Every week, hundreds of children suffering from blood diseases and cancer are diagnosed and treated at the Hematology/Oncology clinic at Ain Shams University Children’s Hospital in Cairo.

As well as various immune blood diseases and anemias, the most common blood diseases that many of these children are diagnosed with include sickle cell disease (an inherited disease of red blood cells which can cause attacks of pain, damage to vital organs, risk of serious infections and early death) and Thalassemias (a group of inherited diseases of the blood combined with a number of different forms of anemia. Heart failure and infection are the leading causes of death among children with untreated Thalassemia Major).

Many children at the clinic are also diagnosed with blood-related cancers such as acute leukemia (cancer of the blood) and lymphoma (cancer of the lymphatic system).

In order to survive, these patients need extensive care, sometimes including regular blood transfusions and comprehensive care for body organ systems to detect early damage. Besides being extremely expensive, repeated blood transfusions also result in a buildup of iron in the body, which can damage the heart, liver and other organs. A drug referred to as an iron chelator can help rid the body of excess iron, preventing or delaying problems related to iron overload. This drug is usually administered daily via a mechanical pump that pumps the drug underneath the skin while the child is sleeping.

Whenever possible, patients are given the option of having a bone marrow transplant. Bone marrow transplantation has become the treatment of choice for a number of blood diseases and malignancies. Since 1989, almost 1000 patients have been transplanted. However, bone marrow transplants are only possible for a small minority of patients who have a suitable bone marrow donor, and the transplant procedure is still risky and can result in death.

Staff at the Hematology/Oncology clinic say that the biggest problem and cause of death amongst the children currently being treated at the clinic is liver disease. Patients undergoing chemotherapy and blood transfusions are extremely vulnerable to hepatitis B and C viruses, which are easily transmitted from one patient to another, or as a result of regular blood transfusions. In patients undergoing chemotherapy, hepatitis B is extremely aggressive, hindering the effects of the chemotherapy and leading to liver failure within 5-10 years. In some cases when the patient acquires hepatitis, chemotherapy needs to be stopped, causing the cancer to return and spread.

During the last four years alone, 5 patients have died as a result of liver failure while undergoing chemotherapy. One 12 year old boy, who had been cured of leukemia at the age of 6, died of aggressive liver cancer after being diagnosed with both hepatitis B and C at age 12.

Liver disease is also the most common cause of death among bone marrow transplant patients, accounting for almost 50% of deaths, at least 85% occuring within the first 100 days post-transplant.

A very large group of children with blood diseases and infected with either Hepatitis B or Hepatitis C are currently being treated at the at Ain Shams University’s Children’s Hospital under the supervision of Dr. Manal Hamdy El-Sayed (in photo). Several of these children are undergoing bone marrow transplantation, and Dr. El-Sayed says that staff at the clinic are reporting a lot of hepatic complications among these patients. At least 15 children are also currently suffering from complications of progressive liver disease.

Since Dr. El-Sayed started prescribing a new, but extremely expensive form of antiviral therapy to the children, Dr. El-Sayed reports that the result has been "a remarkable improvement in those children with improved liver disease proved by biopsy. A very large group of children infected with either hepatitis B or C are currently being treated under my supervision with much better and promising outcome."

Many of the children have a good chance of halting the progression of their liver disease and surviving, but this can only happen if they are able to cover the extremely high costs of their treatment. Almost all of the children come from families that are barely able to cover their daily costs of living, and have no way of paying for their children's medical bills.

Every patient undergoing chemotherapy requires at least LE 2000 per month, and extra medications for supportive care might increase the cost to almost LE 10,000. Patients with hepatitis require LE 2000, and an extra LE 1000 per month if the patient is infected with two viruses rather than one.

For treatment of Hepatitis B virus, an oral antiviral therapy for at least 18 months is required, with the monthly cost of around LE 300, in addition to the bimonthly costs of blood tests which approach LE 1000. As far as Hepatitis C treatment is concerned, interferon and ribavirin therapy (currently the only standard therapy) cost almost LE 2,500 per month for one year, added to the cost of blood tests on three monthly basis (LE 1000).

Although the Egyptian health ministry supports part of the funding required, the clinic mainly depends on individual donations in order to be able to provide these children with the treatment they need to survive.

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