The Child with a Condition of the Blood, Blood-forming Organs, or Lymphatic System

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Questions and Answers

What is the primary site of blood formation in a fetus during the last trimester of pregnancy?

Bone marrow

Yolk sac

Liver (correct)

Spleen

Which component is NOT a part of the formed elements of blood?

Leukocytes

Thrombocytes

Plasma (correct)

Erythrocytes

At what stage of life does hematopoiesis primarily take place in the marrow of long bones?

Older adulthood

Infancy (correct)

Neonatal

Adolescence

What is the typical effect of vitamin K administration immediately after birth?

Promotes development of blood clotting factors Signup and view all the answers

What regulates the rate of red blood cell production in the body?

Erythropoietin Signup and view all the answers

What is the main function of erythrocytes in the blood?

Transport oxygen and carbon dioxide Signup and view all the answers

Which of the following is NOT a common manifestation of iron deficiency anemia?

Increased energy levels Signup and view all the answers

What is one of the primary risks for infants regarding T-cell activity?

Immature immune response Signup and view all the answers

Which condition is caused by inherited defects in hemoglobin?

Sickle cell disease Signup and view all the answers

What should be avoided when administering iron supplements to infants?

Milk Signup and view all the answers

What complication can arise from a vasoocclusive sickle cell crisis?

Obstruction of blood flow Signup and view all the answers

What is the recommended age for discontinuing iron-fortified formula in infants who are not breastfed?

12 months Signup and view all the answers

Carriers of the sickle cell trait primarily do not exhibit symptoms because:

Hemoglobin A protects them from hemoglobin S. Signup and view all the answers

In the context of a child experiencing a sickle cell crisis, what is the most appropriate nursing intervention?

Monitor the effectiveness of analgesics. Signup and view all the answers

Frequent blood transfusions in children with thalassemia major are primarily used to maintain:

Hemoglobin levels above 9.5 g/dL. Signup and view all the answers

Which symptom is considered classic for hemophilia?

Hemarthrosis. Signup and view all the answers

How does desmopressin acetate work in treating hemophilia A?

It increases factor VIII levels. Signup and view all the answers

Which factor deficiency is associated with Hemophilia B?

Factor IX Signup and view all the answers

What are children with thalassemia major at risk of developing due to treatment?

Hemosiderosis Signup and view all the answers

What immediate action should be taken for infants with hemophilia to prevent injuries?

Delay heel sticks and IM injections. Signup and view all the answers

Which of the following describes the nature of bleeding in hemophilia?

Prolonged bleeding time. Signup and view all the answers

What is the primary reason that classification is important in the treatment of childhood cancer?

It influences the design of individual treatment and prognosis. Signup and view all the answers

Which of the following is NOT a common complication observed in leukemia patients?

Liver failure Signup and view all the answers

Which diagnostic method is specifically used to determine the central nervous system involvement in leukemia?

Spinal tap Signup and view all the answers

Which therapeutic approach is primarily used to treat patients with Hodgkin’s Disease?

Chemotherapy and radiation therapy Signup and view all the answers

This side effect of prednisone may lead to significant changes in a child's appearance. Which one is it?

Moon-shaped face Signup and view all the answers

What is a significant characteristic of hyperhemolytic crises?

Functional hyposplenism Signup and view all the answers

Which treatment is indicated for managing severe anemia in aplastic crises?

Fresh packed RBC transfusion Signup and view all the answers

Which of the following is a primary goal in nursing care for children with thalassemia major?

Maintain hemoglobin levels at 9.5 g/dL Signup and view all the answers

What condition might result from thalassemia major if not properly managed?

Iron overload leading to cardiac failure Signup and view all the answers

Which vaccine is crucial for the prevention of infections in children with sickle cell disease?

Pneumococcal vaccine Signup and view all the answers

How does hydroxyurea treatment benefit patients with sickle cell disease?

It helps reduce the occurrence of vaso-occlusion. Signup and view all the answers

Which laboratory study is crucial for identifying the type and severity of thalassemia?

Hematologic studies Signup and view all the answers

What is a potential side effect of deferasirox, a medication used for thalassemia treatment?

Kidney toxicity Signup and view all the answers

What is a common way to manage bleeding in children with hemophilia?

Using a cold compress and rest Signup and view all the answers

Which condition does not involve thrombocytopenia?

