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Course: Pediatric Nursing

Topic: Nursing care of child with Hematological Disorders Part III

The Nurses International Community

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Module Goals

The Learner will be able to:

Define anemia
Discuss causes and/ or risk factors for anemia
Describe types of anemia
Identify signs and symptoms of anemia
Describe common diagnostic procedures for anemia
Explain management of a child with anemia
Discuss nursing management of a child with anemia

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Anemia

Condition where red blood cells or the hemoglobin concentration is reduced.

A serious global public health problem that particularly affects young children and pregnant women.

WHO estimates that 42% of children less than 5 years of age and 40% of pregnant women worldwide are anemic.

WHO, n. d

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Hemoglobin Level

Nall, 2020, Healthline

Age	Female range (g/dL)	Male range (g/dL)
0–30 days	13.4–19.9	13.4–19.9
31–60 days	10.7–17.1	10.7–17.1
2–3 months	9.0–14.1	9.0–14.1
3–6 months	9.5–14.1	9.5–14.1
6–12 months	11.3–14.1	11.3–14.1
1–5 years	10.9–15.0	10.9–15.0
5–11 years	11.9–15.0	11.9–15.0
11–18 years	11.9–15.0	12.7–17.7

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Critical Thinking Question

Anemia is the condition where red blood cells or hemoglobin concentration is reduced.

True
False

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Causes

3 main causes

Loss of decreased red blood cells
Inability to make enough red blood cells
Destruction of red blood cells

Decreased red blood cells or hemoglobin levels may be due to:

Inherited red blood cell defects
Infections
Some diseases
Certain medicines
Lack of some vitamins or minerals in the diet

Cedars Sinai, 2022

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Risk Factors

Premature or low birth weight
Living in poverty or immigrating from a developing country
Early use of cow’s milk
Diet low in iron
Surgery or accident causing blood loss
Long-term illnesses (infections, kidney or liver disease)
Family history of an inherited type of anemia (sickle cell anemia)

Cedars Sinai, 2022

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Critical Thinking Question

Which are the risk factors of anemia in children? (Select all that apply)

Low iron diet
Early us of cow’s milk
Inherited family history
Accidental blood loss

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Anemia Types

Iron deficiency anemia

Not enough iron in the blood needed to form hemoglobin.
The most common cause of anemia.
Most commonly affects infants 9 through 24 months old.
Breastfed babies need less iron because the iron in breast milk is better absorbed.
Infants younger than 12 months who drink cow's milk rather than breast milk or iron-fortified formula are more likely to have anemia.

Medlineplus, 2022

Cedars Sinai, 2022

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Anemia Types

Megaloblastic anemia:

Red blood cells are too large and abnormally shaped.
The bone marrow makes fewer cells and they don’t live a normal life span.
Causes:

Lack of folic acid or vitamin B-12 (common)
Digestive diseases (celiac disease, chronic infectious enteritis)
Inherited congenital folate malabsorption: inability to absorb folic acid
Anti seizures medicine that interferes with folic acid absorption
Restrictive diet (vegetarian diet)

Cedars Sinai, 2022

University of Rochester, 2022

(Cedars Sinai, 2022)

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Anemia Types

Pernicious anemia:

A type of megaloblastic anemia
The body can't absorb vitamin B-12
Lack of intrinsic factor which is normally made in the stomach and helps the body absorb B-12.
Treatment: B-12 or folic acid supplements

Meat and dairy products have the most vitamin B-12.
Foods that have natural folate: Oranges, orange juice, Dark green and leafy vegetables, Liver, Barley, Sprouts, Beans, peas, lentils, Peanuts.

