If the situation is not a life-threatening emergency, two tests will be performed:

  1. Blood typing. To confirm your child's blood type, a nurse or technician will draw a sample from a vein in your child's arm using a sterile needle. (Except for the brief needle stick, this isn't painful and only takes a few minutes.) This blood is immediately labeled with your child's name, birth date, and medical record number, and an armband with matching information is made for your child to wear. The blood is then sent to the hospital's blood bank lab, where technicians test it for blood type.
  2. Cross-matching. Once typing is complete, a compatible donor blood is chosen. As a final check, a blood bank technologist will mix a small sample of your child's blood with a small sample of the donor blood to confirm they are compatible. If they clump together, the blood is not compatible. If the blood mixes smoothly, they are. Blood that is considered compatible is then labeled with your child's name, birth date, and medical record number and delivered to where your child will be receiving the transfusion.

Most transfusions occur in a hospital setting, often at a patient's bedside, or in the operating room, emergency room, or chemotherapy unit. They also can be performed in an outpatient care clinic or even at home, if necessary.

As long as the transfusion is not being done during surgery, you can stay with your child, who will be awake. Your child can sit comfortably in a reclining chair or lie down on a bed, watch a movie, listen to music, or play quietly, and might be able to eat and drink, walk around a bit, and use the bathroom.

Starting an IV Line

A nurse will begin an intravenous line (IV). After the needle is inserted into an arm or hand, a small sample of blood is taken and sent to a lab to confirm the blood type. Once the results are obtained, a tiny plastic tube is left in the vein and attached to the IV tubing, which is then used to connect to the bag containing the blood.

Since puncturing the skin involves a small needle, starting an IV can cause a little bit of pain (kind of like a small pinch). To reduce discomfort, a nurse might put some numbing cream on your child's skin a half hour before inserting the needle.

Though the vein is typically in the arm or hand, it can be done in other places, if necessary, especially if conditions like severe dehydration or blood loss have made the veins harder to find. For example, babies often receive transfusions through veins in their foot or scalp.

Children who need many transfusions may require a central line (a tube inserted into a larger vein in the chest) or a PICC line (a longer tube inserted through a vein near the bend of the elbow). These lines allow easy access and also spare smaller veins the damage that can come from repeated punctures.

Most kids don't require any special medications before or during a blood transfusion. However, if your child has had a mild reaction during a previous transfusion, the doctor might give your child some medication just before the procedure, either by mouth or through the IV.

Just before the transfusion, two nurses will read to each other the names and identification numbers on your child's armband and on the blood that came from the blood bank. The transfusion won't begin unless there is a match.

Transfusing the Blood

The blood bag is hung upside down from an IV pump that controls the speed of the flow.

Teen Blood Transfusions

The nurse will measure your child's blood pressure, body temperature, and pulse several times throughout the procedure. Your child also will be watched closely for any signs of an allergic or other type of reaction, including rash, fever, headache, or swelling.

After a transfusion, if your child is going home, the tiny plastic tube is removed from the vein and a bandage is placed over the area. The site may be slightly sore or tingly for a little while. Medication may be given for any mild side effects, such as fever or headache. If your child is having surgery or is in the hospital, the IV line will stay in place.

Benefits

In kids with anemia or those undergoing chemotherapy, the greatest benefit of a transfusion is increased blood flow to nourish the organs and improve oxygen levels in the body. This can keep them from feeling extreme fatigue and help give them enough energy for the activities of daily life. Benefits like this often are felt fairly quickly.

For patients with bleeding problems, transfusions with platelets or plasma can help to control or prevent bleeding complications.

Serious reactions to transfusions are rare, but as with any medical procedure, there are a few potential risks, which your doctor will review with you.

When your child is having any kind of procedure, it's understandable to be a little uneasy. But it helps to know that blood transfusions are common procedures and complications are rare. If you have any questions about transfusions, talk with your doctor.

Reviewed by: Kate M. Cronan, MD
Date reviewed: March 2012