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Peds-Hematologic

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cdunbar4's version from 2017-02-23 17:03

WBCs

Question Answer
Bone marrow analogyA "dimmer switch" immunosuppressed will lower switch, other things (infection) will raise switch
WBC normal range (abbreviated and non-abbreviated)4500-17000; 4.5-17
Neonate WBC if they have an infection?Sometimes could be low (little bodies can't keep up with the issues), but could also be increased.
Reasons for increased WBCinfection, necrosis, malignancies and inflammation
Meds that can put you at risk for infectionsteroids; antipsychotics; seizure meds (anticonvulsants)
conditions that put you at risk for infection renal insufficiency (↓ perfusion to kidneys=↓ filtration→ ↑dehydration/↑toxicity), Cushings, cancer
Neutrophils normal %31-57%
Two types of neutrophilsBands and Segs
What are "bands?" What does an increase in bands indicate?immature neutrophils; bacterial infection or malignancy (normal value is 0%)
What are "segs?" mature neutrophils; increase means infection.
Lymphocytes (B & T cells) normal %35-61%
increase in lymphocytesmore common in viral infection; ↓=lymphophilia
How does renal disease put you at risk for infection, r/t erythropoietin (EPO)?prevent prod. of EPO and sets them up for anemia
Monocytes normal %; what causes ↑4-7%; viral infx (herpes); rocky mountain spotted fever
Causes of decrease in monocytes leukemia and bone marrow failure
Eosinophils normal %; released during when2-4%; allergies & parasites
Basophils 0-1% release what?allergies→histamine
What does the percentage indicate when looking at labs for WBC counts? Example?% gives us an idea of why the total is off. If total of WBC is WNL, you know there most likely isn't something wrong.
ANCAbsolute neutrophil count
normal range ANC>1000
Moderate risk of infx of ANC500-1000
Neutropenia is and why do we calculate ANC?low ANC; want to know patient risk for infection, especially if on chemotherapy (neutropenia is complication of chemo)
ANC <500 indicates?indicates severe RF infection; immunosuppression; neutropenia of childhood
Calculation ANC
(Bands + Segs) X (Abbreviated WBC X 10) = ANC
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RBCs

Question Answer
MCVmean corpuscular volume (size of RBCs)
normocyticnormal
macrocytic: reasons for?Big! Folate or b12 insufficiency; aplastic or hemolytic anemia (a lot of big cells, but low amounts)
microcytic causesanemia-small cells in low amounts, lack of iron
MCH25-33pg=weight of rbcs
MCHC33-36%= concentration of RBC's (also indicates color depth)
Heriditary spherocytosishemolytic disorder; hyperchromic RBCs is the only clinical indication of
Hypochromic vs. hyperchromic normal 25-43: hypochromic as a result of decrease in Hgb production
RDWvariability is either normal or increased variability
When will you see increased RDW?iron deficiency, b12 anemia, folic acid, ansiocytosis
ansiocytosis↑RDW
Reticulocytes normal %0.5%-1.5% immature RBCs
Increased or decreased reticulocyte countindirect measure of hematopoiesis or production of RBCs (dimmer switch goes up); Decreased: dimmer down-bone marrow suppression
Hemoglobin (Hgb) normal?11.5-14.5dl
Hgb is inversely r/t to?reticulocyte counts: if you have enough you do not need an increase in new RBC's
Low H/H BOLOfluid boluses as can decreased further; watch retic. for stabilization
High H/H during what instances?dehydration
↓ Hgb in what conditions?aplastic anemia, renal disease, iron deficiency (can't make hemoglobin if you don't have iron); bone marrow suppression
Hematocrit↑in men and 3x hemoglobin
↑ HgB conditionschronic hypoxia (cyanotic heart defects) fluid loss
Platelets normal150,000-450,000
If a child has low H&H and you give them fluid bolus, what happens to HHHH goes down (you are diluting them, they still need the oxygen to go around)
Decreased plateletsleukemia, idiopathic polycythemia purpura
abnormal poolingsplenic sequestration, mono
Increased destruction of RBCssickle cell, hereditary sperocytosis
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Hematologic Conditions

