Pediatric Hematology and Oncology

GENERAL INFORMATION
Our unit has begun to function as ‘Unit of Pediatric Hematology and Oncology’ after integration of Pediatric Hematology and Pediatric Oncology units which worked previously as separate units, in 2011 by High Education Board of Turkey.

SUBDIVISION OF PEDIATRIC HEMATOLOGY

HISTORY
The Subdivision of Pediatric Hematology of Ankara Başkent Hospital in which service was done being separate from Pediatric Oncology before that date, was founded by Prof Dr Namık Özbek in 1996 and service was presented to outpatients in Pediatric Hematology outpatient clinics and inpatients in Pediatric Hematology and General Pediatrics inpatient clinics during 1996-2012.
 During this time, four Pediatric Hematology fellows were graduated and contribution was also made for the trainining of residents of Pediatrics and additionally the medical students of our faculty were trained practically and theoretically.
The inpatient clinic of our subdivision, the name of which was changed as ‘Unit of Pediatric Hematology Oncology’ after adjunction of the Units of Pediatric Hematology and Pediatric Oncology was closed in 2012 due to reconstructional works in our hospital
At present, the service of Pediatric Hematology is done by Prof. Dr. Lale Olcay and Assoc. Prof. Dr. Fatma Burcu Belen. Patients who do not have hematologic malignancy and require hospitalization for therapy are hospitalized in the General Pediatrics Inpatient Clinic while those with hematologic malignancy are hospitaized and treated in isolated rooms in Bone Marrow Transplantation Unit (for adults) for a while.
The name of Pediatric Oncology Subdivision in Adana Başkent Hospital in which we had served for a long time was also changed as ‘Unit of Pediatric Hematology and Oncology’ and service has been given to Pediatric Hematology patients herein also. 

INTRODUCTION
In our Ankara Hospital, three academics  from our  unit work.  Of those, Prof. Dr. Faik Sarıalioğlu serves for oncology, Prof. Dr. Lale Olcay serves for hematology and Assoc. Prof. Dr. Fatma Burcu Belen serves for both oncology and hematology patients. 
The service on Pediatric Hematology continues since 1996, as mentioned above. In our subdivision, many diseases like leukemia, myelodysplastic syndrome, hemophagocytic syndrome, lymphoproliferative syndrome, hemorrhagic diathesis,  thromboemboli, aplastic anemia, isolated cytopenias and various types of anemia are diagnosed and treated.
Of these, patients with hematologic malign diseases could not be admitted for a while after the Inpatient Clinic of Pediatric Hematology Oncology was closed, since they require long-term therapy in special inpatient clinics with special staff; however it has become  possible to treat them in isolated rooms of Bone marrow Transplantation Unit (for adults) since 2017. 
Moreover, the required services on correction of hematologic problems that had developed in the pediatric patients in the other units of our hospital in which a lot of surgical intervention including transplantation are performed, are also given.
The same services have been done in the Adana Hospital also, both in out- and inpatient clinics.
SUBDIVISION OF PEDIATRIC ONCOLOGY

HISTORY
Ankara Hospital: In our country, Pediatric Oncology  became a discipline of science by the way of law at date of September 11, 1983 (law number: 6834). In our university, Subdivision of Pediatric Oncology was founded at July 6, 2006. After the integration of Pediatric Hematology and Pediatric Oncology subdivisions by the government, between dates of December 11, 2009 – October 8, 2010  the two subdivisions worked together as ‘Unit of Pediatric Hematology and Oncology’.  After a short duration of separation at October 2010; these two subdivisions were reintegrated to a single unit again on  December 30, 2011. Although functioning as a single unit, the education formation of the academic personel  forming the unit and absence of fellowship degree lead the doctors of the two subdivisions still to work separately. It is because of this that the present presentation of the two subunits is given separately for Ankara.
Adana  Hospital: Subdivision of Pediatric Oncology was founded by Prof. Dr. Faik Sarıalioğlu at May 5, 2005.  Before that date, a few number of lymphoma cases were followed up by the previous Hematology Subdivision.  Foundation of the unit in Ankara led its foundation in Adana also. The subdivision in which service for hematology patients were also given since 2008 was legally integrated with Pediatric Hematology in November 2009.
Leukemia and other myeloproliferative diseases has been followed up and all of hematology patients have been seen by the unit since then. Prof. Dr. Nalan Yazıcı founded the Oncology Subdivision and  Assoc. Prof. Dr. Ayşe Erbay gave much support to the hematological progress in the unit.

