Incorporating gonadal health counseling into pediatric care of sickle cell patients

Author:

Meacham Lillian R.12,Pecker Lydia H.3,Gee Beatrice,Mishkin Adrienne45

Affiliation:

1. 1 Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Atlanta, GA

2. 2 Department of Pediatrics, Division of Hematology and Oncology, Emory University, Atlanta, GA

3. 3 Division of Hematology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD

4. 4 Department of Psychiatry, Division of Consultation-Liaison Psychiatry

5. 5 Blood and Marrow Transplantation and Cell Therapy Program, Division of Hematology and Oncology, Columbia University Irving Medical Center, New York, NY

Abstract

Abstract Discussions regarding gonadal function and possible disease or treatment-related ovarian or testicular dysfunction, sexual dysfunction, and possible future infertility can be challenging in the sickle cell disease (SCD) pediatric care setting. A construct that stratifies topics into those that are time sensitive and those that require reproductive care expertise vs address gonadal health as a part of normal SCD care may be helpful. Pediatric health care discussions of gonadal function/dysfunction for patients with SCD can include (1) time-sensitive fertility consults preceding the start of gonadotoxic therapy and (2) targeted discussions at key time points during normally scheduled hematology clinic visits. The former conversations are best led by individuals with expertise in the risk for treatment-related infertility and fertility preservation. The latter discussions can be incorporated into targeted regularly scheduled visits with hematologists. These topics can be addressed as a part of planned education in pediatric care for adolescents and incorporated into transition plans as young adults transfer care to adult providers. Although the topics of puberty and gonadal health can be uncomfortable and many complex interdisciplinary and ethical issues arise in this process, these discussions can be aided by the collaterals and teaching handouts presented in this article.

Publisher

American Society of Hematology

Subject

Hematology

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