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NURSING CARE OF THE
CHILD WITH A HEMATOLOGIC
ALTERATION
Disorders of the red blood cells
– RBCs are pale and smaller
• Iron Deficiency Anemia
– Most common anemia caused by improper iron intake
» Giving cow’s milk instead of baby formula is main
culprit during the first year
» Adolescent girls are at risk because of menstruation
» Causes poor growth, poor test scores later
– Treatment
» Ferrous Sulfate for two months
» Restoration takes three months
» Retic count will increase 7-10 days after starting
therapy
– Education
» Give between meals for better absorption
» Vit C increases absorption
» Milk and tea with meals reduces absorption
Disorders of the red blood cells
• Macrocytic Anemias
– RBCs are larger than usual
– Megaloblastic Anemias
• Folic Acid Deficiency
– Causes in children
» Low birth weight
» Intake of powdered or goat’s milk
» Defective absorption
– S/S
» Poor weight gain
» Chronic diarrhea
– Management
» Folic acid
– Megaloblastic Anemias
• Pernicious Anemia
• Causes
– Lack of intrinsic factor, must be deficient ~ 2 years
for symptoms to develop
• Management
– Vitamin B12 1mg daily x 1-2 weeks, then once weekly
until H&H are normal, then monthly for life
– Hemolytic Anemias
• Sickle Cell Disease
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Autosomal recessive, sickle shaped RBCs
Asymptomatic in infancy prior to 5-6 months
Clinical course characterized by episodic crises
Management
» Pain relief, hydration, oxygenation
DISORDERS OF BLOOD
COAGULATION
• Hemophilias
– Hemophilia A (Factor VIII deficiency)
• Sex-linked recessive
• S/S
– Soft tissue bleeding and bleeding into joints
• Management
– Administration of factor VIII
– Von Willebrand’s disease
• Autosomal dominant
• Factor VIII defect, inability of platelets to aggregate, and
inability of blood vessels to constrict
• Hemophilias continued
• S/S
– Bleeding, esp, from m.m.
• Management
– Factor VIII replenishment or DDAVP
– Christmas disease (Hemophilia B, Factor
IX deficiency)
• Sex-linked recessive
• Treated with factor IX
– Hemophilia C (Factor XI deficiency)
• Autosomal recessive
• Symptoms are mild when compared to other
types
Immune Thrombocytopenia Purpura
• Acquired disorder characterized by low platelet count
• Etiology
– Can be drug-induced or follows a febrile illness
• S/S
– Bruising and petechiae
• Therapeutic Management
– Usually self-limiting but may require steroids, IV
immunoglobulin, or splenectomy
• Nursing considerations
– No IM injections
– No rectal temps
– Avoid meds that kill/interfere with platelet production
Aplastic Anemia
• Bone marrow ceases production of all cells
• S/S
– Petechiae, pallor, fatigue, bruising
• Etiology
– Congenital, exposure to drugs/chemicals, idiopathic
• Therapeutic Management
– Transfusions, stem cell transplant, chemotherapy
• Nursing Considerations
– Low-platelet considerations plus reverse isolation