CPHON cheat sheet

Absolute neutrophil count (ANC) = WBC count × (% neutrophils + % bands) ÷ 100; severe neutropenia is an ANC below 500/µL and is the threshold used for fever risk.

After chemotherapy, the neutrophil nadir typically occurs 7–14 days after administration, with recovery generally following within 3–5 days.

Common pediatric oncology transfusion triggers: platelets below 10,000/µL (below 20,000/µL with fever, bleeding, or a procedure) and hemoglobin below 7 g/dL (below 8 g/dL with active disease or symptoms).

Platelet count below 50,000/µL: avoid intramuscular injections, rectal temperatures, and suppositories; below 20,000/µL: risk of spontaneous bleeding is high.

Childhood acute lymphoblastic leukemia is the most common pediatric malignancy and peaks at ages 2–5 years; Hodgkin lymphoma shows Reed-Sternberg cells that are CD15 and CD30 positive.

Sickle cell disease: penicillin prophylaxis until age 5 years, hydroxyurea to raise fetal hemoglobin, and acute chest syndrome is the leading cause of death.

Hemophilia A (factor VIII deficiency) and B (factor IX deficiency): treat bleeding with factor replacement, avoid NSAIDs and intramuscular injections, and use desmopressin only in mild hemophilia A.

Immune thrombocytopenia presents with isolated thrombocytopenia and petechiae without hepatosplenomegaly or lymphadenopathy; many children are managed with observation alone.

Alkylating agents such as cyclophosphamide and ifosfamide cause hemorrhagic cystitis and are given with mesna plus vigorous hydration.

Vincristine is a vesicant and neurotoxin given only intravenously; intrathecal administration is fatal, so the route is verified independently before the infusion begins.

High-dose methotrexate requires urine alkalinization (pH 7 or higher), vigorous hydration, and leucovorin rescue dosed according to serum methotrexate levels.

Anthracyclines cause cumulative dose-related cardiotoxicity; ejection fraction and shortening fraction are monitored by echocardiogram at baseline and serially.

Asparaginase (pegaspargase) toxicities include hypersensitivity, pancreatitis, hyperglycemia, and coagulopathy with low fibrinogen and low antithrombin.

Hematopoietic stem cell transplant engraftment is defined as an ANC of at least 500/µL for 3 consecutive days; allogeneic recipients risk acute graft-versus-host disease of skin, liver, and gut.

CAR-T cell therapy complications are cytokine release syndrome, treated with tocilizumab and corticosteroids, and immune effector cell-associated neurotoxicity.

Leukemia therapy phases are induction, consolidation/intensification, and maintenance; intrathecal chemotherapy is given for central nervous system prophylaxis.

Febrile neutropenia: a single oral temperature of 38.3 °C or higher, or 38.0 °C or higher sustained for 1 hour, with an ANC below 500/µL; cultures are drawn and broad-spectrum IV antibiotics started within 60 minutes.

Pain management follows the WHO analgesic ladder; give around-the-clock dosing for persistent pain and reserve naloxone for opioid-induced respiratory depression.

Antiemetic classes include 5-HT3 antagonists (ondansetron, which prolongs the QT interval), NK-1 antagonists (aprepitant), corticosteroids, and olanzapine for delayed nausea.

Mucositis care uses saline or sodium bicarbonate rinses and a soft toothbrush; alcohol- and peroxide-based rinses are avoided, and palifermin is used in some transplant settings.

A prophylactic bowel regimen of a stimulant laxative plus a stool softener is required with opioids and vincristine because tolerance to constipation does not develop.

Filgrastim and pegfilgrastim cause bone pain, most often in the sternum, spine, and long bones; it is managed with non-opioid analgesics.

Cellular blood products given to children with cancer or after transplant are leukoreduced and irradiated to prevent transfusion-associated graft-versus-host disease.

Live-virus vaccines are contraindicated during immunosuppressive chemotherapy and for at least 3 months after completion; inactivated vaccines are preferred.

Tumor lysis syndrome: hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia; prevention uses hydration plus allopurinol or rasburicase, with G6PD status checked before rasburicase.

Hyperleukocytosis (WBC above 100,000/µL) risks leukostasis with pulmonary and neurologic compromise; maintain hydration without fluid overload and use cytoreduction.

Superior vena cava syndrome presents with facial and upper-extremity edema, distended neck veins, and dyspnea; urgent imaging and airway assessment are required.

Spinal cord compression presents with back pain, motor weakness, and bowel or bladder dysfunction; give dexamethasone and obtain urgent MRI before radiation or surgery.

Extravasation management: stop the infusion, aspirate residual drug, do not flush; dexrazoxane is the antidote for anthracyclines and sodium thiosulfate for mechlorethamine.

Neutropenic enterocolitis (typhlitis) causes fever and right lower quadrant pain in a neutropenic child and is managed with bowel rest, broad-spectrum antibiotics, and surgical consultation.

SIADH from vincristine or cyclophosphamide causes hyponatremia, concentrated urine, and seizures; treatment is fluid restriction and careful sodium correction.

Hypercalcemia of malignancy (corrected calcium above 10.5 mg/dL) causes confusion, constipation, polyuria, and dehydration; treat with IV isotonic fluids and a bisphosphonate.

Erikson stages guide communication: infancy trust versus mistrust, toddler autonomy, preschool initiative, school-age industry, adolescent identity.

Concepts of death by age: under 3 years no understanding; preschool that death is reversible; school-age that it is final and fear of body changes; adolescent abstract and existential thinking.

Pain assessment by age: NIPS for neonates, FLACC for 2 months to 7 years, Wong-Baker FACES from about 3 years, numeric rating scale from about 8 years.

Palliative care can begin at diagnosis alongside curative-directed therapy; hospice care begins when curative treatment is no longer being pursued.

Fertility preservation counseling occurs before gonadotoxic therapy, such as alkylating agents or pelvic radiation, and includes sperm banking, oocyte or embryo cryopreservation, and gonadal shielding.

Siblings of children with cancer have higher rates of anxiety, depression, and school problems; they benefit from accurate information, inclusion, and one-to-one caregiver attention.

Child life specialists provide developmentally appropriate preparation, medical play, and distraction to reduce procedural distress.

Anticipatory grief begins before the child's death and is supported through honest communication, memory-making, and bereavement follow-up for the family.