eMedicine Specialties > Pediatrics: General Medicine > Hematology

Shwachman-Diamond Syndrome: Follow-up

Author: Antoinette C Spoto-Cannons, MD, FAAP, Associate Professor, Department of Pediatrics, Director, Undergraduate Children's Health Care Education, University of South Florida College of Medicine
Coauthor(s): Jessica Marie Keshishian, MD, Resident Physician, Department of Pediatrics, University of South Florida; Sarah Syed, University of South Florida College of Medicine; Mudra Kumar, MD, MBBS, MRCP, Associate Professor, Department of Pediatrics, University of South Florida College of Medicine
Contributor Information and Disclosures

Updated: Sep 30, 2009

Follow-up

Deterrence/Prevention

  • No prevention for Shwachman-Diamond syndrome (SDS) is known.
  • Advise parents to obtain genetic counseling.
  • Currently, the medical profession is unable to detect the carrier state of this disease.

Complications

  • Malabsorption due to pancreatic insufficiency
    • Diarrhea
    • Hypoproteinemia
    • Fat-soluble vitamin deficiencies
  • Failure to thrive20
  • Recurrent bacterial infections (eg, upper respiratory tract infections, otitis media, sinusitis, pneumonia, aphthous stomatitis, skin infections, paronychia, osteomyelitis, bacteremia); patients at risk for overwhelming sepsis21
  • Hearing loss secondary to recurrent otitis media
  • Predilection for developing bone marrow failure and leukemic transformation in 5-33% of patients with Schwachman-Diamond syndrome49
    • Frequency increases with age.
    • Acute myeloid leukemia, acute lymphoid leukemia, and juvenile chronic myeloid leukemia have been reported in patients with Schwachman-Diamond syndrome.
  • Hemosiderosis secondary to multiple red cell transfusions
  • Coxa vara deformity
  • Osteopenia, osteoporosis43
  • Cirrhosis of the liver

Prognosis

Long-term prognosis for individuals with Schwachman-Diamond syndrome is uncertain and varies.

  • Patients with Schwachman-Diamond syndrome are at an increased risk of infection secondary to neutropenia and a neutrophil migration defect. Sepsis and death may occur.21
  • An increased incidence of myelodysplasia and transformation to acute myeloid leukemia is reported. Acute myeloid leukemia is usually unresponsive to conventional chemotherapy and requires allogenic hematopoietic stem cell transplantation.25,48 Even after stem cell transplantation, the prognosis in these patients is poor, mainly due to organ toxicity related to treatment (specifically cardiotoxicity).11 This has led to a new debate regarding whether patients with Shwachman-Diamond syndrome have a predisposed myocardium, through genetic mechanisms, which become clinically significant after stress of treatment with cardiotoxic conditioning regimens such as whole-body radiation and cyclophosphamide.53

Patient Education

  • Educate families on all aspects of this disease and the importance of notifying a physician whenever the patient has a fever or is not acting well.

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider Shwachman-Diamond syndrome if the patient has pancreatic insufficiency and a negative finding on sweat test
  • Failure to avoid underdiagnosis, which is caused by lack of awareness of this condition
 


More on Shwachman-Diamond Syndrome

Overview: Shwachman-Diamond Syndrome
Differential Diagnoses & Workup: Shwachman-Diamond Syndrome
Treatment & Medication: Shwachman-Diamond Syndrome
Follow-up: Shwachman-Diamond Syndrome
Multimedia: Shwachman-Diamond Syndrome
References
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References

  1. Ip WF, Dupuis A, Ellis L, Beharry S, Morrison J, Stormon MO. Serum pancreatic enzymes define the pancreatic phenotype in patients with Shwachman-Diamond syndrome. J Pediatr. Aug 2002;141(2):259-65. [Medline].

  2. Albrecht LA, Gorges SW, Styne DM, Bremer AA. Shwachman-Diamond syndrome presenting as hypoglycemia. Clin Pediatr (Phila). Mar 2009;48(2):212-4. [Medline].