Question Answer
Causes of anemia/destruction of RBCshemorrhage; bone marrow issues; sickle cell; iron deficiency; b12 (anything that leads to lost RBCs, kidney disease too!)
Blood transfusion for acute anemia protocol will get transfusion if Hgb <8
blood transfusion for chronic anemia HgB must be at<6 because they have so many compensatory things going on.
What two drugs interfere RBC productionsulfonamides; phenytoin
What drug class should you NOT give to babies before 6months and why?sulfonamides during jaundice or breastfeeding mothers. Sulfa displaces bilirubin from plasma proteins. Since babies BBB is immature, bili can get through and deposit in brain, causing kernicterus. Immature kidneys/GI system can't effectively clear excess bili, leading to jaundice.
Acute signs of hypoxiamuscle weakness, fatigue, pallor, h/a, lightheadedness, ↑HR
Chronic hypoxia(compensated signs) growth retardation; delayed sexual maturation; ↑ HR; heart murmur
Assessment: diet history specificsiron, folic acid, B12; also check urine, stool, emesis for blood
Other hypoxia manis/things to assessHgb, RBC, skin brkdown, jaundice, RR, HR, alt neuro (eventually), hepatomegaly and/or splenomegaly (sequestration); weak; exercise intolerance (will start to act like cardiac patients); growth
Interventions hypoxiaeliminate cause; ↓O2 demands, proper hand washing & mouth care, maintain body temperature (even if they feel warm, they use a lot of energy to stay warm, don't let them get cold stress)
Full term infant has RBC stores for how long?6 months; preterm do not have any (they need iron supplements bc no iron is in breast milk)
Children who are excessive ____ drinkers get anemic bc of lack of nutritional value from foodmilk
Iron supplements patient/parent teachingstains teeth so use dropper in the back of mouth; absorbed best b/t meals but tastes awful so if kid needs to eat, let them. Take with citrus fruit or juice.
Iron supplements are not absorbed well with what types of drugs?antacids, tetracyclines & histamine-2 receptor blockers
Can be extremely toxiciron supplements so keep out of reach of children; brush teeth after administration
How to prevent iron deficiency anemiabreastfed babies need supplements; preterm/twins get supplement and/or formula.
When can babies get whole milk and solid foods?no earlier than 12 months; start solid foods 4-6months
Aplastic anemia main causebone marrow failure (won't make RBCs or components (autosomal dominant); can have intermittent, acute or chronic.
aplastic manisjaundice & splenomegaly; assess for aplastic crisis of NO RBC production!
Tx aplastic anemiafolic acid, splenectomy (avoid in kids <5 d/t rf infx; do not give like vaccinations such as MMR, varicella, rota, nasal flu
B-thalassemiaexcess iron storage in tissues
B-thalassemia skin colorbronze d/t the dark color of iron
B-thalassemia causes what deformities?skeletal→ watch for pathologic fx
Tx B-thalassemiairon chelation therapy & medication is desperol (removes excess iron)
Sickle cell geneticsautosomal recessive
sickle cell patients with or without enough oxygen effectsenough O2 pt. is fine, but in any type of environment or situation where O2 levels are decreased, cells will sickle & cannot pass through small vells
Key patient care with sickle cellPAIN is one of key tx's; also oxygenate & hydrate to get cells unsickled.
RBC lifespan with sickle cell patients20 days; rarely see symptoms before 4months of age
Dactlytishand foot syndrome with sickle cell patients where hands and feet in a lot of pain
1st sign in sickle cell kids of bacteremiatemp of only 101.5-need to see these kids asap
Assessment & interventions sickle cellpain, hydrate (decreases viscosity) promote deep breathing; avoid excessive exercise or extreme hot/cold
Altered clotting functionplatelets live 4-10days; 150,000-400,000
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Idiopathic thrombocytopenic purpura

Question Answer
Platelet count isdown to 20,000
Assessment findings of skinpetechial rash, bruising, bleeding
InterventionsIVIG (intravenous immunoglobin therapy)
What types med and other treatments should patients avoid?injections (including vaccines) and aspirin
What is usually suspected after a circumcision if it doesn't stop bleeding?hemophilia (x linked recessive)
assessment findings hemophiliableeding (bruising, joint bleeding)
Which two clotting factors are replaced during treatment hemophilia?IV recombinant Factor VIII or IX replacement
Other interventions hemophiliaimmobility and elevation of joint/affected area; monitor for bleeding, PT, exercise after acute injury and bleeding subsides.
Developmental considerations toddler with hemophilia (what are they prone to?)falling, try to prevent them, consider a helmet
Developmental considerations of school age child with hemophiliaencourage non-contact sports, educate about disease, discuss limitations, psychosocial support.
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