General Anemia + Blood Transfusions

Question 1

How would you Assess the Hematologic Function of a child?

Answer 1

• Complete blood count (Table 35-1, p.1413)
• History and assessment findings
  
  • Nurse may be the first to record symptoms of blood dysfunction. Be award of clinical manifestations (s/s) of blood disease
  • History of fatigue (due to lack of O2 in system), lethargy, poor concentration, uncontrolled bleeding, frequent bruising, etc…
  • Look at growth patterns
• Child’s energy and activity level
• Growth patterns

Question 2

What is anemia and what are some of its characteristics?

Answer 2

• The most common hematologic disorder of childhood
• Decrease in number of RBCs and/or hemoglobin concentration below normal for age (Appendix C).
• Decreased oxygen-carrying capacity of blood

Question 3

What are the main cuases of anemia?

Question 4

What are the effects of anemia?

Answer 4

• Decrease in oxygen-carrying capacity of blood and decreased amount of oxygen available to tissues
• When anemia develops slowly, child adapt
  
  • **The child’s body is able to compensate for gradual changes. Then they suddenly crash, it is insidious. **
• Hemodilution
• Decreased peripheral resistance
• Increased cardiac circulation and turbulence
• May have murmur
• May lead to cardiac failure
  
  • The body will compensate by increasing HR (tachy), can produce murmurs, can lead to cardiac failure (from infection, excessive exercise).
• Growth retardation (CNS sign due to decreased O2)

Question 5

How would you diagnose a child with anemia?

Answer 5

• History:
  
  • Lack of energy
  • Easy fatigability
  • Pallor
• Labs:
  
  • RBCs decreased
  • HGB decreased
  • HCT decreased
• Other tests for particular type of anemia (hemoglobin electrforisis, blood smear)

Question 6

How would you treat a child with anemia?

Answer 6

• Treat underlying cause
• Transfusion after hemorrhage if needed
• Nutritional intervention for deficiency anemias
• Provide Supportive care:
  
  • ​IV fluids to replace intravascular volume
  • Oxygen
  • Bed rest – play games in bed

Question 7

What are some nursing consdierations for children with anemia?

Answer 7

• Prepare child and family for laboratory tests
  
  • Try to make blood draws more comfortable, numb the area of the stick.
• Decrease oxygen demands
  
  • We don’t want the kid up and running around, play games with the kid to keep them calm
• Prevent complications
• Support family
  
  • Teach parents about s/s of infection, teach good hand washing techniques.

Question 8

What are some nursing considerations when transfusing blood to a child?

Answer 8

• Verify identity of recipient and verification of donor’s blood group
• Monitor VS (especially important for the first 15min, it is when an adverse reaction can manifest)
• Use appropriate filter
• Use blood within 30 minutes of arrival
• Infuse over 4 hours maximum (don’t want it to coagulate) MAKE SURE BLOOD IS @ ROOM TEMP, DON’T LET BLOOD SIT
• Identify donor and recipient blood types and groups before transfusing
• Transfuse slowly for first 15 to 20 minutes
• Observe carefully for patient response
• Stop transfusion immediately if signs/symptoms of transfusion reaction; notify practitioner
• See Table 35-2 PG 1420

Question 9

What are some transfusion reactions?

Answer 9

• Hemolytic: the most severe, but rare
• Febrile reactions: fever, chills
• Allergic reaction: urticaria, pruritus, laryngeal edema
• Air emboli: may occur when blood is transfused under pressure
• Hypothermia (don’t give cold blood)
• Electrolyte disturbances: hyperkalemia from massive transfusions or patient with renal problems

Question 10

What are some Delayed Reactions
to Blood Transfusions?

Answer 10

Transmission of infection

• Hepatitis, HIV, malaria, syphilis, other
• Blood banks test vigorously and discard units of infected blood

Delayed hemolytic reaction

• Destruction of RBCs and fever 5 to 10 days after transfusion
• Observe for post transfusion anemia