  3. Wessels D, Srikantha T, Yi S, Kuhl S, Aravind L, Soll DR. The Shwachman-Bodian-Diamond syndrome gene encodes an RNA-binding protein that localizes to the pseudopod of Dictyostelium amoebae during chemotaxis. J Cell Sci. Jan 15 2006;119:370-9. [Medline].

  4. Orelio C, Kuijpers TW. Shwachman-Diamond syndrome neutrophils have altered chemoattractant-induced F-actin polymerization and polarization characteristics. Haematologica. Mar 2009;94(3):409-13. [Medline].

  5. Aggett PJ, Cavanagh NP, Matthew DJ, Pincott JR, Sutcliffe J, Harries JT. Shwachman's syndrome. A review of 21 cases. Arch Dis Child. May 1980;55(5):331-47. [Medline].

  6. Kent A, Murphy GH, Milla P. Psychological characteristics of children with Shwachman syndrome. Arch Dis Child. Dec 1990;65(12):1349-52. [Medline].

  7. Cipolli M, D'Orazio C, Delmarco A, Marchesini C, Miano A, Mastella G. Shwachman's syndrome: pathomorphosis and long-term outcome. J Pediatr Gastroenterol Nutr. Sep 1999;29(3):265-72. [Medline].

  8. Toiviainen-Salo S, Makitie O, Mannerkoski M, Hamalainen J, Valanne L, Autti T. Shwachman-Diamond syndrome is associated with structural brain alterations on MRI. Am J Med Genet A. Jun 15 2008;146A(12):1558-64. [Medline].

  9. Mack DR, Forstner GG, Wilschanski M, Freedman MH, Durie PR. Shwachman syndrome: exocrine pancreatic dysfunction and variable phenotypic expression. Gastroenterology. Dec 1996;111(6):1593-602. [Medline].

  10. Federman N, Sakamoto KM. The genetic basis of bone marrow failure syndromes in children. Mol Genet Metab. Sep-Oct 2005;86(1-2):100-9. [Medline].

  11. Dror Y. Shwachman-Diamond syndrome. Pediatr Blood Cancer. Dec 2005;45(7):892-901. [Medline].

  12. Leung EW, Rujkijyanont P, Beyene J, Wei K, Abdelhaleem M, Freedman MH. Shwachman-Diamond syndrome: an inherited model of aplastic anaemia with accelerated angiogenesis. Br J Haematol. Jun 2006;133(5):558-61. [Medline].

  13. Nihrane A, Sezgin G, Dsilva S, et al. Depletion of the Shwachman-Diamond syndrome gene product, SBDS, leads to growth inhibition and increased expression of OPG and VEGF-A. Blood Cells Mol Dis. Jan-Feb 2009;42(1):85-91. [Medline].

  14. Austin KM, Gupta ML, Coats SA, Tulpule A, Mostoslavsky G, Balazs AB. Mitotic spindle destabilization and genomic instability in Shwachman-Diamond syndrome. J Clin Invest. Apr 2008;118(4):1511-8. [Medline].

  15. Maserati E, Pressato B, Valli R, et al. The route to development of myelodysplastic syndrome/acute myeloid leukaemia in Shwachman-Diamond syndrome: the role of ageing, karyotype instability, and acquired chromosome anomalies. Br J Haematol. Apr 2009;145(2):190-7. [Medline].

  16. Dror Y. Shwachman-Diamond syndrome: implications for understanding the molecular basis of leukaemia. Expert Rev Mol Med. Dec 23 2008;10:e38. [Medline].

  17. Watanabe K, Ambekar C, Wang H, Ciccolini A, Schimmer AD, Dror Y. SBDS-deficiency results in specific hypersensitivity to Fas stimulation and accumulation of Fas at the plasma membrane. Apoptosis. Jan 2009;14(1):77-89. [Medline].