Henoch-Schönlein purpura Signup and view all the answers

Which of the following treatments is considered first-line for ITP?

Steroids Signup and view all the answers

What is a key clinical manifestation of ITP?

Petechiae and purpura Signup and view all the answers

Which should be avoided in children with hemophilia to minimize bleeding risks?

Salicylate medications Signup and view all the answers

What is the recommended approach to foster independence in a child with hemophilia?

Encourage participation in care decisions Signup and view all the answers

In the context of leukemia, what consequence arises from the uncontrolled growth of immature white blood cells?

Anemia from reduced RBC production Signup and view all the answers

What is a classic symptom of hemophilia?

Bleeding into joints (hemarthrosis) Signup and view all the answers

What is an important aspect of care for children with ITP?

Ongoing neurologic assessments Signup and view all the answers

What dietary consideration is important for managing a child with hemophilia?

Adequate intake of vitamin-rich foods Signup and view all the answers

Study Notes

Hematological System in Children

The hematological system includes blood and blood-forming organs. Blood is essential for all bodily functions. Blood dyscrasias (disorders) occur when blood components don't form correctly or are outside normal ranges.
Blood cells form mostly in the yolk sac in the early stages of gestation. Later, the spleen, liver, thymus, lymph system, and bone marrow contribute to blood formation.
Fetal blood formation mainly occurs in the liver until the third trimester. During childhood, red blood cells (RBCs) are produced in the marrow of long bones (e.g., femur, tibia). By adolescence, hematopoiesis (blood cell formation) takes place in various bone marrows (ribs, sternum, vertebrae, pelvis, skull, clavicle, scapulae).
RBC production is controlled by erythropoietin.
The blood components are plasma and formed elements (erythrocytes, leukocytes, thrombocytes).

Blood Component Differences in Infants

Newborns have high hemoglobin and RBC counts due to high erythropoietin levels, placental blood shift, and lower extracellular fluid volume.
White blood cell (WBC) counts are high at birth, decreasing to a stable level within a week.
Low vitamin K levels in newborns require immediate administration after birth. Vitamin K is crucial for blood clotting factor development.

Lymphatic System in Children

The lymphatic system (lymphocytes, lymphatic vessels, lymph nodes, spleen, tonsils, adenoids, thymus gland) drains the body to lymph nodes. Here, infection-fighting organisms are destroyed, and antibody production is stimulated.
Tonsils and adenoids are larger in preschool and school-aged children, acting as part of the body's defense.
The thymus gland plays a vital role in newborn immune system development. Premature and term infants are at increased risk for infections due to immature T-cell activity.

Anemias

Anemia results from various causes, reducing circulating hemoglobin and oxygen-carrying capacity. Hemoglobin levels below 8 g/dL increase cardiac output and blood flow to vital organs.
Anemia's general manifestations include pallor, weakness, tachycardia, shortness of breath, and possible congestive heart failure.

Iron Deficiency Anemia

The most common nutritional deficiency in U.S. children, particularly during infancy and adolescence due to rapid growth.
Causes include severe hemorrhages, poor iron absorption, excessive growth needs, and inadequate diet (e.g., cow's milk).
Manifestations include pallor, irritability, anorexia, decreased activity, and even growth retardation and cognitive changes in long-standing cases.
Treatment aims at providing iron, typically ferrous sulfate orally between meals; Vitamin C aids absorption. Liquid preparations are often given via straw.
Parent education regarding breastfeeding (at least 6 months, recommended 12 months), iron-fortified formula, and iron-rich solid foods is crucial.
Stools may be tarry or green. Iron shouldn’t be given with milk.
Monitor treatment response with follow-up visits.

Sickle Cell Anemia

Inherited hemoglobin defect results in abnormal hemoglobin S (sickling).
Predominantly affects African Americans.
Sickling (clumping) is triggered by decreased oxygen, dehydration, infection, stress, and cold exposure.
Sickle cells obstruct capillaries, causing clots and infarcts (tissue damage) in various organs.
Acute pain often results in affected areas.
Sickle cell trait (AS) does not cause disease; genetic counseling is important.

Sickle Cell Crisis Types

Vasoocclusive: Most common, blood flow obstruction and vasospasm. Symptoms include dactylitis (painful hands and feet), joint pain, abdominal pain, strokes, etc.
Splenic Sequestration: Blood pools in the spleen, causing abdominal pain, circulatory collapse, and potentially sudden death.
Aplastic: Bone marrow stops producing RBCs, often triggered by infections, resulting in severe anemia
Hyperhemolytic: Accelerated RBC breakdown superimposed on existing anemia, rare but severe.

