Hello and welcome to Nursing School Explained! Today's topic
are different anemias that we will see in the pediatric setting. They'll
cover iron deficiency, sickle-cell anemia and also hemophilia. So let's get started
with iron deficiency anemia. Iron deficiency anemia is usually caused
in infants by intake of cow's milk instead of breast milk. So unfortunately
this happens mostly in patients of lower socioeconomic status where the mother
might not be producing enough milk and they might not be able to afford formula
and therefore feed the child cow's milk but this will deplete their iron stores
and unfortunately lead to iron deficiency anemia. Keep in mind that
cow's milk should be fed to children only after the age of 12 months. Iron
deficiency can also be caused because of loss during growths
periods and a big one here is lead poisoning. Unfortunately, this is again
mostly prevalent in children of lower socioeconomic status and lead still
exists in paint and certain types and so forth and children that live in those
kind of environments are more prone to iron deficiency anemia. And then
adolescents unfortunately they have poor diets or they tend to have poor diets so
sometimes that can also lead to iron deficiency. In terms of labs, if we do
suspect iron deficiency anemia, certainly we would one want to monitor the hemoglobin
and hematocrit, MCV and MCH to see how big those blood cells are. And then
ferritin and total iron binding capacity. Those are very
specialized tests to assess specifically for iron deficiency anemia. Now what do
we do if the patient is iron deficient? So, first of all, we need to increase
dietary sources. That should always be your number one treatment because we
don't want to unnecessarily give the patient medication when it can just be
solved with with diet. If it's caused by cow's milk and the child is less than a
year old, certainly we want to provide some education to the parents to make
sure and explain to them why the cow's milk is not ideal for the infants and
provide them with alternatives. Now iron- rich foods that's anything - beef,
dark green leafy vegetables, for children there is a lot of variety of enriched
rice cereals with that are iron fortified so those are some good options.
Now if that's not sufficient to replace the iron deficiency with dietary
resources, the patient will need to get iron supplements. And iron supplements
there are basically three to four things to consider. First of all they need to be
taken on an empty stomach for best absorption and they cannot be taken
within one to two hours of any other medications, specifically not any other
electrolyte such as calcium. We want to divide the doses for maximum absorption
and that's true for most minerals and vitamins because of our bodies can only
absorb so much at a time so it's always best to give the iron supplements BID
rather than just once a day. We want to give it with a source of vitamin C to
increase absorption. If there's not enough vitamin C in the diet or at the
time that the patient takes the iron supplement, only a very low
percentage of iron will be absorbed. And the easiest way in children is to give
it to them with a glass of orange juice. I wrote here with an exclamation mark:
teeth-staining because in the pediatric population we do administer medications
mostly in liquid form and it's black, kind of a thick,
charcoal kind of a medication so if they drink that then it can cause some
teeth staining. So we want to advise the parents to have the child drink through
a straw to kind of bypass the oral cavity and avoid the teeth staining. Side
effects of iron supplements include constipation and black stools so this is
something that we want to educate the parents on. So in order to avoid
constipation make sure your child stays hydrated as well as increase the fiber
in their diet. And then we want to educate them about the black stools
because that might scare them because sometimes that can mean that there's
bleeding in the GI tract but that's a common side effect of iron supplements.
And certainly if the cause for the iron deficiency anemia was
lead poisoning we want to remove the lead from the environment.
Moving on to sickle cell anemia. So sickle cell anemia is a genetic disorder
and I've drawn out a normal red blood cell in the sickle blood cell. So a
normal red blood cell is nice and round and it's kind of very pliable, it's able
to fit through tight spaces and blood vessels; where the sickled cell is kind of
a Halfmoon shape as you can see here. The other interesting thing about sickle
cells is their lifespan is much much shorter. So a typical red blood cell's
life span is about 120 days, 3 months, where some sickled cells might only have
a lifespan of about 10 days. And then what happens - these sickle cells, this is
a blood vessel, and they all clump together and they are not very pliable
so they're very stiff and so they can cause an occlusion of the blood vessel.
And this occlusion puts the patient at increased risk for any of those things
that can cause problems when there is an occlusion. So that would be pulmonary
embolus, stroke, myocardial infarction, and any problems with any circulation
anywhere also in the peripheries or the lower extremities, they can have
peripheral vascular issues and sores because of poor circulation there. So
this is something that we need to always think of and then certainly when this is
happening, when this blood vessel gets acutely occluded it's going to cause a
lot of pain.
