1. Blood system in Children
Anaemia
Leukaemia

2. Anaemia
Describes a condition in which the number of red blood cells (RBCs) or the hemoglobin Hgb or Hb) concentration is reduced below normal values for age.
Diminishes the O2 carrying capacity of the blood  a reduction in the O2 available to  tissues.
Most common hematologic disorder of infancy and childhood.

3. Classified into 2
Etiology or physiology [manifested by erythocyte or Hgb depletion
Morphology [characteristic changes in RBC size, shape, or color]
Morphology - more useful in terms of lab evaluation of anaemia
Etiology – provide direction for planning nursing care. E.g. reduce Hgb concentration may be caused by a dietary depletion of iron. Principal of intervention - replenishing iron stores.
Hgb – 12 – 16gm/dl

5. Causes of low hb Anaemia (sickel cell)
Loss of blood due to surgery, colon cancer, stomach ulcer
Nutritional deficiency (Vit. B12 and folate)
Bone marrow problems
Suppression by medication i.e. Chemotherapy
Kidney failure

6. Consequences of anaemia
Decrease O2 carrying capacity of blood and consequently a reduction in the amount of O2 available to the cells  the child will have declining Hgb level.
Circulatory system – effect on the circulatory system can be profound.
viscosity [thickness] of blood depends on the concentration of RBCs, the resulting of hemodilution of severe anemia  decreases peripheral resistance  causing greater quantities of blood to return to the heart  heart murmur.
With other activity i.e. exercise, infection, or emotional stress  cardiac failure.

7. Child  has remarkable ability to function well despite low level of Hgb
Cyanosis  result of the quantity of deoxygenated Hbg in arterial blood.
Growth retardation  result from decrease cellular metabolism and coexisting anorexia [chronic anaemia]
Delayed sexual maturation in the older child.

8. Nursing management
Assessment Age – provide possible etiology of the anaemia iron deficiency occurs more frequently in toddler between 12 to 36 months and during the growth spurt adolescence. Racial and ethical background is significant (South East Asians and African or Mediterranean) these group  may be genetically deficient in the enzyme lactase after the period of infancy affect individual  unable to tolerate lactose in the diet, with consequent intestinal irritation and chronic blood loss. Stool examination for occult blood [can identify chronic intestinal bleeding

9. Prepare child and family for laboratory tests – child/toddler subjected to multiple finger or heel punctures or venipunctures
Trauma because of multiple finger or heel punctures
Used of ELMA
Information giving – explaining the significance of each test why the tests are important. Allow the child to play with the equipment on a medical doll
Opportunity for the child to observe the blood cells under the microscope or in photographs BT
Bone marrow aspiration – essential for definite diagnosis of other blood disorder i.e. leukemia, lymphomas etc.

11. Decrease tissue O2 needs
Assess the child’s energy level and minimize excess demands
Assess the child level of activity tolerance for activities of daily living and play  make adjustment to allow as much self-care as possible without exertion of energy expenditure
Prevent complication
Child increase risk to infection
Practicing thorough hand washing
Restricting no. of visitors
Adequate nutrition
Observe sign of infection (elevation of temperature of the child)