HEMATOLOGICAL
FUNCTION
Chapter 26
Assessm
ent Interven
tions
A&P
Norm Sickle-cell
al FE
Deficient
Hematolo
Anemia
gical
s
Hemophili Function
a
Aplastic
Bleeding
DIC Disorders
NORMAL
•The hematological system incorporates: erythrocytes (red blood cells), Leukocytes (white blood
cells), and thrombocytes (platelets), as well as the plasma.
•Erythrocytes A key variation in children is the presence of fetal Hgb until 4 to 6 months of life.
At this time, it is replaced by adult Hgb or one of the variants.
•WBCs
• Granulocytes-neutrophils, the most abundant, primarily the first line of defense that battle
or phagocytize bacterial invaders. Eosinophils, which function in allergic reactions, and
basophils, which have function in parasitic infections and a protective function in creating
pathways for the phagocytes to move to sites of inflammation.
• Agranulocytes are lymphocytes and monocytes. Lymphocytes are small, less powerful
phagocytes, first responders in viral infections. During a bacterial or immune-regulated
process, lymphocytes become T cells and B cells. Monocytes, which are the most powerful
phagocytizers and which become macrophages, phagocytize viral and bacterial infections.
•Thrombocytes and other clotting factors in the plasma
Assessment- CBC and absence of cue indicating alteration in normal function.
Interventions-Oxygenation, Hydration, Perfusion, Infection Control, Bleeding, Pain, Education,
Support, Stress
Amelia's Case
Norma
Age: 4YO
l
Growth: WNL for age
Normal Interpretatio
Meeting all developmental milestones
Lab Test Results
Ranges n Denies pain, 0 on FACES scale
HEENT- Symmetrical with smooth
RBC 4.2 3.9-5.5 Normal movement, CN intact. mucus membranes
pink, moist, no rhinorrhea or congestion.
HGB 16.3 14-17.5 Normal breath sounds CTAB, no increased WOB,
skin pink, warm, dry, no rashes noted, color
HCT 48 41-50 Normal
appropriate for ethnicity. Normoactive
bowel sounds x 4 quads, mom reports last
WBC 6.9 4.23-9.07 Normal
bm was yesterday. Fully potty trained. No
redness, warmth, edema to joints, easy
Platelets 256k 150k-300k Normal
movement, no complaints with movement.
Gait even and steady. Posture upright with
no obvious curvature of the spine.
ANEMIAS
Anemias are conditions in which mature erythrocytes are decreased in number or volume or impaired in
function.
•Sickle Cell Disease- Autosomal recessive abnormal Hgb gene results in
sickle-shaped RBCs that tend to clump together, occluding blood vessels,
impairing oxygen delivery, pain crises, premature RBC death causing
hemolytic anemia, organ and tissue damage, and premature death. Most
common in African American population. Cues- vaso-occlusive crisis,
dactylitis and SCI (birth-5 years), myriad other events that may occur in
small vessels all over the body from vaso-occulsion.
Diagnosis- clinical presentation, CBC, sickledex, Hgb electrophoresis
Treatment-resolution of trigger, supplemental oxygen, fluids, blood
transfusions, pain management, folic acid and hydroxyurea. Bone marrow
transplant may be the last resort.
Charlie's Case
Sickle Cell
Anemia Age: 4 yo
Lab Test Results Normal Range Interpretation
C/O:Dactylitis to first
RBC 2.9 3.9-5.5 low three fingers on Left
HGB 6.2 14-17.5 low hand
HCT 19.3 41-50 low
Hx: SCI (August 2021)
with facial droop, pain,
WBC 19.5 4.5-11 high
priapism, hematuria
Platelets 120k 150k-300k low
and retinal detachment
Neutrophils-
1.67 3 low Medications: folic acid
bands
Triggers: infections,
Neutrophils-
segs
68.1 56 high cold intolerance,
dehydration
Reticulocytes 2.4 0.5-1.5 high
ANEMIAS
•Content Check!
How are children screened for
Sickle-Cell Disease?
ANEMIAS
•Content Check!
How are children screened for
Sickle-Cell Disease?
ANEMIAS
•Content Check!
What are the manifestations of a
blood transfusion reaction?
ANEMIAS
•Content Check!
What are the manifestations of a blood transfusion
reaction?
Table 12.2 in
T&K
ANEMIAS
•Content Check!
Identify priority findings for a school-age
child experiencing a vaso-occulusive
crisis.
ANEMIAS
•Content Check!