INTRODUCTION
Ankara Hospital: When first founded, service for Pediatric Oncology patients were given in Pediatric Oncology Outpatient Clinics. Outpatient chemotherapy Unit and Inpatient Clinic with 10 beds were shared with Pediatric Hematology Subdivision.
Pediatric Oncology Unit took over the mission of many  specific and rare diagnostic and therapeutic interventions, many of which cannot be done by the other hospitals in Ankara, with the support of comprehensive Departments of Radiology, Interventional Radiology, Pathology, Medical and Molecular Genetics, Surgery and Transplantation Surgery. 
With the experience of  Prof. Dr. Sarıalioğlu many patients with special problems had been consulted.  Due to reconstruction period in our hospital, the Inpatient Clinic was closed and daily clinic and treatment unit had to be relocated. Benign tumors were still consulted. Meanwhile, due to the requirement of inpatient service in Pediatric Hematology and Oncology, malign diseases could not be treated in the unit between January 2013 and October 2017 and only consultations from our hospital or other hospitals were being held; however since October 2017 it has become possible to hospitalize and treat these patients in isolated rooms of Bone marrow Transplantation Unit (for adults). In the last five years, a new infantile hemangioma treatment protocol was developed and our subdivision became a large center of benign vascular tumors to which many patients from Turkey's 81 provinces were referred.
Adana Hospital: Baskent University Adana Medical and Research Center Subdivision of Pediatric Oncology came into service in 2005 in Seyhan Hospital in the outpatient clinic at the sixth floor. Inpatient service had been given together with Pediatrics during those years. The unit had moved to the new outpatient clinics on the ground floor in June 2008. The number of beds in the inpatient unit which was 16 previously was increased to 22. Four rooms  were isolated for neutropenic patients and a chemotherapy preparation unit was began to give service. Renovation work was completed for inpatient and outpatient units. In the Oncology Center which owned a complete oncology team with advanced Radiology, Interventional Radiology, Pathology, Nuclear Medicine, Medical Genetics (Ankara supported), Pediatric Surgery, Neurosurgery, Orthopedics, Ophthalmology, Ear Nose Throat departments and units and weekly Pediatric Tumors Board has been carried out with the highest level of education, research and treatment plans. About half of the patients with infantile hemangiomas are seen in Adana with the support of Ankara unit.  Dr. Sarıalioğlu spend his half of the working days in Adana.


 

UNDERGRADUATE EDUCATION

SUBDIVISION OF PEDIATRIC HEMATOLOGY
Theoretical and practical lessons about Pediatric Hematology have been given to Medical Faculty 3rd, 4th, 6th class students, since our subdivision was founded. Additionally, theoretical lessons about hematology were/are being given to students of other faculties or colleges of our university on the request of the relevant authorities.  
 
SUBDIVISION OF PEDIATRIC ONCOLOGY
Lectures of Pediatric Oncology  have been given by us in Faculty of Medicine since May 2005. Bed side education was also given by us until January 2013. Due to the  closure of the inpatient unit, the bedside education was  ceased and restarted after October 2017.  Theoretical lessons for Pediatric Oncology, Hematology and Tumor  Immunology  for the 3rd and 4th classes in medical faculty are being lectured by the subunit. Until 2014; intensive clinical education was given during  Adana rotations for the last year medical students (internship)
Undergraduate lessons were given for 2. class students of Unit of Nursing in Health Sciences Faculty of our university along with students in Nursing Faculty of Koç University in 2015-2016.

POSTGRADUATE EDUCATION  

SUBDIVISION OF PEDIATRIC HEMATOLOGY

Education of Fellows
In our subdivision, four pediatric hematologists were educated before 2012 (Dr. Başak Taburoğlu Yılmaz, Assoc. Prof. Dr. Bülent Alioğlu, Assoc. Prpf. Dr. Zekai Avcı, Assoc. Prof. Dr. Barış Malbora)

Training in Pediatrics
In our subdivision, practice lessons for the residents of Pediatrics are given in out- and inpatient Pediatrics Clinics. Every month, a different resident works in our subdivision according to the rotation program. The studies of the division include theoretical education, journal clubs and education on microscope. Moreover, according to the resident education program made by our Department of Pediatrics, case presentations and discussions are held and current medical articles are discussed with our residents under the guidance of our  professors weekly, on designated days.

