Hematological & Immunological Dysfunction Flashcards
History for child with suspected hemotological/
immunological issue
what’s normal for them vs new onset
child’s energy
family history
pale, fatigued, easily bruised (low platelets)
bleeding
diet (iron sources)
infections
Complete Blood Count components
WBCs
RBCs
Hemoglobin
Hematocrit
Platelets
WBCs indicate…
infection, leukaemia, immunodeficiency, viral illness
bone marrow or immune dysfunction
Hemoglobin indicates…
also in bone marrow
can be low in anemia?
Hematocrit
% of RBC in the blood
will be low with anemia
Most common RBC/hematological disorder for childhood
anemia
Anemia
decrease in the # of RBCs AND/OR hemoglobin concentration below normal
decreased oxygen-carrying capacity of blood
T or F: Anemia is usually a manifestation of something else.
TRUE
leukemia or lymphoma
T or F: It is normal for newborns to experience anemia.
TRUE
why - premature - not getting all the iron rich blood from mom
delayed cord clamping can help to increase iron
Sign of SEVERE anemia
murmur
Classification of anemias (2)
1) Etiology and physiology
2) Morphology
1) Etiology and physiology classification
RBC and/or Hgb depletion
2) Morphology classification
characteristic changes in RBC size, shape, and/or color
Management of anemia
physical exam & diagnostics
treat underlying cause
-transfusion
-nutrition
supportive care
-IV fluids
-O2
-bed rest - decrease the demand
prep for lab tests
prevent complications
support/educate family
Things you can do to help kids during lab tests
play with equipment beforehand
educate, explain
bring stuffed animal
distraction**
freezing cream or spray
sucrose in infants
Safety thing to look out for with anemia patients
dizziness
falls risk
Anemia signs and symptoms
tired
pallor
sometimes jaundice
splenomagoly
Iron deficiency anemia
inadequate supply of dietary iron
Who is at a higher risk of iron deficiency anemia?
a) bottled fed babies
b) breast fed babies
b) breast fed babies
supplementation in the formula
may need to supplement iron at 4 months
Populations at an increased risk of iron deficiency anemia
Indigenous populations
babies
adolescence
Ways to prevent iron deficiency anemia
iron-fortified cereals and formulas for infants
breastfed babies: supplement at 4 months
premature: supplement at 2 weeks
T or F: Cow’s milk contains iron.
FALSE
avoid until 12 months
limit to 600 mL daily
Amount of iron to give
3-6 mg per kg
Sickle cell anemia
normal adult hemoglovin is partly or completely replaced by abnormal sickle hemoglobin
most common in black population
doesn’t necessarily present in infants
changes over time - crisis starting in toddlerhood
Sickle cell anemia patho
obstruction of the sickled RBCs
vascular inflammation
increased RBC destruction
abnormal adhesion + inflammatory process = vasoconstriction
Sickle cell anemia can result in…
local hypoxia
tissue ischemia
infarction
Clinical manifestations of sickle cell anemia
vaso-occlusive crisis
stroke (cells block vessels)
Chest Syndrome
Acute Splenic Sequestration
Hyperhemolytic
Infection
vaso-occlusive crisis
pain crisis
episode characterized by ischemia
pain can be very very severe
minutes to days
Chest Syndrome
similar to pneumonia
fever, cough, hypoxia, wheezing
Acute Splenic Sequestration
pooling of blood, usually in the spleen
may have to have spleen removed
or not working properly
increased risk of infection
Hyperhemolytic
anemia
jaundice
Management of a sickle cell crisis
prevent and treat
rest
hydration
oxygen - above 95%
electrolyte replacement
pain management!**
-morphine or hydromorphone
blood tranfusions
antibiotics
education/support
What is an important focus of education for parents of a child with sickle cell?
education surrounding addiction
medication important for a child in pain
Leading cause of death from disease in children past infancy
neoplastic disorders
most common childhood cancer: leukemia
T or F: Leukemia has a good prognosis.
TRUE
survival rate: 95%
Between what ages does leukemia peak?
2 and 5 years
Leukemia
broad group of malignant diseases of bone marrow and lymphatic system
Types of leukemias (3)
1) Acute lymphoid leukemia (ALL)
-most common**
2) Acute nonlymphoid (myelogenous) leukemia (ANLL or AML)
3) Stem cell or blast cell leukemia
Pathophysiology of leukemia
overproduction of WBC, but immature
can have high WBC count
acute - super low leukocytes
bone marrow
most affected organs: liver and spleen
cellular destruction takes place by infiltration and subsequent competition for metabolic elements
Symptoms of leukemia
presents like a viral illness, then more frequent illnesses
fever, fatigue (anemic)
aching bones or joints (bone marrow full of cells)
headaches
rashes
swollen glands (lymph nodes)
frequent infections
unexplained weight loss
bleeding or swollen gums
enlarged spleen or liver, or a feeling of abdominal fullness
slow-healing cuts, nosebleeds, or frequent bruises
Leukemia rashes (2)
1) purpleish rash
-blood pooling caused by a lack of platelets
2) petichia
-broken capillaries from low platelets
Term for low platelets
thrombocytopenia
Term for low hemoglobin
anemia
Term for low WBC/leukocytes
leukopenia
Term for when everything is low
pancytopenia
Diagnostic evaluation for leukemia (4)
1) history, physical manifestations**
2) Peripheral blood smear
-immature leukocytes
-frequently low blood counts
3) Bone marrow aspiration or biopsy
-taken at the iliac crest
-to see if there are blasts in the bone marrow
4) Lumbar puncture to evaluate CNS involvement/disease
-test for blasts or leukaemia cells as well
What does chemo help prevent?