Identify priority findings for a school-age child
experiencing a vaso-occulusive crisis.
Ischemic infarcts at the site of occlusion, severe
pain in (swollen) joints, bones, abdomen (splenic
sequestration), hematuria, obstructive jaundice,
visual disturbances, Silent Cerebral Ischemia,
Acute Chest Syndrome
ANEMIAS
•Iron-Deficiency Anemia- most common nutritional deficiency worldwide. Occurs
between the ages of 1-2 and adolescent girls. Prolonged deficiency can cause
behavioral and neurocognitive changes. This happens by 4 methods- 1).
inadequate iron absorption due to lack of intake 2). impaired iron absorption due
to disease process 3). increased iron requirements 4). blood loss Usually
asymptomatic, can cause fatigue, pallor, irritability, anorexia. Oral iron
supplements can stain teeth, tarry stools, Take with vit. C for increased
absorption.
• Aplastic Anemia- is a condition of complete bone marrow suppression or
failure that produces pancytopenia. The red marrow is replaced by a
fatty yellow substance. This condition can be congenital (autosomal
recessive gene) or acquired (autoimmune). Cafe au lait spots,
microcephaly and cognitive delays, delays growth, skeletal defects,
diagnosed with CBC. Treated with bone marrow transplant.
ANEMIAS
Content Check!
What food choices will the nurse
encourage for a client with iron-
deficiency anemia?
fortified cereals, leafy greens,
iron-rich veggies (brassicas),
meats
BLEEDING DISORDERS
Hemophilia is a bleeding disorder
that is usually inherited and
involves a deficit in a coagulation
factor, specifically, factor VIII
(FVIII) or factor IX (FIX). Cues-
excessive bleeding. Treatment is
aminocaproic acid for
replacement of clotting factors by dental procedures and
inhalation, IV infusion, or oral losing baby teeth
BLEEDING DISORDERS
Jamie's Case
Normal Interpretatio
Lab Test Results Hemophel
Range n
•ia6 yo
RBC 4.1 3.9-5.5 normal
• History of: bleeds in
HGB 8.5 14-17.5 low joints after walking
HCT 25.1 41-50 low briskly in a parking
lot, Spontaneous
WBC 350 4.23-9.07 low
bleeding, prolonged
Clotting
5% 50-100% low bleeding episodes
Factor VIII
with normal activity
Clotting
Factor IX
5% 50-100% low • C/O swelling, pain,
redness, ecchymosis
11-13.5
PT 14
seconds
high or purpura at the
joint
BLEEDING DISORDERS
Content Check!
How will the nurse plan care for a toddler with
Hemophilia?
Manage bleeding: administer injections SQ, not IM if
possible. Avoid unnecessary punctures, but venipuncture
favored over heelstick. Monitor for occult blood. No
aspirin.
Manage localized bleeding: administer factor
replacement, observe for adverse effects (HA, flushing,
BLEEDING DISORDERS
Disseminated intravascular coagulation (DIC) is a condition characterized
by systemic coagulation throughout the bloodstream (due to thrombosis
from stimulated thrombin) and consequent hemorrhage (due to
fibrinolysis stimulated by plasmin), which uses up all the available
coagulation factors. DIC is a secondary consequence in children that
occurs because of some severe disease process or injury that is
associated with hypoxia, acidosis, shock, burns, or sepsis and that is
heralded by simultaneous bleeding and clotting. It is an emergency for an
already ill child. Diagnosis is made by the presence of peripheral
thrombosis, excessive bleeding from a venipuncture, oozing from old
entry sites, petechiae, ecchymoses, purpura, epistaxis, gingival bleeding,
gastrointestinal or pulmonary hemorrhage, tachycardia, hypotension,
and muscle, back, or chest pain, a CBC, PT, PTT. Treatment is to get
Frankie's Case
DIC
Lab Test Results Normal Range Interpretation
RBC 4.5 3.9-5.5 normal
HGB 16.8 14-17.5 normal
6 yo, Oozing noted from L
HCT 46 41-50 normal
ac piv with bleeding from
Platelets 80 k 150k-450k low
gums, bruising on UE with
RBC 1.7 4.63-6.08 low petechiae on LE
WBC 7.7 4.23-9.07 normal C/O: Chest pain, epistaxis
PT 47 11.6-15.2 high Hypotension noted on VS,
PTT 75 25.3-37.3 seconds high 75/45 mmHg at last check.
Fibrinogen 100 177-466 low
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