  18. Alter, BP, Young, NS. The bone marrow failure syndromes. In: Nathan DG, Orkin SH, eds. Nathan and Oski's Hematology of Infancy and Childhood. Philadelphia, PA: WB Saunders; 1998:276-8.

  19. Ginzberg H, Shin J, Ellis L, Morrison J, Ip W, Dror Y. Shwachman syndrome: phenotypic manifestations of sibling sets and isolated cases in a large patient cohort are similar. J Pediatr. Jul 1999;135(1):81-8. [Medline].

  20. Hill RE, Durie PR, Gaskin KJ, et al. Steatorrhea and pancreatic insufficiency in Shwachman syndrome. Gastroenterology. Jul 1982;83(1 Pt 1):22-7. [Medline].

  21. Gaskin KJ. Hereditary disorders of the pancreas. In: Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. St. Louis, MO: Mosby; 1996:1488-92.

  22. Szuts P, Katona Z, Ilyes M, et al. Correction of defective chemotaxis with thiamine in Shwachman-Diamond syndrome. Lancet. May 12 1984;1(8385):1072-3. [Medline].

  23. Higashi O, Hayashi T, Ohara K, Honda Y, Doi S. Pancreatic insufficiency with bone marrow dysfunction (Shwachman-Diamond-Oski-Khaw's syndrome). Report of a case. Tohoku J Exp Med. May 1967;92(1):1-12. [Medline].

  24. Ho W, Cheretakis C, Durie P, Kulkarni G, Glogauer M. Prevalence of oral diseases in Shwachman-Diamond syndrome. Spec Care Dentist. Mar-Apr 2007;27(2):52-8. [Medline].

  25. Durie PR. Inherited and congenital disorders of the exocrine pancreas. Gastroenterologist. Sep 1996;4(3):169-87. [Medline].

  26. Hall GW, Dale P, Dodge JA. Shwachman-Diamond syndrome: UK perspective. Arch Dis Child. Jun 2006;91(6):521-4. [Medline].

  27. Ginzberg H, Shin J, Ellis L, Goobie S, Morrison J, Corey M. Segregation analysis in Shwachman-Diamond syndrome: evidence for recessive inheritance. Am J Hum Genet. Apr 2000;66(4):1413-6. [Medline].

  28. Boocock GR, Morrison JA, Popovic M, et al. Mutations in SBDS are associated with Shwachman-Diamond syndrome. Nat Genet. Jan 2003;33(1):97-101. [Medline].

  29. Boocock GR, Marit MR, Rommens JM. Phylogeny, sequence conservation, and functional complementation of the SBDS protein family. Genomics. Jun 2006;87(6):758-71. [Medline].

  30. Zhang S, Shi M, Hui CC, Rommens JM. Loss of the mouse ortholog of the shwachman-diamond syndrome gene (Sbds) results in early embryonic lethality. Mol Cell Biol. Sep 2006;26(17):6656-63. [Medline].

  31. Hesling C, Oliveira CC, Castilho BA, Zanchin NI. The Shwachman-Bodian-Diamond syndrome associated protein interacts with HsNip7 and its down-regulation affects gene expression at the transcriptional and translational levels. Exp Cell Res. Dec 10 2007;313(20):4180-95. [Medline].

  32. Menne TF, Goyenechea B, Sanchez-Puig N, et al. The Shwachman-Bodian-Diamond syndrome protein mediates translational activation of ribosomes in yeast. Nat Genet. Apr 2007;39(4):486-95. [Medline].

  33. Ganapathi KA, Shimamura A. Ribosomal dysfunction and inherited marrow failure. Br J Haematol. May 2008;141(3):376-87. [Medline].

  34. Shimamura A. Shwachman-Diamond syndrome. Semin Hematol. Jul 2006;43(3):178-88. [Medline].

  35. Smith OP, Hann IM, Chessells JM, et al. Haematological abnormalities in Shwachman-Diamond syndrome. Br J Haematol. Aug 1996;94(2):279-84. [Medline].