As for lab tests there's a special test called a sickle turbidity test and
hemoglobin electrophoresis. Sickle cell disease is one of those things that is
typically tested for in the very early postnatal period so that we can find out
of this child is at risk or the parents are known to be carriers and certainly
this is something that would need require genetic counseling before the
parents decide to have a child. Now treatment and nursing considerations: so
if the patient is an acute sickle cell crisis; so now the sickle cells they have
clumped together that caused this occlusion, the best management is IV fluids to kind of
dilute this clot and cluster of blood cells that we have here, give them fluids,
make them flow along, provide oxygen because again there is no blood flow
distal to that occlusion so we want to provide oxygen to get some more
oxygenl into the cells, and then pain management. Remember we said there's a
lot of pain involved when there's a blood vessel occluded because again
there's ischemia and then eventually there will be tissue infarction when
there the blood flow completely ceases. As for teaching, those are important
nursing considerations in patients with sickle cell anemia. They want to avoid
extreme temperatures , cold or hot, as well as dehydration
for obvious reasons. It makes the sickle cells more prone to clumping together.
They should also avoid tight clothing or jewelry to make sure that that doesn't
occlude the blood vessels, strenuous exercise although so they could still
participate in sports and activities that are not necessarily strenuous are
still very much encouraged, just like in any child that does not have sickle cell
disease. Smoking certainly we should avoid that because it causes
vasoconstriction could cause some problems here, and then high altitudes
because there is just less oxygen available and that can make them prone
to having a crisis. As for medical treatment there's a medication called
hydroxyurea that the patients sometimes get prescribed. They might need a bone
marrow transplant and they might also need transfusions because we know that their
life span is so much shorter than our regular red blood cell. Now if we move on
over here to hemophilia. So hemophilia is a disorder that affects the clotting
factors. And most common clotting factor deficiency is factor VIII (8). Remember from
your pathophysiology background that there's several different
clotting factors that help in the coagulation cascade. And that's the
intrinsic and the extrinsic pathway. And when we're missing these clotting
factors were going to be prone to bleeding. So hemophilia also is a genetic
disorder and certainly we already talked about that. For labs we want to assess
the clotting factors, so how, which ones do they have and how
much of them. And then we want to check their coagulation times by checking the
prothrombin time and then their aPTT and certainly also the INR because
we want to see how are they clotting and how is that going to play a role in
them to be able to stop the bleeding if they're now in a hemophilic crisis.
Nursing considerations: so when a patient with hemophilia is admitted we want to avoid
punctures for IVs, IMs and lab draws so they might need a central line where we
can access this line for multiple purposes rather than puncturing the skin
every single time we need a drop of blood from this child because that might,
they might not stop bleeding due to the deficiency of the clotting factors. Now
then we're gonna have to replace the clotting factor and I wrote in
parenthesis here - it is a blood product - so all the measures that you would take for
blood transfusion would definitely play a role or be a consideration here as well. And then children with hemophilia, we want to tell them to avoid activities that increase the
risk of bleeding, certainly that makes common sense. We want to make sure that
this is not necessarily a rugby player or somebody who likes to play football or
ride motocross where there's a high risk for injury, high risk for collision,
because if that happens they might, they might have very poor consequences from
traumatic injury. And then certainly we want to handle them very gently for all
those reasons that we already talked about. Now for hemophilia what can happen
children tend to play and run around and fall so sometimes they fall and they
injure a joint. Most likely it's going to be a knee and then what happens that
joint capsule on the inside kind of bursts and there's a little bit of
bleeding. Now generally it would cause a little bruising,
little swelling in a normal child, but in a child with hemophilia that can
certainly cause this joint to be extremely swollen and the blood
basically just escapes, there's some bleeding inside the joint, and then the
treatment for that is that you want to immobilize that joint, with let's say
a knee immobilizer for the knee and certainly do all those other
measures that you would do for for an injury. So rest, ice, compression and
elevation. So thank you for watching this review of the different pediatric
anemias. I hope it has helped you get a better understanding of this topic and I
will see you next time. Thanks for watching Nursing School Explained!