Dr. DKL Cheuk

Interestingly, three of the five original articles in the current issue are related to the field of paediatric haematology-oncology (PHO), but they belong to quite diverse topics reported by authors in different localities, illustrating that haematology or oncology problems actually infiltrate widely in the practice of paediatrics. It is in fact an exciting time in Hong Kong at the moment that the Hong Kong College of Paediatricians is reviewing the application of accreditation for the new PHO subspecialty training, which is expected to be inaugurated very soon, and will mark the commencement of a new era in the training of PHO in Hong Kong.

"Your present is the result of your past, and your present will make your future" (By Dr Abu Siyam). It is certainly important to look into the past to summarise what we learnt so that we have a strong base to advance into the future. Dr Chan YLF from Hong Kong and Dr Ang SH from Singapore presented their review of patients with childhood immune thrombocytopenia (ITP) and hereditary spherocytosis (HS) respectively.^1,2 These are not uncommon paediatric haematological diseases, many a time managed by general paediatricians and occasionally in consultation with paediatric haematology subspecialist in complicated patients. Dr Chan provides a systematic report of a cohort of childhood ITP in Hong Kong.¹ This is the second report of local patients after the one reported 25 years ago.³ Although these cohorts are not population-based but derived from a few hospitals only, the findings of the two cohorts over the past decades are comparable and similar with cohorts reported overseas and I believe they likely more or less represent the overall situation in Hong Kong, and open the future for development of clinical score for Chinese children as the authors conclude. It is also high time to consider setting up a territory-wide registry for this distinct disease group for future genetic and treatment studies. On the other hand, Dr Ang reported the findings in her cohort of HS in KK Women's and Children's Hospital.² The clinical presentations in these Asian children are similar to those reported in the Western population, but the proportion with family history is notably lower, likely indicating different genetic spectrum between the East and the West. Unfortunately, no complete genetic information is available for this Singapore cohort for further comparison. I am eager to see a systematic review of a cohort of patients in Hong Kong, which has never been reported. It would be interesting and informative to see if the clinical course and genetic spectrum of HS in Hong Kong resemble those reported in Singapore and elsewhere. As in the case of childhood ITP, a local registry of HS is highly worth considering so as to facilitate longitudinal follow-up and future studies.

While most haematology problems in children are managed by general paediatricians as in ITP, or joint efforts with paediatric haematologists as in HS, it is not uncommon to see cross-talk between paediatric haematologists and other paediatric subspecialists, such as neonatologists in the case of HS presenting as severe neonatal jaundice which is quite prevalent as reported by Dr Ang.² In fact, haematology problems are so common that they are seen in nearly all paediatric subspecialties, and therefore all paediatricians and subspecialists have to be aware of haematology problems seen in their own fields. Blood and blood cells are everywhere in our body and they certainly play some roles in diseases of nearly every organ system. Dr Ugurlu and colleagues from Turkey reported interesting findings of increased neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio within the first 72 hours after birth as independent predictors of retinopathy of prematurity (ROP).⁴ These findings not only open the realm for further studies of the roles of different blood cells in the pathophysiology of ROP and perhaps development of innovative treatments in the future, but also give insights into the possible roles of blood cells in other inflammatory or complex diseases of different organ systems, which await joint efforts and cross-talks among different paediatric subspecialists and haematologists.

Through the concerted efforts of paediatricians with special interests in haematology and oncology, the field of PHO has made tremendous progress in the past 25 years.⁵ With formal establishment of the subspecialty of PHO in Hong Kong in the near future and commencement of structured training of the younger generation in Hong Kong, I am optimistic that the future holds great promise for ever-improving management of children with primarily haematological or oncological conditions and many other conditions with haematological abnormalities, or conditions that blood elements play a significant part. Needless to say, collaboration among all paediatricians and subspecialists are of overarching and paramount importance for future research and practice.

References

1. Chan FLY, Fung GPG, Chan LTW, Chiu WK. Predictors of Remission in Childhood Immune Thrombocytopenia. HK J Paediatr (new series) 2022;27:100-6.

2. Ang SH, Lam JCM. Hereditary Spherocytosis in an Asian Children's Hospital. HK J Paediatr (new series) 2022;27:113-7.

3. Lee V, Chik KW, Shing MK, et al. Treatment Practice of Idiopathic Thrombocytopenia Purpura. HK J Paediatr (New Series) 1997;2:179.

4. Ugurlu A, Icel E. Are the Neutrophil-to-lymphocyte, Platelet-to-lymphocyte and Monocyte-to-lymphocyte Ratios Predictive Factors for the Retinopathy of Prematurity? HK J Paediatr (new series) 2022;27:107-12.

5. Ha SY, Cheuk DKL. Paediatric Haematology and Oncology in Hong Kong: A Quarter Century of Progress. HK J Paediatr (New Series) 2019;24:216-26.