University of Rochester, 2022

(Cedars Sinai, 2022)

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Anemia Types

Hemolytic anemia:

Red blood cells are destroyed faster than they can be replaced
Causes:

Intrinsic

Destruction of red blood cells due to a flaw within the RBC
Inherited (sickle cell anemia, thalassemia, or erythrocytosis)

Extrinsic (autoimmune hemolytic anemia)

Due to: Infections from bacteria or viruses
Cancers, Malarial medicine

Stanford Children’s Hospital, 2022

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Anemia Types

Sickle cell anemia: Sickle cell disease (SCD)

Genetic
Present at birth
Children with SCD make an abnormal type of hemoglobin.
Red blood cells are hard and sticky and shaped like the letter C (a sickle) can’t move easily through the blood vessels.
Normally the spleen helps filter infections but sickle cells get stuck in this filter and die causing anemia.

Stanford Children’s Hospital, 2022

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Critical Thinking Question

Which is true about pernicious anemia?

Red blood cells are too large and abnormally shaped
The body can't absorb vitamin B-12
Red blood cells are destroyed faster than they can be replaced
Bone marrow doesn't make enough new blood cells

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Anemia Types

Aplastic anemia

Rare but serious blood disorder where bone marrow doesn't make enough new blood cells

Causes:

Autoimmune disorders (most common)
Inherited gene changes that can cause Fanconi anemia
Toxic substances, such as pesticides, arsenic, and benzene
Radiation therapy and chemotherapy
Certain medicines
Viral infections such as hepatitis, Epstein-Barr virus, or HIV

Cooley's anemia (thalassemia)

Medlineplus, 2022

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Symptoms

Increased heart rate
Breathlessness, or trouble catching a breath
Lack of energy, or tiring easily
Pale skin
Yellowing of skin, eyes, and mouth (jaundice)
Enlarged spleen or liver
Sore or swollen tongue
Dizziness, or vertigo, especially when standing
Slow or delayed growth and development
Poor wound and tissue healing
Irregular menstrual cycles
Absent or delayed menstruation

University of Rochester, 2022

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Critical Thinking Question

A nurse is caring for a child with a diagnosis of anemia. Which clinical manifestations are most likely to observe when assessing this child? (Select all that apply)

Pale skin
Lack of energy
Tachycardia
Bradycardia

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Diagnosis

Hemoglobin and hematocrit

The first screening test.
Measures the amount of hemoglobin and red blood cells in the blood.

Complete blood count (CBC)

Includes hemoglobin and hematocrit and more details about the red blood cells.

Peripheral smear

To see if the blood cells look normal.

University of Rochester, 2022

Contact info: info@nursesinternational.org

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Treatment

Depends on symptoms, age, general health, and the cause
May include:

Vitamin and mineral drops or pills
Changing the child's diet
Stopping a medicine that causes anemia
Blood transfusions
Stem cell transplants
Surgery to remove the spleen (very rare)

University of Rochester, 2022

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Prevention through Education

Breastfeed if possible
Give infant formula with iron
Don't give cow’s milk until the child is a year old
Provide iron-rich foods

Iron-enriched grains and cereals
Egg yolks, Red meat
Potatoes, tomatoes, and raisins

University of Rochester, 2022

(Hockenberry and Wilson, 2007)

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Nursing Care Management

Adequate tissue perfusion

Assess for the sign of decreased tissue perfusion

Monitor vital signs, capillary refill, skin color, mucous membranes
Observe the existence of the cold skin
Observe for the sign of confusion

Maintain temperature to maintain warmth
Provide oxygen as needed

NANDA Blogspot, 2012

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Nursing Care Management

Determine the degree of pain
Assess hydration status
Determine oxygenation
Administer pain medications
IV fluids
Administer antibiotics as prescribed
Administer blood transfusions
Encourage healthy diet with folate supplements

Mangla, Ehsan, & Agarwal, 2021

Contact info: info@nursesinternational.org

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Nursing Care Management

Activity

Assess ability to perform activities in accordance with physical and developmental tasks.
Assist family in planning and prioritizing ADLs.
Assist in developing a schedule for daily activity and rest.
Monitor vital signs during and after activity, and note physiological response to activity.
Provide information to the family about need to restrict activity if symptoms of increased heart rate, increased blood pressure, rapid breathing, dizziness or fatigue occur.