CNS involvement
High risk WBC count
over 50,000
High risk age of diagnosis
over 10
-high risk: ALL
want adolescents to have AML
under want, want to have ALL
Low risk cell involvement
B cells
High risk phenotype
Philadelphia chromosome
Higher risk gender
boys
girls have more favourable outcome
When should patients ideally be in remission?
end of induction therapy (1 month)
Relapse after transplant prognosis
dismal
stem cell or bone marrow transplant
Therapeutic management of leukemia
Chemotherapeutic agents
Cranial irradiaiton
Transfusion
When are transfusions needed?
hemoglobin < 70, OR symptomatic e.g. fatigue, pallor
platelets < 10
4 phases of leukemia therapy
1) Induction therapy: 4 to 6 weeks
2) CNS prophylactic therapy
-intrathecal chemotherapy
3) Intensification (consolidation/post remission) therapy
-to eradicate residual leukemic cells and prevent resistant leukemic clones
4) Maintenance therapy
-to preserve remission
Mneumonic for 4 phases
I care, I monitor
Length of leukemia treatment
2 years
Febrile Neutropenia criteria (2)
1) absolute neutrophil count <0.5
2) fever
T or F: Feb neut is a medical emergency.
TRUE
go to ER asap**
Feb neut management
admitted to hospital
IV antibiotics
-Pip/Tazo
min. 48H in hospital
When can a child with feb neut be discharged?
no fever within 48h –> can be discharged
once 48h period is up, must go 24h without a fever to be discharged
What happens if cultural are positive?
10 - 14 days of IV antibiotics
What happens if the child continues to have a fever?
will think fungal infection
kidneys, brain, lungs, heart
Chemo precautions
nitrile gloves
-and while changing diapers
flush toilet 2x with lid down
beware of bodily fluids
letting others know cytotoxic status of child when transferring
How long is a child cytotoxic for after chemo?
7 days
What to do if you are exposed/contaminated to chemo meds?
spill kits
eye wash
Main types of lymphomas (2)
1) Hodgkin’s disease
2) Non-Hodgkin’s lymphoma (NHL)
Which lymphoma is more common?
a) Hodgkin’s
b) non-Hodgkin’s
b) non-Hodgkin’s
Which lymphoma is worse?
a) Hodgkin’s
b) non-Hodgkin’s
b) non-Hodgkin’s
Hodgkin’s disease most prevalent in…..
15 to 19 years
usually diagnosed at earlier stage of disease
Non-Hodgkin’s lymphoma (NHL) most prevalent in….
<14 years of age
Hodgkin’s lymphoma
cancer of lymph tissue found in the lymph nodes, spleen, liver, bone marrow, and other sites
RF: past EBV
Hodgkin’s lymphoma - Classification A symptoms
PAINLESS swelling of the LYMPH NODES in the neck,armpits, or groin (swollen glands)
Hodgkin’s lymphoma - Classification B symptoms
PAINLESS swelling of the LYMPH NODES in the neck,armpits, or groin (swollen glands)
fatigue
fever and chills that come and go
unexplained itching
soaking night sweat
unexplained weight loss
chest pain - depending on where tumour is
big spleen, liver, abdominal fullness
What is one of the first signs of Hodgkin’s lymphoma type B
pruritis
itching
Hodgkin’s lymphoma diagnostics (4)
1) lymph node biopsy
2) chest x-ray
3) bone marrow biopsy
4) Presence of Reed-Sternberg cells
-owl looking cells
-double nucleus
Hodgkin’s lymphoma management
radiation and/or chemo
infection prevention
Non-Hodgkin’s Lymphoma
cancer of the lymphoid tissue
Non-Hodgkin’s Lymphoma symptoms
depend on area affecting, how fast its growing
new onset wheeze
facial swelling
respiratory distress
asymmetrical tonsils
acute abdominal pain
Non-Hodgkin’s Lymphoma treatment
depends on age, stage, symptoms etc.
CHEMO**
radiation –> not often
surgery
Rituximab (Rituxan) (B-cell)
Care priorities for the child with cancer
Family Centred Care
-health care team
-support
-education
-cultural considerations
