Anemias

what are the steps for a blood transfusion for a pediatric patient

• verify the childs identity

• verify the donor type and compatibility

• obtain baseline vitals

• begin transfusion within 30 minutes of receiving blood

• complete within 4 hours

• remain w the child for 15 minutes

• monito vs and child’s response

what to do if a transfusion reaction is suspected:

1. stop the transfusion

2. maintain IV access according to facility protocol

3. notify HCP

4. follow facility protocol

Iron deficiency anemia common causes;

• inadequate iron intake

• breastfeeding fter 6 months without adequate iron

• premature

• malabsorption

• chronic blood loss

• cows milk

s/s of iron deficiency anemia:

• tachy

• pallor

• fatigue

• irritability

• weakness

• systolic murmur

• brittle nails

iron administration:

• give 1 hour before or 2 hours after a meal

• take with vitamin C

• give with citrus if age appropriate

iron administration education

• liquid iron can stain teeth

• constipation

• black stools are expected

• iron fortified formula when indicated

• limit formula to 32 o/day

sickle cell anemia

triggers RBC’s to become rigid and sickle shape

what can sickle cell anemia cause in the body

• obstructed small vessels

• increased blood viscosity

• decreased circulation

• tissue ischemia

• pain and swelling

• organ damage

• clots

general findings of sickle cell anemia

• fatigue

• dizziness

• SOB

• pallor

• pain

• jaundice

• hematuria

• splenomegaly

• recurrent infections

what are some sickle cell triggers

• dehydration

• infection

• hypoxia

• acidosis

• physical and emotional stress

• high altitudes

• extreme temperatures

what are the different types of sickle cell crisis

• vasocclusive

• sequestrian

• aplastic

• acute chest syndrome

vasoclusive sickle cell crisis

sickled cells blocks circulation

s/s of vasoclusive sickle cell crisis:

• severe pain

• hematuria

• jaundice

• swelling

nc of svasoclusive sickle cell crisis:

• asses pain

• admin analgesics

• provide oral and IV hydration

• admin O2 of hypoxia

• cool/warm packs

• rest

sequestrain sickle cell crisis

blood pools mostly in the sleep

this is life threatening

s/s of sequestrain sickle cell crisis

• enlarged spleen

• hypovolemic shock

• profound anemia

what are some s/s of hypovolemic shock

• irritability

• tachycardia

• fever

• decrease UO

• cool extremities

• thready pulse

• hypotension

aplastic sickle cell crisis

RBCs drop dramatically

often triggered by viral infection

s/s of aplastic sickle cell crisis

• profound anemia

• pallor

• lethargy

• sleepiness

• dyspnea

acute chest syndrome sickle cell crisis

presents like pneumonia

can lead to pulmonary hypertension

s/s of acute chest syndrome

• chest pain

• cough wheezing

• fever

• hypoxia

repeated episodes may cause pulmonary HTN

management of acute chest syndrome

• aggressive treatment of infection

• blood transfusion if needed

• O2 and resp support

what do we give our sickle cell patients who are going through a crisis

1. pain meds

2. hydration

3. oxygen

4. rest

5. infection prevention

6. education

thalassemia characteristics (chronic anemia and hypoxia)

• chronic anemia and hypoxia

• Hbg life span is shortened

• body produces Hgb rapidly

s/s of thalassemia:

• failure to thrive

• severe anemia

• Hbg falls under 6

• frontal bossing may occur

hemophilia

patient bleeds longer, clotting factors take a while to work

what are the two different types of hemophilia and what are some characteristics:

hemophillia a: 80% of all cases, in males, deficiency of factor VII

hemophillia b: 15% of all cases, deficiency of factor IX

s/s of hemophilia

• bleeding tendicies ranging from mild to severe

• hemarthritis → can lead to impaired movement

• ecchymosis

• epistasis

• bleeding after procedures

diagnosis of hemophilia

• amniocentesis

• genetic testing

• Hx and exam

• labs

PTT will be prolonged; platelets may still be normal

management of hemophilia

• replace missing clotting factors

• DDVAP (hemophilia A)

• PRICE (pressure, rest, ice, compress, elevation)

what are some education tips for hemophilia

• shave only with an electric razor

• apply press for 15 minutes

• close supervision and safe environment