Chapter 32: Anemia (Children)

Question 1

Anemia

Answer 1

most common hematological condition of infancy and childhood
-decrease in the number of red blood cells (RBCs)
-the reduction in circulating RBCs decreases the oxygen-carrying capacity of the blood
>anemia is more of a symptom of other diseases

Question 2

Causes of Anemia

Answer 2

• decreased production of RBCs, such as in bone marrow failure and myelodysplastic syndromes (a group of disorders resulting from poorly formed or dysfunctional blood cells)
• increased destruction of RBCs, such as in sickle cell anemia or hereditary spherocytosis (abnormality of red blood cells, or erythrocytes)
• acute or chronic blood loss

Question 3

Signs and Symptoms

Answer 3

signs can be subtle, and may be asymptomatic b/c of compensatory mechanisms
>Initial Signs:
-fatigue
-SOB
-headache
-difficulty concentrating
-dizziness 
-pale skin

> with mild to moderate to severe anemia:

• irritability
• fatigue
• delayed motor development
• tachycardia
• SOB
• pale skin
• listlessness
• systolic heart murmur
• hepatomegaly, congestive heart failure

Question 4

Diagnosis

Answer 4

if diagnosed with anemia, a thorough history and physical examination are essential to establish a possible etiology
-CBC and reticulocyte count are obtained to evaluate hemoglobin and hematocrit
>anemia= when the hemoglobin content is less than required to meet the oxygen demands of the body

Question 5

Hemoglobin

Answer 5

the iron-containing pigment of the RBC that carries oxygen from the lungs to the tissues
>Normal Hemoglobin Values in Children:
-Newborn: 12.7-18.6 g/dL
-2 Months: 9.0-14.0 g/dL
-2 Years: 10.5-12.7 g/dL
-6-12 Years: 11.2-14.8 g/dL
-12-18 Years: 10.7-15.7 g/dL

Question 6

Hematocrit

Answer 6

percent of whole blood that is composed of RBCs

-average value in children: 35-45%

Question 7

A child’s CBC measures what?

Answer 7

the formed elements in the blood, including RBCs, WBCs, and platelets

Question 8

Labs: CBC, Reticulocyte, and Peripheral Smear Lab Values for Children

Answer 8

when evaluating the presence of anemia, initial lab tests include CBC and reticulocyte count.

• CBC: hemoglobin, hematocrit, RBC indices, platelet count, WBC count with a differential, and a peripheral smear to examine the morphology of the RBCs
• The peripheral blood smear is imperative to confirm diagnosis; consists of a glass slide coated on one side with a thin layer of blood; the slide is stained with dye and reviewed under a microscope to identify the red cell characteristics to confirm a diagnosis

Question 9

Prevention

Answer 9

anemia caused by clinical conditions such as sickle cell disease, hereditary spherocytosis, and disorders of the red blood cell often do not respond to traditional preventive measures

• anemia caused by iron deficiency and poor nutrition may be prevented by following screening guidelines and encouraging a well-balanced diet
• preventing exposure to lead-containing items such as paint, gasoline, and other household hazards

Question 10

Nursing Care

Answer 10

varies on the etiology

-responsible for administering and monitoring blood transfusions and other pharmacological treatments prescribed

Question 11

Medical Care

Answer 11

varies based on etiology

• mild anemia= nurse provides supportive care through diet or vitamin supplement
• moderate to severe anemia= may need a RBC transfusion to restore blood volume

Question 12

Education/Discharge

Answer 12

• home care instructions
• be made aware of the signs and symptoms that may indicate anemia: pallor, fatigue, dizziness, and lethargy
• alterations in daily activities may be necessary such as quiet play, allowing for periods of rest, and a diet high in iron
• teaching on how to administer iron supplements
• may need to have lab tests and medical exams periodically to evaluate the status of the anemia

Question 13

Platelet Testing

Answer 13

-number of platelets will determine efficacy of clotting

Question 14

PT Testing

Answer 14

• extrinsic pathway (activated by external trauma)
• vitamin K deficiency
• used to assess Coumadin dosing

Question 15

INR testing

Answer 15

• extrinsic pathway (activated by external trauma)
• provides uniformity in testing for Coumadin dosing
• may be therapeutically high

Question 16

aPTT testing

Answer 16

• intrinsic pathway (trauma inside vascular system)
• shows if patient is adequately heparinized
• vitamin k deficiency

Question 17

Platelet Aggregation Testing

Answer 17

• aspirin use

- not usually tested but may determine appropriate Plavix dosing