Hematology Flashcards
(30 cards)
review of RBCs
RBCs are produced in bone marrow of long bones
increase age (age 5)- RBCs produced in vertebrae, sternum, & ribs
erythropoietin hormone stimulates production of RBC precursors- cause them to mature rapidly
RBC function is to transport O2 to tissue
stimulus for RBC production is decrease in circulating O2- kidneys produce erythropoietin (may need blood transfusion/ Epogen)
avg. life span- 120 days
spleen removes damaged/ aging RBCs
pediatric hematological system
life span of erythrocytes in neonates is shorter (more prone to increased RBC destruction)
by 2 mos- erythropoiesis increases, leading to rise in Hgb
fetus has higher O2 carrying capacity
adult Hgb values noramlize during puberty
iron deficiency anemia
iron necessary for synthesis of Hgb; low iron= low hemoglobin= low O2 carrying ability= low O2 to cells
most common cause of anemia in infancy, childhood, adolescence
full-term infant has enough maternal stores for 4-6 mos
AAP recommends iron supplementation for all preterm infants
manifestations:
pale (mucus membranes/ conjunctiva)
tachycardia/ tachypnea
fatigue
irritability
administration of iron supplements
administer iron in 3 divided doses w/ meal
give w/ Vit. C rich foods to facilitate absorption (eg. OJ)
administer through straw/ medicine dropper to avoid staining teeth
brush teeth/ rinse mouth afterward
avoid administration w/ milk/ milk products (inhibit absorption of iron)
adequate dosage of oral iron turns stools tarry green color
continue for 3 mo after H&H return to normal
sickle cell disease
inherited autosomal recessive disease
mostly af. americans, mediterranean, indian, middle eastern descent
during increased metabolic needs/ decreased O2, cells change into elongated crescent shape & can’t move freely through vessels
stasis & further sickling occurs; blood flow halts & tissue distal to blockage becomes ischemic resulting in acute pain & cell destruction causing vascular occlusion & ischemia
manifestations of sickle cell disease
sickling of RBC
delayed growth & puberty
pallor
jaundice
fatigue
acute splenic sequestration- lg amounts of blood pool in spleen causing signs of hypovolemic shock
no s/s in early infancy bc of fetal Hgb stores whcih have higher O2 carrying capacity
sickle cell disease
prenatal, newborn screening, family hx
treatment- prevent infections, immunizations, penicillin prophylaxis for children <6 yo, influenza vaccine
if crisis occurs- pain management (narcotics- morphine), adequate hydration, oxygenation (to prevent further sickling)
transfusions- if necessary (failure to thrive/ stroke)
gene/ stem cell therapy
monitor for fever (1st sign of bacteremia)
sickle cell crisis
vaso-occlusive (pain crisis)- severe pain in extremities, chest & abdomen, at risk for CVA (treatment- fluids, hydration, oxygenation)
acute sequestration- spleen enlarges & blood pools in it- low blood volume & shock
aplastic- profound anemia requiring transfusions (body stops making all blood cells- WBC, RBC, platelets)
hemophilia
sex-linked recessive trait causing decrease in factor 8 coagulation activity
severity depends on amount of activity of factor 8
manifestations- often diagnosed w/ prolonged circumcision shortly after birth
bleeding/ bruising @ injection site
bruise easily
hemarthrosis- bleeding in joints causing swelling, pain, & joint limitation- develop arthritis/ limited mobility
hemophilia
prolonged PTT, low factor 8
therapeutic management- infusion of factor 8
NC- prevention of injury- padded crib/ furniture, non contact-sports, avoid aspirin products
prevention of infection- immunizations
reducing effects of injury- joint immobilization
regular exercise program/ PT
cancer
cells lost ability to perform intended function, continue to proliferate & crowd out normal cells
neoplastic cells lost ability to adhere to one another, don’t know when to halt growth
childhood cancer is 2nd leading cause of death during childhood
lymphatic system- drain fluid & cellular waste products, filter & strain out invading organisms & cancerous cells
lymph nodes- produce WBcs called lymphocytes which protect against bacteria/ viruses
s/s of cancer
may be subtle in children bc many symptoms diagnosis may be delayed unusual mass/ swelling pallor fatigue localized pain/ limping prolonged unexplained fever (RED FLAG) frequent headaches w/ vomiting eye/ vision changes/ hearing problems excessive rapid weight loss
diagnosis of cancer
CBC x-ray bone marrow aspiration- type/ quantity of cells being produced tumor staging I- not extended into surrounding tissue II- some local spread III- spread to local lymph nodes IV- spread systemically staging- treatment r/t this local regional systemic
therapy
surgery- biopsy/ excision of tumor, best when tumor is encapsulated
chemotherapy-
chemotherapy
non-selectively kills rapidly cells
hematopoietic system
bone marrow is most affected; nadir- time of greatest bone marrow suppression occurring 7-10 days after chemo; greatest concern is infection
GI- painful lesions in mouth; don’t want to eat
skin- high risk of infection (NO RECTAL TEMPS)
usually given in combination according to protocols
minimize toxic effects & resistance- leucovorin
use of central venous access
central lines- single, double, triple lumen (TPN, meds, blood draws)
kids usually have double/ triple lumen; don’t have to be accessed/ de-accessed, but increased risk of infection
port-a-caths
PICC
effects of chemotherapy
depends on agent often involves hair loss diarrhea N/V stomatitis dermatitis renal/ neuro toxicity immunosuppression anaphylaxis extravasation
therapy (cont.)