  36. Rothbaum RJ. Cystic fibrosis and congenital anomalies of the exocrine pancreas. In: Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. Philadelphia, PA: WB Saunders; 1999:665-79.

  37. McLennan TW, Steinbach HL. Schwachman's syndrome: the broad spectrum of bony abnormalities. Radiology. Jul 1974;112(1):167-73. [Medline].

  38. Brown SM, Buchdahl R. Shwachman-Diamond syndrome in a child presenting with cystic fibrosis-type symptoms and a false-positive sweat test. J R Soc Med. Jul 2008;101 Suppl 1:S39-43. [Medline].

  39. Wilschanski M, van der Hoeven E, Phillips J, et al. Shwachman-Diamond syndrome presenting as hepatosplenomegaly. J Pediatr Gastroenterol Nutr. Jul 1994;19(1):111-3. [Medline].

  40. Berrocal T, Prieto C, Pastor I, et al. Sonography of pancreatic disease in infants and children. Radiographics. Mar 1995;15(2):301-13. [Medline].

  41. Lee JH, Bae SH, Yu JJ, Lee R, Yun YM, Song EY. A case of Shwachman-Diamond syndrome confirmed with genetic analysis in a Korean child. J Korean Med Sci. Feb 2008;23(1):142-5. [Medline].

  42. Ruggiero A, Molinari F, Coccia P, et al. MRI findings in Shwachman diamond syndrome. Pediatr Blood Cancer. Feb 2008;50(2):352-4. [Medline].

  43. Toiviainen-Salo S, Mayranpaa MK, Durie PR, et al. Shwachman-Diamond syndrome is associated with low-turnover osteoporosis. Bone. Dec 2007;41(6):965-72. [Medline].

  44. Berrocal T, Simon MJ, al-Assir I, et al. Shwachman-Diamond syndrome: clinical, radiological and sonographic aspects. Pediatr Radiol. 1995;25(4):289-92. [Medline].

  45. Donadieu J, Michel G, Merlin E, et al. Hematopoietic stem cell transplantation for Shwachman-Diamond syndrome: experience of the French neutropenia registry. Bone Marrow Transplant. Nov 2005;36(9):787-92. [Medline].

  46. Azzara A, Carulli G, Polidori R, et al. In vitro restoration by lithium of defective chemotaxis in Shwachman-Diamond syndrome. Br J Haematol. Dec 1988;70(4):502. [Medline].

  47. Lozada-Munoz L, Aliaga MD. Shwachman-Diamond syndrome: the clinical imitator of cystic fibrosis. P R Health Sci J. Dec 1995;14(4):275-7. [Medline].

  48. Barrios N, Kirkpatrick D, Regueira O, et al. Bone marrow transplant in Shwachman Diamond syndrome. Br J Haematol. Oct 1991;79(2):337-8. [Medline].

  49. Okcu F, Roberts WM, Chan KW, et al. Bone marrow transplantation in Shwachman-Diamond syndrome: report of two cases and review of the literature. Bone Marrow Transplant. Apr 1998;21(8):849-51. [Medline].

  50. Sauer M, Zeidler C, Meissner B, et al. Substitution of cyclophosphamide and busulfan by fludarabine, treosulfan and melphalan in a preparative regimen for children and adolescents with Shwachman-Diamond syndrome. Bone Marrow Transplant. Feb 2007;39(3):143-7. [Medline].

  51. Bhatla D, Davies SM, Shenoy S, Harris RE, Crockett M, Shoultz L. Reduced-intensity conditioning is effective and safe for transplantation of patients with Shwachman-Diamond syndrome. Bone Marrow Transplant. May 26 2008;[Medline].

  52. Marseglia GL, Bozzola M, Marchi A, et al. Response to long-term hGH therapy in two children with Schwachman- Diamond syndrome associated with GH deficiency. Horm Res. 1998;50(1):42-5. [Medline].

