Anemia (aplastic anemias, IDA, pernicious, sickle cell) Anemia Anemia is defined as "a pathologic deficiency in the amount

of oxygen-carrying hemoglobin in the red blood cells." Blood deficiency (iron) Causes Anemia from active bleeding Iron deficiency anemia: Anemia of chronic disease: Pernicious Anemia: . Sickle cell anemia: Alcoholism: Aplastic anemia: Hemolytic anemia: Signs and Symptoms Fatigue decreased energy weakness shortness of breath lightheadedness palpitations (feeling of the heart racing or beating irregularly) looking pale Diagnostic Findings CBC Hematologic studies

Iron studies MCV (mean corpuscular volume) RDW (red cell distribution width) Aplastic anemia Fatal disease in which the bone marrow doesn't make enough blood cells. Congenital aplastic anemia (Fanconi syndrome) is inherited as an autosomal recessive trait. (e.g. A child is born with several congenital anomalies, such as skeletal and renal abnormalities, hypogenitalism, and short stature. Between 4 and 12 years of age, a child begins to manifest symptoms of pancytopenia or reduction of all blood cell components Acquired aplastic anemia is a decrease in bone marrow production that can occur if a child is exposed excessively to radiation, drugs, or chemicals known to cause bone marrow damage. Signs and Symptoms of aplastic anemia include: Pale skin Fatigue Weakness Dizziness Light-headedness Rapid pulse Heart murmur Bruising and tiny areas of bleeding in the skin Abnormal bleeding from the gums, nose, vagina or gastrointestinal tract, or blood in the urine Iron deficiency anemia A type of anemia due to lower intake of iron more common in growing children when infant s diet lacks sufficient iron 1. 2. low birth weight infants born with structural defect of the gastrointestinal system rather than the amount needed.

adolescent girls can become IDA because of attempts to diet and overconsumption of snack foods low in iron. Pernicious Anemia (vitamin B12 deficiency) a disease of the blood and blood-forming organs, characterized by excessive destruction associated with defective production of red cells. In children, the cause is more often lack of ingestion of vitamin B12. Signs and Symptoms Pale Anorexia Irritable Hyporeflexia Ataxia (shaky movements) Sickle anemia A serious disease in which the body makes abnormally shaped red blood cells. A serious disease in which the body makes abnormally shaped red blood cells. The disorder is caused by a single base pair change in one of the genes that codes for hemoglobin, the blood protein that carries oxygen. People who have sickle cell anemia are born with it. It is a lifelong disease. Sickle Cell Crisis Term used to denote a sudden, severe onset sickling. Occur when a child has an illness causing dehydration or respiratory infection or after extremely strenuous exercise. Sometimes no obvious cause of a crisis can be found. Types of crisis Sequestration crisis may occur when there is splenic sequestration of RBCs or severe anemia occurs due to pooling and increased destruction of sicked cells. Hyperhemolytic crisis can occur when there is increased destruction of RBCs

Aplastic crisis is manifested by severe anemia due to a sudden decrease in RBC production, usually occur with infection. Prevention avoid exposure to toxins, radiation and medications that can cause the disease avoid being infected with hepatitis B virus (which can cause aplastic anemia) vaccination for pneumonia, meningitis, influenza, hepatitis. Increased iron intake Medical management If anemia is mild and associated with no symptoms or minimal symptoms, a thorough investigation by a doctor will be done in the outpatient setting (doctor's office). Blood transfusion may be required in other less critical circumstances as well. bone marrow transplant with a sibling donor who is human lymphocyte antigens (HLA) matched. Immunotherapy with either antithymocyte globulin (ATG) or antilymphocyte globulin (ALG) is the primary treatment for those children not candidates for bone marrow transplant. The child will respond within 3 months or not at all to this therapy. Cyclosporine A is also an effective immunosuppresant that can be used in the treatment of aplastic anemia. Androgens are rarely used unless no other treatment is available. Nursing management Identify and report signs and symptoms of hemorrhage. Vital signs (increased apical pulse, thready pulse, decreased blood pressure) Bleeding sites Skin color (pallor) and signs of diaphoresis Weakness Decreased level of consciousness Protect from trauma. Do not administer aspirin or nonsteroidal antiinflammatory drugs (NSAIDs) Administer contraceptive to decrease excessive menstruation. Protect from infection.

Provide frequent rest periods. Monitor child's therapeutic and untoward response to medications; monitor the action and side effects of administered medications. Prepare child and family for bone marrow transplant. Monitor for signs of bone marrow transplant complications. Provide age-appropriate diversional and recreational activities. Provide age-appropriate explanation before procedures.