Hockenberry and Wilson, 2007

Contact info: info@nursesinternational.org

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Home Care Management

For recommended oral iron tablets.

take the pills on an empty stomach.

Do not take antacids or drink milk or anything with caffeine within 2 hours of taking iron.
Vitamin C helps the body absorb iron. Give iron with orange juice or some other food high in vitamin C.
Keep iron pills out of the reach of small children.

Alberta, 2021

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Critical Thinking Question

The nurse is providing teaching for the parents with iron-deficiency anemia who has been prescribed iron supplements.

What beverage should the child take with the iron medication?

Milk
Ginger juice
Orange juice
Water

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Cultural Considerations

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Health beliefs: In some cultures talking about a possible poor health outcome will cause that outcome to occur.
Health customs: In some cultures family members play a large role in health care decision-making.
Ethnic customs: Differing gender roles may determine who makes decisions about accepting & following treatment recommendations.

AHRQ, 2020

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Cultural Considerations (Continued):

Religion, culture, beliefs, and ethnic customs can influence how families understand and use health concepts:

Religious beliefs: Faith and spiritual beliefs may effect health seeking behavior and willingness to accept treatment.
Dietary customs: Dietary advice may be difficult to follow if it does not fit the foods or cooking methods of the family
Interpersonal customs: Eye contact or physical touch may be ok in some cultures but inappropriate or offensive in others.

AHRQ, 2020

Contact info: info@nursesinternational.org

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References:

WHO. (n. d). Anaemia. https://www.who.int/health-topics/anaemia#tab=tab_3

Medlineplus. (2022). Anemia caused by low iron - infants and toddlers. https://medlineplus.gov/ency/article/007618.htm

Cedars Sinai. (2022). Anemia in Children. https://www.cedars-sinai.org/health-library/diseases-and-conditions---pediatrics/a/anemia-in-children.html#:~:text=Anemia%20is%20a%20common%20problem,other%20cells%20in%20the%20body

University of Rochester. (2022). Anemia in Children. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=P02311

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References:

University of Rochester. (2022). Megaloblastic Anemia in Children. https://www.urmc.rochester.edu/encyclopedia/content.aspx?contenttypeid=90&contentid=p02325#:~:text=Key%20points%20about%20megaloblastic%20anemia%20in%20children&text=The%20cells%20are%20too%20large,as%20tiredness%20and%20pale%20skin.

Nall, R. (2020). Hemoglobin Levels: What’s Considered Normal?. https://www.healthline.com/health/normal-hemoglobin-levels

Stanford Children’s Hospital. (2022). Hemolytic Anemia in children. https://www.stanfordchildrens.org/en/topic/default?id=hemolytic-anemia-in-children-90-P02321

Stanford Children’s Hospital. (2022). Sickle Cell Diseases in Children. https://www.stanfordchildrens.org/en/topic/default?id=sickle-cell-disease-in-children-90-P02327#:~:text=Key%20points%20about%20sickle%20cell%20disease%20in%20children&text=With%20SCD%2C%20the%20red%20blood,organs%2C%20and%20cause%20a%20stroke

Contact info: info@nursesinternational.org

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References:

Medlineplus. (2022). Aplastic Anemia. https://medlineplus.gov/aplasticanemia.

Hockenberry, M. J. & Wilson, D. (2007). WONG’S Nursing Care of Infants and Children. 8th edi. Mosby

Nanda Blogspot. (2012). Nursing Care Plan for Anemia - Nursing Diagnosis and Interventions. https://nanda-nursing-care-plan.blogspot.com/2012/06/nursing-care-plan-for-anemia-nursing.html

Alberta. (2021). Anemia in Children: Care Instructions. https://myhealth.alberta.ca/Health/aftercareinformation/pages/conditions.aspx?hwid=ug5364

Mangla, A., Ehsan, M., & Agarwal, N. (2021). Sickle Cell Anemia( Nursing). https://www.statpearls.com/articlelibrary/nursingarticle/29013

Contact info: info@nursesinternational.org

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