  53. Toiviainen-Salo S, Pitkanen O, Holmstrom M, et al. Myocardial function in patients with Shwachman-Diamond syndrome: aspects to consider before stem cell transplantation. Pediatr Blood Cancer. Oct 2008;51(4):461-7. [Medline].

  54. Azzara A, Carulli G, Ceccarelli M, et al. In vivo effectiveness of lithium on impaired neutrophil chemotaxis in Shwachman-Diamond syndrome. Acta Haematol. 1991;85(2):100-2. [Medline].

  55. Brueton MJ, Mavromichalis J, Goodchild MC, Anderson CM. Hepatic dysfunction in association with pancreatic insufficiency and cyclical neutropenia. Shwachman-Diamond syndrome. Arch Dis Child. Jan 1977;52(1):76-8. [Medline].

  56. Burroughs L, Woolfrey A, Shimamura A. Shwachman-Diamond syndrome: a review of the clinical presentation, molecular pathogenesis, diagnosis, and treatment. Hematol Oncol Clin North Am. Apr 2009;23(2):233-48. [Medline].

  57. Buyse ML. Birth Defects Encyclopedia. Cambridge, MA: Blackwell Scientific Publication; 1990:1535-6.

  58. Calhoun DA, Christensen RD. Recent advances in the pathogenesis and treatment of nonimmune neutropenias in the neonate. Curr Opin Hematol. Jan 1998;5(1):37-41. [Medline].

  59. Dokal I, Rule S, Chen F, et al. Adult onset of acute myeloid leukaemia (M6) in patients with Shwachman- Diamond syndrome. Br J Haematol. Oct 1997;99(1):171-3. [Medline].

  60. Dror Y, Freedman MH. Shwachman-Diamond syndrome: An inherited preleukemic bone marrow failure disorder with aberrant hematopoietic progenitors and faulty marrow microenvironment. Blood. Nov 1 1999;94(9):3048-54. [Medline].

  61. Dror Y, Squire J, Durie P, Freedman MH. Malignant myeloid transformation with isochromosome 7q in Shwachman- Diamond syndrome. Leukemia. Oct 1998;12(10):1591-5. [Medline].

  62. Goobie S, Popovic M, Morrison J, Ellis L, Ginzberg H, Boocock GR. Shwachman-Diamond syndrome with exocrine pancreatic dysfunction and bone marrow failure maps to the centromeric region of chromosome 7. Am J Hum Genet. Apr 2001;68(4):1048-54. [Medline].

  63. Harms HK, Kennel O, Bertele RM, et al. Vitamin B12 absorption and exocrine pancreatic insufficiency in childhood. Eur J Pediatr. Mar 1981;136(1):75-9. [Medline].

  64. Kamoda T, Saito T, Kinugasa H, et al. A case of Shwachman-Diamond syndrome presenting with diabetes from early infancy. Diabetes Care. Jun 2005;28(6):1508-9. [Medline]. [Full Text].

  65. Kornfeld SJ, Kratz J, Diamond F, et al. Shwachman-Diamond syndrome associated with hypogammaglobulinemia and growth hormone deficiency. J Allergy Clin Immunol. Aug 1995;96(2):247-50. [Medline].

  66. Kuijpers TW, Alders M, Tool AT, et al. Hematologic abnormalities in Shwachman Diamond syndrome: lack of genotype-phenotype relationship. Blood. Jul 1 2005;106(1):356-61. [Medline].

  67. Liebman WM, Rosental E, Hirshberger M, Thaler MM. Shwachman-Diamond sydnrome and chronic liver disease. Clin Pediatr (Phila). Nov 1979;18(11):695-6, 698. [Medline].

  68. Mah V, Nelson L, Vinters HV. Focal pontine leukoencephalopathy in a patient with the Shwachman- Diamond syndrome. Can J Neurol Sci. Nov 1987;14(4):608-10. [Medline].

  69. Majeed F, Jadko S, Freedman MH, et al. Mutation analysis of SBDS in pediatric acute myeloblastic leukemia. Pediatr Blood Cancer. Dec 2005;45(7):920-4. [Medline].

