Welcome to "PICU Doc on Call," the podcast where the world of pediatric critical care comes alive! Today, Dr. Monica Gray, Dr. Pradip Kamat, and Rahul Damania delve into a fascinating case involving a 16-year-old male presenting with headache, photophobia, anemia, and cerebral venous thrombosis. After some detective work, the diagnosis? Paroxysmal nocturnal hemoglobinuria, or PNH.

Join us as we break down the pathogenesis and clinical features of PNH, walk through the diagnostic workup, and discuss management strategies, especially the game-changing role of complement inhibitors like Eculizumab. We’ll also review this patient’s clinical journey, highlighting the key pearls for recognizing and treating PNH in the pediatric intensive care unit.

So, tune in to hear more!

Show Highlights:

Clinical case presentation of a 16-year-old male with symptoms including headache, photophobia, and anemia
Diagnosis of paroxysmal nocturnal hemoglobinuria (PNH) and its clinical significance
Pathogenesis of PNH, including the role of the PIGA gene mutation and GPI-anchored proteins
Clinical features and complications associated with PNH, such as thrombosis and hemolysis
Diagnostic workup for PNH, including laboratory tests and flow cytometry
Management strategies for PNH, focusing on complement inhibitors like Eculizumab
Importance of supportive care in the PICU for patients with PNH
Discussion of emerging therapies and advancements in PNH treatment
Patient outcome and clinical course following treatment for PNH
Key takeaways regarding the diagnosis and management of PNH in pediatric intensive care

References:

Fuhrman & Zimmerman - Textbook of Pediatric Critical Care.
Reference 1: Brodsky RA. Paroxysmal nocturnal hemoglobinuria. Blood. 2014 Oct 30;124(18):2804-11.
Reference 2 Waheed A, Shammo J, Dingli D. Paroxysmal nocturnal hemoglobinuria: Review of the patient experience and treatment landscape. Blood Rev. 2024 Mar;64:101158.
Reference 3: Kokoris S, Polyviou A, Evangelidis P, Grouzi E, Valsami S, Tragiannidis K, Gialeraki A, Tsakiris DA, Gavriilaki E. Thrombosis in Paroxysmal Nocturnal Hemoglobinuria (PNH): From Pathogenesis to Treatment. Int. J. Mol. Sci. 2024 Nov 11;25(22):12104.

Paroxysmal Nocturnal Hemoglobinuria in the PICU

PICU Doc On Call