1 Understanding the Blood Count in the Pediatric Oncology Patient Gina Brandl RN, BSN, MSN-Cand Pediatric Clinical Nursing Instructor Mid-State Technical College

2 Objectives At the completion of this presentation the student will be able to: –Explain myelosuppression and the effects chemotherapy has on bone marrow –Explain what nadir is –Explain the nursing management and interventions related to low blood counts

3 Myleosuppression Suppression of blood cells produced in bone marrow Common side effect of chemotherapy Affects seen 7-14 days post-chemotherapy –Nadir –Cells affected Red blood cells Platelets White blood cells

4 Red Blood Cells Anemia –Due to decreased amount of circulating red blood cells –Symptoms Pallor Fatigue Increased heart rate and/or low blood pressure Dyspnea –Medical management Bone marrow stimulation

5 Red Blood Cells Transfusion –Recommended with HgB < 7 or symptomatic –Complications Transfusion reactions Infection –Nursing assessment Monitor for anemia Nadir –Nursing interventions Monitor for side-effects of blood administration

6 White Blood Cells Neutropenia – decreased circulating neutrophils in blood –Neutrophils – most common leukocyte –Compromises 50-60% of WBCs –Survive 4 days –Phagocytosis Banded –Immature – shift to the left –Elevated in bacterial infections Segmented –Mature – shift to the right –Elevated in viral infections

7 White Blood Cells –Signs & symptoms Fever Redness at IV catheter site Sore throat, new onset shortness of breath or shaking chills –Medical management Prevent and treat infections –Initiate antibiotics Colony stimulating factor

8 White Blood Cells –Complications Prevent and treat sepsis –Risk if ANC 3 days –Nursing Assessment Calculate and monitor ANC Anticipate nadir –Nursing Interventions Monitor and report signs and symptoms of an infection

9 White Blood Cells Promote good handwashing Initiate antibiotics promptly Follow institutional immunosuppressive policy and procedures –Patient and family education Avoid crowds and people known to have infections Avoid sharing eating utensils No live viruses

10 Absolute Neutrophil Count Determines susceptibility to infections –Calculating the ANC (% segs+ % bands) x WBC = ANC –Risk for developing an infection 1,500-2,000 – not significant 1,000-1,500 – minimal 500-1,000 – moderate <500 - severe <200 - hospitalized

11 Platelets Essential part of blood-clotting process Thrombocytopenia –Low platelet count –Signs Bruise easily Bleed longer than normal Bleeding from nose or gums Petechiae Blood in urine or stool

12 Platelets –Medical management Platelet transfusion –Complications Transfusion related reactions –Nursing interventions Monitor for bruising, petechiae and bleeding Anticipate platelet nadir Administer platelets Minimize invasive procedures Stool softeners Patient and family education

13 References American Cancer Society. (2007). How will chemotherapy affect my cell count?. Retrieved December 12, 2007, from the website ow_Will_Chemotherapy_Affect_My_Blood_Cell_Count.asp?s itearea=MBC Decker, M. (2007). The chemotherapy/biotherapy provider course. Marshfield, WI: Ministry Health Care. London, M. L., Ladewig, P. W., Ball, J. W., & Bindler, R. C. (2007). Maternal & child nursing care (2nd ed.). Upper Saddle River, NJ: Prentice Hall. Gould, B. E. (2006). Pathophysiology for the health professions (3rd ed.). Philadelphia, PA: Saunders Elsevier. Jackson, J., E. (2003). Pathogen inactivation of platelet concentrates and fresh frozen plasma. British Journal of Biomedical Science. 60(4), Retrieved December 31, 2007, from the website &sid=1&Fmt=3&clientId=13118&RQT=309&VName=P QD