SUBDIVISION OF PEDIATRIC ONCOLOGY

Sub-specialty  Education
Except graduated specialists from Pediatric Hematology Subdivision before the integration of two sub-specialties,  no Pediatric Oncology education could be given by Pediatric  Oncology Subdivision since there had been no students in this area.   In order to have  a research assistant from government, persistent attempts have been made since 2007.  There has been no responses from numerous initiatives from  Turkish Republic  Higher Education Council and the Ministry of Health  for his purpose. Our unit has available staff and facilities for high quality training and can simultaneously educate 4-5 people in this area, in Ankara and Adana hospitals. 

Training in Pediatrics
Our unit provides education to residents in both Adana and Ankara Hospitals of our Department of Pediatrics. Our education service on malignant diseases in Ankara Hospital is restricted due to cessation of inpatient services for malignant diseases. In Adana Unit, morning meetings, theoretical courses, case discussions and meetings, children's oncology service training visits, journal clubs, pediatric tumor board meetings, and training programs are implemented.

 

Graduated Specialist Doctors from Pediatric Hematology Department

 
  1. Barış Malbora, M.D.

2010

2-) Zekai Avcı, M.D.

2008

3-) Bülent Alioğlu, M.D.

2006

4-) Başak Taburoğlu Yılmaz, M.D.

2006

WORKING AREAS AND SCIENTIFIC EVENTS  

SUBDIVISION PEDIATRIC HEMATOLOGY

Working Areas
In our subdivision, service is given for patients aged 0-18 years.
The main hematologic diseases which are diagnosed, treated and followed in our unit are as follows:
Neonatal anemias, iron deficiency and iron deficiency anemia, megaloblastic anemia, bone marrow failure disorders (acquired/congenital aplastic anemia, Diamond-Blackfan anemia, transient erythroblastopenia of childhood, congenital dyserythropoietic anemia, sideroblastic anemia), erythrocyte membrane disorders, erythrocyte enzyme deficiencies, disorders of hemoglobin (hemoglobinopathies, alpha and beta thalassemias, acquired hemolytic anemias (immune –isoimmune, autoimmune-, non-immune –), those due to infections, drugs, chemical agents, hematologic disorders, microangiopathic  hemolytic anemia (thrombotic thrombocytopenic purpura, hemolytic uremic syndrome, chronic recurrent schistocytic anemia), other diseases (polycytemia, diseases of leukocytes,  leukocytosis,  leukopenia, neutropenia, congenital neutropenia), diseases of bleeding and coagulation,  hemophagocytic syndrome. The patients with hematologic malignancies are hospitalized and treated in the isolated rooms of Bone Marrow Transplantation Unit (for adults) at present, since the reconstruction of the Pediatric Hematology Oncology Service has not been completed yet. In our unit, Pediatric Bone Marrow Transplantation Unit is not available.
 
Scientific Events
Our professors attend to national and international Hematology and Pediatric Hematology congresses regularly and submit oral or poster presentations for pertinent ones.

SUBDIVISION OF PEDIATRIC ONCOLOGY

Working Areas
Pediatric Oncology experts participate in the process of diagnostic procedure. Most patients are referred directly or as a  result of consultation and the all diagnostic procedure is carried out in our department. The main tasks of Pediatric Oncology specialists in our organization are:
*    Diagnosis and treatment of childhood malignancies
*    Diagnosis of all benign tumors of childhood and guiding therapy
*    Identifying high risk patients for the development of malignant tumor and their follow-up
*    Guidelines of anticancer drug usage in other specialties

Scientific Events
Regular scientific activities of the members of the subdivision are given below. Our members participate at the vast majority of these activities as speakers, panelists,  chairperson and reporters. The principle and purpose of attending to most of the cross-border meetings is to make scientific contributions rather than being passive listeners.
*    To attend the annual meetings regularly International Society of Pediatric Oncology (SIOP)
*    To participate in international meetings on specific oncological diseases
*   To  attend national meetings  of ‘Turkish Pediatric Oncology Group  Congress (TPOG) and  National Cancer Congress (UKK)
*    To organise regional and in university scientific meetings
*   To participate in national and regional meetings at other universities and national organizations