Sickle Cell Diagnostic Evaluation and Treatment

Diagnosis can occur prenatally (chorionic villus sampling, amniocentesis).
Screening tests (sickledex), hemoglobin electrophoresis.
Treatment is supportive and symptomatic. Bedrest, analgesics (IV morphine for severe pain, PCA for older children).
Frequent blood transfusions.
Oral hydroxyurea therapy increases fetal hemoglobin type to reduce sickling and pain. Maintaining hydration, monitoring sodium levels and minimizing risk of thrombosis are important.

Thalassemia

Hereditary blood disorders causing insufficient adult hemoglobin production.
RBCs are abnormal, leading to rapid destruction.
Thalassemia major (Cooley's anemia) results in severe anemia, bone marrow expansion, enlarged spleen and liver, and potentially cardiac failure and death. Thalassemia minor has less severe symptoms.
Treatment mainly involves frequent blood transfusions, chelation therapy (deferasirox, deferiprone), and potential stem cell transplantation to manage iron overload.

Bleeding Disorders

Hemophilia

Hereditary inability to clot blood due to factor VIII (Hemophilia A) or factor IX (Hemophilia B) deficiency.
Common in males, transmitted by females.
Prolonged bleeding, hemarthrosis (bleeding into joints).
Treatment mainly involves replacement of missing factors (recombinant antihemophilic factor) or using desmopressin (DDAVP) for less severe cases.
Avoid aspirin and NSAIDs.
Educate parents/patients on preventing injuries, and on managing bleeding episodes.

Idiopathic Thrombocytopenic Purpura (ITP)

Autoimmune disorder causing decreased platelets; unknown cause, likely autoimmune response to a virus.
Manifestations include easy bruising, petechiae, purpura, bleeding from mucous membranes.
Treatment involves avoiding drugs affecting platelets, limited activity during acute stages, and use of prednisone (first-line treatment).
Close monitoring, especially for intracranial signs.

Henoch-Schönlein Purpura

Autoimmune condition involving blood vessel inflammation; likely triggered by infections or allergies.
Clinical presentations include palpable purpura, abdominal pain, gastrointestinal bleeding, and hematuria. Treatment is largely supportive.

Disorders of White Blood Cells

Leukemia

Cancer of blood-forming tissues characterized by uncontrolled immature WBC production; most common childhood cancer.
Manifestations include fever, pallor, bleeding tendencies, leg/joint pain, listlessness, abdominal/lymph node enlargement, skin discoloration, petechiae, purpura, anorexia, vomiting, dyspnea, hematuria, anemia, thrombocytopenia.

Leukemia Diagnostic Evaluation and Treatment

Diagnosed through blood tests, bone marrow biopsy, X-rays, and spinal tap (to check for central nervous system involvement).
Treatment involves a multidisciplinary approach (often chemotherapy phases, possibly radiation).
Close observation for infections, bleeding, and other chemotherapy side effects is critical.
Bone marrow transplant might be an option

Hodgkin's Disease

Lymphatic malignancy with specific Reed-Sternberg cells.
Typically presents with painless lumps (often in the neck), low-grade fever, night sweats, and unexplained weight loss.
Treatment primarily involves radiation and chemotherapy, based on the stage.
Follow-up care addresses concerns from therapy (e.g., radiation sensitivity, fertility).

Nursing Care of the Chronically Ill Child

Chronic illnesses significantly impact growth and development.
Nursing interventions focus on ensuring emotional well-being, enabling self-determination, and preventing isolation.
School-based programs and recreational activities maintain normality.
Home care programs promote normalcy in routines, decision-making, and independence.
Nursing priorities in end-of-life care involve supporting the child and family.
Nurses must be empathetic and honest with the family and child with regard to the child's awareness and emotional responses.
Open communication, honesty, fostering of control, and awareness of cognitive and developmental differences are critical.
Siblings and other family members often face challenges and also deserve the nurse's attention.

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Description

Test your knowledge on blood formation, components, and disorders with this Hematology Quiz tailored for Biology Class 12. Explore topics like erythrocytes, iron deficiency anemia, and the effects of vitamin K in newborns. Perfect for reviewing crucial concepts related to blood health and diseases.