Clinical aspects of Maternal and Child NursingNUR 363Lecture 8

1. Anemia 2. Iron deficiency anemia 3. G6PD deficiency 4. Sickle cell anemia

Definition: Condition in which the concentration of hemoglobin or the number of red blood cells are reduced below normal

1) Inadequate production of HB or RBC’s which may be due toA- lack in the bone marrow (BM) of some substances

necessary in the Formation of cells( Iron,Folic acid ….etc)

B- Decreased number of red cell precursors in the BM, which may be congenital or acquired (eg. Toxic or Chemical agents)

2) Excessive loss of RBC’s( hemolysis or hemorrhage)

1) HB level and RBC’s count

2) Hematocrit

3) Red blood cells indices:

-Mean corpuscular volume (MCV)=(80-100)

-Mean Corpuscular Hemoglobin( MCH) =Normal 27-31

-Mean Corpuscular Hemoglobin Concentration (MCHC= Normal 32-35 %

4) Reticulocytes count = reflect the state of activity of the BM (Normal value is 0.5-1.5%

of the red blood cells ) Level < 0.5 represent inactive BM , High

level represent BM regeneration

5) Other specific tests include: HB electrophoresis, Serum iron,B12,Folic acid…etc

Etiology: Lack of iron in the diet or the child’s inability to use the iron he ingest

1- Low birth weight, Prematurity, twins = decreased storage of iron2- Continued or excessive milk administration

without iron enriched food

3- Blood loss.4- Malabsorption

Clinical manifestations

- Pallor, irritability, anorexia

- Low HB, RBC’s count, & Low hematocrit

- Low serum iron

- Enlarge heart

- Enlarge spleen

- Low level of activity

- Systolic murmur

* TREATMENT- Oral administration of simple ferrous salt: 6 - 10 mg / kg / day of elemental iron- Parenteral iron is seldom indicated- Severely anemic children with HB level < 4 gm / dl may be given blood transfusion- Treat the underlining cause

* PREVENTION

- Adequate diet include vegetables, meat and vitamins for full term infants

- Administration of iron (2 mg/kg/day) from the age of 2 months for low birth weigh and premature infants

Etiology : 1. Decrease intake

2. Decrease absorption: chronic diarrhea

3. Increase demand: chronic hemolytic anemia

Clinical manifestations: MCV >100, low reticulocyte count

Diagnosis Decreased serum folic acid, deceased red

cell folate

Treatment Folic acid 2-5 mg /kg/day for 3-4 weeks

Etiology

- Dietary deficiency is rare (Vegetarians)

- Failure to absorb vit. B 12

Clinical manifestations:

Same as folic acid deficiency

Diagnosis Low serum vit. B 12Treatment Administration of vit. B 12 (1-5 mg/kg/day)

for 2 weeks then once monthly 1 mg IM

* The fundamental basis of the hemolytic anemia is a shortened survival time of the RBC,s (RBC normally spend 120 days in the circulation)

* The normal BM response to hemolysis is by an increase of reticulocytes to > 2%

Glucose-6-phosphate Dehydrogenize (Enzyme which helps red blood cells (RBCs)

function normally).

This deficiency can cause hemolytic anemia, usually after exposure to certain medications, foods, or even

-Transmitted as a sex-linked recessive.

Clinical manifestations:Usually no evidence of hemolysis is apparent

until 48-96 hours after the patient has ingested a substance which has oxidant properties

An acute and severe hemolytic syndrome called FAVISM, Hb. level become very low, presence of hemoglobinemia, mild jaundice, splenomegally and increased reticulocyte count

Diagnosis Low G6PD activity in red blood cells

Treatment When hemolysis has occurred => Red

blood cell transfusion

Prevention Avoiding ingestion of fava beans or

oxidant substances

a genetic life-long blood disorders characterized by red blood cells that assume an abnormal, rigid, sickle shape.

Clinical manifestations: = Moderate anemia = Frequent articular and abdominal painful

crisis= Red blood cells abnormality (sickle cell)= Swelling of hand & feet

= Hepatosplenomegaly= Fever & back pain = Sclera yellowed –decrease vision = Anorexia

Diagnosis Hb electrophoresis Presence of Hb STreatment:Children born with sickle-cell disease will undergo

close observation by the pediatrician and will require management by a hematologist to assure they remain healthy. These patients will take a 1 mg dose of folic acid daily for life. From birth to five years of age, they will also have to take penicillin daily due to the immature immune system that makes them more prone to early childhood illnesses.

Instituted primarily for the crisis, the use of oxygen, the maintenance of good hydration, correction of acidosis,

rest and sedative Blood transfusion BMT (have proven to be effective in children)

Stresses management and family support HB level & blood transfusion Iron formula Immunization Regular school attend

What is leukemia?Leukemia is cancer that starts in the tissue that forms blood. To understand cancer, it helps to know how normal blood cells form.

Leukemia CellsIn a person with leukemia, the bone marrow makes abnormal white blood cells. The abnormal cells are leukemia cells.

Swollen lymph nodes Fevers or night sweats Frequent infections Feeling weak or tired Bleeding and bruising easily Swelling or discomfort in the abdomen (from a

swollen spleen or liver) Weight loss for no known reason Pain in the bones or joints

People with leukemia have many treatment options. The options are: chemotherapy, biological therapy, radiation therapy, and stem cell transplant, etc….

The choice of treatment depends mainly on the following:

The type of leukemia (acute or chronic)

Patient age

Whether leukemia cells were found in the cerebrospinal fluid

http://www.medicinenet.com/leukemia/page2.htm#3whatare