radiation- damages DNA, breaks strands, particularly lethal to radiosensitive skin (bone marrow, GI tract, hair follicles)
most common SE is fatigue; don’t apply lotion to irritated area
biologic response modifiers- monoclonal antibodies- change host’s biologic response to tumor cells; Rituximab
bone marrow & stem cell transplantation- high dose of chemo followed by transplantation to replenish vital immune fxn
supportive therapy- nutrition & analgesics
nursing care of child w/ cancer
recognition & prevention of infection- be aware of signs of septic shock
*FEVER is frequently only indication of infection
monitor for bleeding- platelets <20,000
assess for anemia
assess for ANC <500- risk for infection, need treatment
wipe down toys if shared w/ others
assess for tumor lysis syndrome
goals of teaching
health promotion- avoid live virus vaccines except in certain circumstances (varicella, MMR, OPV)
prepare for procedures- EMLA for venipunctures
prevent infection- hand washing, prophylactic abx, avoid crowds (ANC <500), adequate protein/ calorie diet, avoid live plants & uncooked fruits & vegetables
prevent/ recognize hemorrhage- administer platelets, avoid skin punctures, rectal temps & suppositories, mouth care, emotional support, avoid activities that contribute to bruising
goals of teaching
conserve energy- fatigue from anemia
prevent dehydration from vomiting- antiemetics 30 min prior to chemo & then regularly x 24 hr, fluids
prevent food aversion- don’t give favorite foods before/ after chemo, light protein
prevent constipation
monitor neurotoxic signs- weakness, numbness, walking difficulties, jaw pain
manage body image concerns- alopecia, moon face, mood changes
leukemia
pathophysiology- alternation in genetic makeup of WBC that prevents maturation, immature cells (blasts) crowd out normal cells
ALL- acute lymphoid leukemia; affects cells in lymphatic system (lymphoblasts); 75% of leukemia
AML- acute myelocytic leukemia affects myoblasts (less common, poorer prognosis)
incidence- most common cancer in childhood
s/s- insidious onset
persistent fever
increased bruising (thrombocytopenia)
anemia from low RBCs
infection from increased bands unable to fight infection (leukopenia)
bleeding from low platelets
leukemia
diagnosis- bone marrow biopsy
treatment- based on initial staging of disease; 5 yr survival rate of 85%
allopurinol & IVF to flush WBC breakdown & decreased uric acid
chemo over 1 month
CSN prophylactic therapy w/ intrathcal methotrexate, cytarabine, hydrocortisone
maintenance for 2-3 yrs
bone marrow transplants successful w/ some children
prognosis is excellent if treated properly
most devastating late effect is development of 2nd malignancy
lymphoma/ Hodgkin disease
neoplasm of lymphoid cells in lymph glands
occurs in 15-19 yo; long-term survival rate 90%
diagnose- lymph node biopsy
s/sx- reed-sternberg cells- large multinucleated cells
painless, firm lymphadenopathy (supraclavicular)
fever
night sweats
wt. loss
treatment- radiation & chemo
non-Hodgkin’s lymphoma
similar to Hodgkin’s except spread is via bloodstream (not lymph flow)
metastatic spread may occur early in disease
malignant disorder of lymphocytes (either B or T cells)
dx by bone marrow biopsy (>25 % blasts- ALL, <25% blasts- NHL)
Burkitt’s lymphoma- abnormal cells can grow rapidly & double in size in 24 hrs
