Peds Exam 3 Blueprint- Heme/Onc/GI/GU
Hematology
Iron Deficiency Anemia
*Can cause growth delays, decreased O2 to brain, and developmental delays; caused from
premature birth, insufficient oral intake, excessive intake of milk, exclusively bottle-fed with
breast milk
*Lower limit of normal is 11.0 in peds
- S/S: weakness, fatigue, nail changes, cracked lips, drowsiness, heartache, hair fragility,
dry skin, pallor, irritability, dsypsnea
- Iron supplement education:
o recommend iron-fortified formula, cereal and foods between 4-6 months
o can be taken with ascorbic acid (vitamin c) to absorb iron (take iron 1 hour before
anything so things can be absorbed)
o Low HGB/HCT levels with pica in pregnancy
- Iron between meals with vitamin C, use straw for liquid iron, continue 2 months after
levels normalize
- Treatment recommendations: oral iron + dietary changes (increase meat, fish, poultry)
*Low hgb, hct, ferritin
Sickle Cell Anemia
*Autosomal recessive-must receive a gene from both parents
*RBCs only survive 10-20 days
*Elevated reticulocyte count- screen for nephropathy, HTN, retinopathy, pulmonary disease,
stroke risk
, Peds Exam 3 Blueprint- Heme/Onc/GI/GU
- Trait vs anemia: Sickle cell trait (SCT) means a person carries one sickle gene and
generally lives a healthy life without symptoms. Sickle cell anemia (SCA) is a severe
form of sickle cell disease (SCD) where the person inherits two sickle genes; protective
against malaria
- S/S of crisis: priapism, worsening anemia, fever (this can be fatal), neuro changes, severe
pain, etc.
- Nursing interventions: IVF, pain meds, warm compresses to painful areas, encourage rest,
blood exchange transfusions, hydration, infection prevention, oxygen
- Vaso occlusive: pain and ischemia in extremities
- Sequestration: blood gets “stuck” in the spleen (enlargement, hypovolemia) Life
threatening and requires splenectomy/transfusions
o Mainly affects children under 5
- Acute chest syndrome: Clinically like pneumonia due to blood pooling in the lungs
(fever, chest pain, cough, hypoxia)
- Aplastic crisis: decreased RBC production
- Infarctions: pulmonary emboli/stroke
Beta Thalassemia (iron overload disease)
*Decreased/absent production of the B-chains in the HGB molecule
*Peak age is infancy
s/s: growth delays, skeletal changes
- Common genetic disorder-recessive; defective beta-globin synthesis
- Thalassemia minor- silent carrier
- Thalassemia intermedia- either homozygous or heterozygous, splenomegaly and anemia
- Thalassemia major- severe anemia incompatible with life without transfusions
Manifestations: severe anemia (requires transfusions), skeletal deformities “chipmunk face”,
bronze skin coloring, splenomegaly, high-output heart failure, delays in sexual maturing, small
body build
Nursing care: iron overload risk from repeated transfusions (2-5 weeks), iron chelation therapy
compliance (critical), monitor for hemosiderosis (iron overload), maintain hgb >9.5, monitor for
hepatomegaly and portal fibrosis
Hgb electrophoresis helps in diagnosing through hgb variant determination
Curative is allogenic HSCT but regular transfusions and iron chelation will be needed
Aplastic Anemia
*Rare and life-threatening disorders caused by neoplastic disease of bone marrow, toxic
chemical/radiation exposure, and certain antibiotics or medications
Hematology
Iron Deficiency Anemia
*Can cause growth delays, decreased O2 to brain, and developmental delays; caused from
premature birth, insufficient oral intake, excessive intake of milk, exclusively bottle-fed with
breast milk
*Lower limit of normal is 11.0 in peds
- S/S: weakness, fatigue, nail changes, cracked lips, drowsiness, heartache, hair fragility,
dry skin, pallor, irritability, dsypsnea
- Iron supplement education:
o recommend iron-fortified formula, cereal and foods between 4-6 months
o can be taken with ascorbic acid (vitamin c) to absorb iron (take iron 1 hour before
anything so things can be absorbed)
o Low HGB/HCT levels with pica in pregnancy
- Iron between meals with vitamin C, use straw for liquid iron, continue 2 months after
levels normalize
- Treatment recommendations: oral iron + dietary changes (increase meat, fish, poultry)
*Low hgb, hct, ferritin
Sickle Cell Anemia
*Autosomal recessive-must receive a gene from both parents
*RBCs only survive 10-20 days
*Elevated reticulocyte count- screen for nephropathy, HTN, retinopathy, pulmonary disease,
stroke risk
, Peds Exam 3 Blueprint- Heme/Onc/GI/GU
- Trait vs anemia: Sickle cell trait (SCT) means a person carries one sickle gene and
generally lives a healthy life without symptoms. Sickle cell anemia (SCA) is a severe
form of sickle cell disease (SCD) where the person inherits two sickle genes; protective
against malaria
- S/S of crisis: priapism, worsening anemia, fever (this can be fatal), neuro changes, severe
pain, etc.
- Nursing interventions: IVF, pain meds, warm compresses to painful areas, encourage rest,
blood exchange transfusions, hydration, infection prevention, oxygen
- Vaso occlusive: pain and ischemia in extremities
- Sequestration: blood gets “stuck” in the spleen (enlargement, hypovolemia) Life
threatening and requires splenectomy/transfusions
o Mainly affects children under 5
- Acute chest syndrome: Clinically like pneumonia due to blood pooling in the lungs
(fever, chest pain, cough, hypoxia)
- Aplastic crisis: decreased RBC production
- Infarctions: pulmonary emboli/stroke
Beta Thalassemia (iron overload disease)
*Decreased/absent production of the B-chains in the HGB molecule
*Peak age is infancy
s/s: growth delays, skeletal changes
- Common genetic disorder-recessive; defective beta-globin synthesis
- Thalassemia minor- silent carrier
- Thalassemia intermedia- either homozygous or heterozygous, splenomegaly and anemia
- Thalassemia major- severe anemia incompatible with life without transfusions
Manifestations: severe anemia (requires transfusions), skeletal deformities “chipmunk face”,
bronze skin coloring, splenomegaly, high-output heart failure, delays in sexual maturing, small
body build
Nursing care: iron overload risk from repeated transfusions (2-5 weeks), iron chelation therapy
compliance (critical), monitor for hemosiderosis (iron overload), maintain hgb >9.5, monitor for
hepatomegaly and portal fibrosis
Hgb electrophoresis helps in diagnosing through hgb variant determination
Curative is allogenic HSCT but regular transfusions and iron chelation will be needed
Aplastic Anemia
*Rare and life-threatening disorders caused by neoplastic disease of bone marrow, toxic
chemical/radiation exposure, and certain antibiotics or medications
