1. Clinical Application for Child Health Nursing NUR 327 Lecture 3-D

2.  Definition: Condition in which the concentration of hemoglobin or the number of red blood cells are reduced below normal

3. 1) Inadequate production of HB or RBC’s which may be due to A- lack in the bone marrow (BM) of some substances necessary in the Formation of cells( Iron,Folic acid ….etc) B- Decreased number of red cell precursors in the BM, which may be congenital or acquired (eg. Toxic or Chemical agents) 2) Excessive loss of RBC’s( hemolysis or hemorrhage)

4. 1) HB level and RBC’s count 2) Hematocrit

5. 3) Red blood cells indices: -Mean corpuscular volume (MCV)=(80-100) -Mean Corpuscular Hemoglobin( MCH) =Normal 27-31 -Mean Corpuscular Hemoglobin Concentration (MCHC= Normal 32-35 %

6. 4) Reticulocytes count = reflect the state of activity of the BM (Normal value is 0.5-1.5% of the red blood cells ) Level < 0.5 represent inactive BM, High level represent BM regeneration 5) Other specific tests include: HB electrophoresis, Serum iron,B12,Folic acid…etc

7. Etiology: Lack of iron in the diet or the child’s inability to use the iron he ingest 1- Low birth weight, Prematurity, twins = decreased storage of iron 2- Continued or excessive milk administration without iron enriched food 3- Blood loss. 4- Malabsorption

8. Clinical manifestations - Pallor, irritability, anorexia - Low HB, RBC’s count, & Low hematocrit - Low serum iron

9. - Enlarge heart - Enlarge spleen - Low level of activity - Systolic murmur

10. * TREATMENT - Oral administration of simple ferrous salt: 6 - 10 mg / kg / day of elemental iron - Parenteral iron is seldom indicated - Severely anemic children with HB level < 4 gm / dl may be given blood transfusion - Treat the underlining cause

11. * PREVENTION - Adequate diet include vegetables, meat and vitamins for full term infants - Administration of iron (2 mg/kg/day) from the age of 2 months for low birth weigh and premature infants

12.  Etiology : 1. Decrease intake 2. Decrease absorption: chronic diarrhea 3. Increase demand: chronic hemolytic anemia

14. Etiology - Dietary deficiency is rare (Vegetarians) - Failure to absorb vit. B 12

16. * The fundamental basis of the hemolytic anemia is a shortened survival time of the RBC,s (RBC normally spend 120 days in the circulation) * The normal BM response to hemolysis is by an increase of reticulocytes to > 2%

17. Glucose-6-phosphate Dehydrogenize (Enzyme which helps red blood cells (RBCs) function normally). This deficiency can cause hemolytic anemia, usually after exposure to certain medications, foods, or even -Transmitted as a sex-linked recessive.

18. Clinical manifestations: Usually no evidence of hemolysis is apparent until 48-96 hours after the patient has ingested a substance which has oxidant properties An acute and severe hemolytic syndrome called FAVISM, Hb. level become very low, presence of hemoglobinemia, mild jaundice, splenomegally and increased reticulocyte count

19. Diagnosis Low G6PD activity in red blood cells Treatment When hemolysis has occurred => Red blood cell transfusion Prevention Avoiding ingestion of fava beans or oxidant substances

20. What is leukemia?  Leukemia is cancer that starts in the tissue that forms blood. Leukemia Cells  In a person with leukemia, the bone marrow makes abnormal white blood cells. The abnormal cells are leukemia cells.

21.  Swollen lymph nodes  Fevers or night sweats  Frequent infections  Feeling weak or tired  Bleeding and bruising easily  Swelling or discomfort in the abdomen (from a swollen spleen or liver)  Weight loss for no known reason  Pain in the bones or joints

22.  People with leukemia have many treatment options. The options are: chemotherapy, biological therapy, radiation therapy, and stem cell transplant, etc….

23. The choice of treatment depends mainly on the following:  The type of leukemia (acute or chronic)  Patient age  Whether leukemia cells were found in the cerebrospinal fluid