  70. Maki M, Sorto A, Hallstrom O, Visakorpi JK. Hepatic dysfunction and dysgammaglobulinaemia in Shwachman-Diamond syndrome. Arch Dis Child. Aug 1978;53(8):693-4. [Medline].

  71. Makitie O, Ellis L, Durie PR, et al. Skeletal phenotype in patients with Shwachman-Diamond syndrome and mutations in SBDS. Clin Genet. Feb 2004;65(2):101-12. [Medline].

  72. Mannick EE, Udall Jr JN. Maldigestion and malabsorption. In: Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. Philadelphia, PA: WB Saunders; 1999:273-87.

  73. Minelli A, Maserati E, Nicolis E, et al. The isochromosome i(7)(q10) carrying c.258+2t>c mutation of the SBDS gene does not promote development of myeloid malignancies in patients with Shwachman syndrome. Leukemia. Apr 2009;23(4):708-11. [Medline].

  74. Miniero R, Dalponte S, Linari A, et al. Severe Shwachman-Diamond syndrome and invasive parvovirus B19 infection. Pediatr Hematol Oncol. Nov-Dec 1996;13(6):555-61. [Medline].

  75. Nakashima E, Mabuchi A, Makita Y, et al. Novel SBDS mutations caused by gene conversion in Japanese patients with Shwachman-Diamond syndrome. Hum Genet. Mar 2004;114(4):345-8. [Medline].

  76. Nicolis E, Bonizzato A, Assael BM, Cipolli M. Identification of novel mutations in patients with Shwachman-Diamond syndrome. Hum Mutat. Apr 2005;25(4):410. [Medline].

  77. Rawls AS, Gregory AD, Woloszynek JR, Liu F, Link DC. Lentiviral-mediated RNAi inhibition of Sbds in murine hematopoietic progenitors impairs their hematopoietic potential. Blood. Oct 1 2007;110(7):2414-22. [Medline].

  78. Robberecht E, Nachtegaele P, Van Rattinghe R, et al. Pancreatic lipomatosis in the Shwachman-Diamond syndrome. Identification by sonography and CT-scan. Pediatr Radiol. 1985;15(5):348-9. [Medline].

  79. Rujkijyanont P, Watanabe K, Ambekar C, et al. SBDS-deficient cells undergo accelerated apoptosis through the Fas-pathway. Haematologica. Mar 2008;93(3):363-71. [Medline].

  80. Shammas C, Menne TF, Hilcenko C, et al. Structural and mutational analysis of the SBDS protein family. Insight into the leukemia-associated Shwachman-Diamond Syndrome. J Biol Chem. May 13 2005;280(19):19221-9. [Medline].

  81. Shwachman H, Diamond L, Oski F, Knaw. The syndrome of pancreatic insufficiency and bone marrow dysfunction. J Pediatr. Nov 1964;65(5):645-63.

  82. Tada H, Ri T, Yoshida H, et al. A case of Shwachman syndrome with increased spontaneous chromosome breakage. Hum Genet. Nov 1987;77(3):289-91. [Medline].

  83. Vibhakar R, Radhi M, Rumelhart S, et al. Successful unrelated umbilical cord blood transplantation in children with Shwachman-Diamond syndrome. Bone Marrow Transplant. Nov 2005;36(10):855-61. [Medline].

  84. Welte K, Boxer LA. Severe chronic neutropenia: pathophysiology and therapy. Semin Hematol. Oct 1997;34(4):267-78. [Medline].

  85. Woloszynek JR, Rothbaum RJ, Rawls AS, et al. Mutations of the SBDS gene are present in most patients with Shwachman-Diamond syndrome. Blood. Dec 1 2004;104(12):3588-90. [Medline]. [Full Text].

  86. Yamaguchi M, Fujimura K, Toga H, et al. Shwachman-Diamond syndrome is not necessary for the terminal maturation of neutrophils but is important for maintaining viability of granulocyte precursors. Exp Hematol. Apr 2007;35(4):579-86. [Medline].

