Peds Hematology

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RBCs

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Acute blood loss, acute infection, neoplastic
disease anemias
Aplastic anemia
Iron Deficiency anemia
Sickle cell anemia

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Coagulation

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Purpuras
Hemophilias

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Assessment of Anemia

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Muscle weakness Easily fatigued
Frequent resting
SOB
Poor feeding
Pale skin
Pica
Headache
Dizziness
Irritability |
Slowed thought processes
Decreased attention span
Apathy
Depression

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Blood Loss Anemia

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Trauma, acute nephritis, trauma during or before birth Tachycardia, tachypnea
Newborns may have gasping respirations, retractions, cyanosis; do not respond to 02 due to lack of red blood cells-to transport Reticulocyte count increased NI: supine position, keep warm, volume expander til blood transfusions available

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Acute Infection

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Leads to increased destruction of erythrocytes
Also causes impaired production of erythrocytes
NI: treat the underlying cause
Common infections: osteomyelitis, ulcerative colitis

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Neoplastic Disease

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Proliferation of neoplastic
cells impairs production of
erythrocytes
Platelet formation may
decrease and lead to
further blood loss
NI: measures to achieve remission of neoplastic process, transfusion

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Aplastic Anemia

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Deficiency of circulating erythrocytes resulting from the arrested development of RBCs within bone marrow Causes: chronic exposure to myelotoxic agents, viruses, infection, autoimmune disease, allergic states Dx: bone marrow aspiration demonstrates conversion of red bone marrow to fatty red bone marrow

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Congenital Aplastic

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Fanconi's syndrome-severnl anomalies, 4 to 12 exhibit pancytopenia(reduction of all blood cell components)
Met blood transfusions, splenectomy, corticosteroids, immunosuppressive therapy, bone marrow transplant, globulin (ALG or ATG), erythropoiten, medic alert tag

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Acquired Aplastic

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Causes: infection with HPV, hepatitis, or other infection, drugs such as chemo and antibiotics, industrial and household chemicals, idiopathic
Mgt: ALG, ATG, androgens may be given with ATG, erythropoiten, cyclosporine, high-dose methylprednisolone, BMT

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Nursing Diagnoses

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High risk for infection
Activity intolerance
Diversional activity deficit
High risk for fluid volume
deficit
Risk for altered self
esteem
Fear
Pain

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Iron Deficiency

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Causes: decrease in supply of iron, lack of absorption, increase in body's need, or affect of synthesis
Stored in circulating erythrocytes in fetus and
adequate for 5 to 6 months in full term, 2 to 3
months in multiples or preemies
Mgt: Replace iron either oral or injectible, increase absorption with Vit C, increase dietary intake

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Nursing Education/NI

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Children who are anemic usually need to take an iron supplement, two divided doses, between meals.
To help your child take her medicine, mix it with juice. Give her only the amount prescribed.
Wipe your child's teeth after she takes her medicine, give with straw.
The medicine may make your child's stools dark green or black. This is okay. Constipation or diarrhea are common.
Add more iron-rich food to your child's diet Foods that say "enriched" or "iron-fortified" on the label are a good source of iron.

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Some iron rich foods are

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Cereals Almonds Prune juice Dried fruit Peas & lentils White, red, baked beans Spinach

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Sickle Cell

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Most common in black Americans Sx: splenic enlargement, liver failure, hepatamegaly, hematuria, inability to concentrate urine, osteoporosis, stroke or CVA, exercise intolerance, anorexia, jaundiced sclera, gallstones, chronic leg ulcers, growth retardation, delayed sexual maturation Dx: Stained blood smear, sickle-turbidity test, hemoglobin electrophoreses HgbS changes form to long slender crystals under conditions of dehydration, acidosis, hypoxia and temperature elevations

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Nursing Diagnoses

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Pain
Risk for altered growth
and development
Activity intolerance
Risk of infection
Potential for injury
Risk for impaired skin
integrity
Impaired gas exchange

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Nursing

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Administer 02
Hydration
Bedrest
Antibiotics
Pneumococcal and
meningococcal
vaccines, Hep B
Transfusion
PainRx

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Interventions

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Education
Disease and process
Dangers of crisis
Prevent dehydration
Seek early intervention for fever, etc
Recognition of
respiratory and splenic
involvement
Pain meds for home