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Further Reading

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Keywords

Shwachman-Diamond syndrome, SDS, bone marrow dysfunction, pancreatic insufficiency, short stature, congenital lipomatosis of pancreas, metaphyseal dysplasia, pancreatic hypoplasia, marrow dysfunction, pancreatic hypoplasia, marrow dysfunction, metaphyseal dysplasia, Shwachman-Bodian syndrome, Shwachman-Diamond-Oski-Knaw syndrome, cystic fibrosis, Fanconi anemia, Blackfan-Diamond, skeletal dysplasia, osteoporosis, upper respiratory tract infections, otitis media, sinusitis, pneumonia, aphthous stomatitis, skin infections, paronychia, osteomyelitis, bacteremia, myelodysplastic syndrome, MDS, leukemia, malabsorption, imperforate anus, Hirschsprung disease, constipation, diarrhea, hearing loss, tooth enamel defects, hypomaturation, hypocalcification, hypoplasia, treatment, diagnosis

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Contributor Information and Disclosures

Author

Antoinette C Spoto-Cannons, MD, FAAP, Associate Professor, Department of Pediatrics, Director, Undergraduate Children's Health Care Education, University of South Florida College of Medicine
Antoinette C Spoto-Cannons, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, Council on Medical Student Education in Pediatrics, and Florida Pediatric Society
Disclosure: Nothing to disclose.

Coauthor(s)

Jessica Marie Keshishian, MD, Resident Physician, Department of Pediatrics, University of South Florida
Jessica Marie Keshishian, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Student Association/Foundation, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Sarah Syed, University of South Florida College of Medicine
Sarah Syed is a member of the following medical societies: American Medical Student Association/Foundation
Disclosure: Nothing to disclose.

Mudra Kumar, MD, MBBS, MRCP, Associate Professor, Department of Pediatrics, University of South Florida College of Medicine
Mudra Kumar, MD, MBBS, MRCP is a member of the following medical societies: American Academy of Pediatrics and American Society of Hematology
Disclosure: Nothing to disclose.

Medical Editor

Sharada A Sarnaik, MBBS, Professor of Pediatrics, Wayne State University School of Medicine; Director, Sickle Cell Center, Attending Hematologist/Oncologist, Children's Hospital of Michigan
Sharada A Sarnaik, MBBS is a member of the following medical societies: American Association of Blood Banks, American Association of University Professors, American Society of Hematology, American Society of Pediatric Hematology/Oncology, New York Academy of Sciences, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

James L Harper, MD, Associate Professor, Department of Pediatrics, Division of Hematology/Oncology and Bone Marrow Transplantation, Associate Chairman for Education, Department of Pediatrics, University of Nebraska Medical Center; Assistant Clinical Professor, Department of Pediatrics, Creighton University; Director, Continuing Medical Education, Children's Memorial Hospital; Pediatric Director, Nebraska Regional Hemophilia Treatment Center
James L Harper, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Federation for Clinical Research, American Society of Hematology, American Society of Pediatric Hematology/Oncology, Council on Medical Student Education in Pediatrics, and Hemophilia and Thrombosis Research Society
Disclosure: Nothing to disclose.

CME Editor

Helen SL Chan, MBBS, FRCP(C), FAAP, Senior Scientist, Research Institute; Professor, Division of Hematology/Oncology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Canada
Helen SL Chan, MBBS, FRCP(C), FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association for Cancer Research, American Society of Hematology, and Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

Chief Editor

Max J Coppes, MD, PhD, MBA, Senior Vice President, Children's National Medical Center (Center for Cancer and Blood Disorders); Director, Center for Cancer and Immunology Research, Children's Research Institute, Children's National Medical Center; Professor of Medicine, Oncology, and Pediatrics, Georgetown University
Max J Coppes, MD, PhD, MBA is a member of the following medical societies: American Association for Cancer Research, American Society of Pediatric Hematology/Oncology, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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