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

Lymphatic System

• Drains body regions to lymph nodes, where infectious organisms are destroyed and antibody production is stimulated.
• Lymphadenopathy is enlarged lymph nodes, indicative of infection or disease.
• The spleen, the largest lymphatic organ, brings blood into contact with lymphocytes.
• Splenomegaly (enlarged spleen) occurs during infections, congenital and acquired hemolytic anemias, and liver malfunction.

Circulating Blood

• Blood consists of plasma and formed elements (red blood cells [RBCs], white blood cells [WBCs], and platelets).
• Erythrocytes transport oxygen and carbon dioxide.
• Leukocytes defend against infection.
• Lymphocytes are produced in lymphoid tissues.

Anemias

• Diverse causes can result in reduced circulating hemoglobin, impacting blood's oxygen-carrying ability.
• Hemoglobin (Hgb) below 8 g/dL causes increased cardiac output and blood shunting from the periphery to vital organs.
• Symptoms can include pallor, weakness, rapid breathing (tachypnea), shortness of breath (SOB), and congestive heart failure (CHF).

Iron Deficiency Anemia

• Most common nutritional deficiency in children, highest incidence in infancy (9-24 months) and adolescence.
• Causes may include severe hemorrhage, impaired iron absorption, high growth needs, or poor diet (e.g., excessive cow's milk).
• Manifestations: pallor, irritability, anorexia, decreased activity. Infants may be overweight from excessive milk consumption.
• Diagnostics: red blood cell count, hemoglobin and hematocrit levels, morphological cell changes, iron concentration; stool test for occult blood.
• Untreated, anemia progresses slowly; severe cases can cause heart weakness; long-standing cases may lead to growth and cognitive issues.
• Treatment: oral iron supplements (usually ferrous sulfate), two to three times daily, with Vitamin C to aid absorption.

Sickle Cell Disease

• Two types:
  • Sickle cell trait (asymptomatic): Mixed hemoglobin A and sickle (S) with low S proportion. Normal Hgb and RBC counts.
  • Sickle cell anemia (more severe): Symptoms appear in late infancy, possibly with finger and toe swelling. Results from enlarged marrow sites and vessel obstructions, causing ischemia.
• Manifestations:
  • Hemoglobin levels are 6-9 g/dL or lower.
  • Pallor, fatigue, and poor appetite.
  • Painful crises (vaso-occlusive, splenic sequestration, aplastic, hyperhemolytic) can be fatal. Symptoms include abdominal pain, muscle spasms, leg pain, painful swollen joints, fever, vomiting, or neurological issues.
  • Risk for stroke.

Thalassemia

• Hereditary blood disorders causing insufficient adult hemoglobin production.
• Abnormal RBC size and shape lead to rapid destruction, resulting in chronic anemia. The body compensates by producing fetal hemoglobin.
• Categorized by affected polypeptide chains.
  • Beta-thalassemia is the most common type, affecting beta chains.
  • Two forms: thalassemia minor and major (Cooley anemia).
• Can result from spontaneous mutations.

Hemophilia

• Inherited sex-linked recessive trait on the X chromosome.
• Diagnosed via fetal blood samples.
• Two main types:
  • Hemophilia B (Christmas disease): factor IX deficiency.
  • Hemophilia A: factor VIII deficiency.
• Deficiency in any factor interferes with blood clotting.
• Hemophilia A: factor VIII deficiency; severity depends on factor VIII level. Minor injuries can pose significant risk for some. Treatment aims to increase factor VIII for clotting, monitored by partial thromboplastin time (PTT) test.

Idiopathic (Immunological) Thrombocytopenic Purpura (ITP)

• Acquired childhood platelet disorder, most common type of purpura.
• Cause unknown; suspected autoimmune reaction to a virus, resulting in antiplatelet antibodies that are seen as "foreign". Platelets are destroyed by the spleen.
• Affects all ages, with highest incidence between 2-4 years of age.
• Manifestations: easy bruising (petechiae, purpura); recent history of rubella, rubeola or viral infections; 2 week interval between exposure and onset; a platelet count below 20,000/mm3 (normal range 150,000-400,000/mm3).

Treatment of ITP

• Neurologic assessment is primary.

• Treatment is usually not needed initially; prednisone, IV gamma globulin, anti-D antibody, or splenectomy for chronic cases.

• Avoid aspirin, phenylbutazone, phenacetin, caffeine during acute states.

• Avoid activity that increases bruising risk. Platelets are usually not directly given.

• Complications include GI bleeding, hemarthrosis, intracranial hemorrhage.

Leukemia

• Most common childhood cancer, malignant blood disorder causing uncontrolled growth of immature white blood cells (WBCs) in the bone marrow.
• Classified according to WBC type affected.
  • Acute lymphoid leukemia (ALL)
  • Acute non-lymphoid (myelogenous) leukemia (AML)
• Disrupts bone marrow function, reducing RBCs and platelets.
• Bone weakening and pathological fractures.

Manifestations of Leukemia

• Common symptoms: low-grade fever, pallor, bruising, leg/joint pain, listlessness, abdominal pain, and enlarged lymph nodes.
• Progress: liver/spleen enlargement, lemon-yellow skin, early petechiae/purpura; anorexia, vomiting, weight loss, and dyspnea.

Diagnosis of Leukemia

• Based on history, symptoms, blood tests, and the presence of leukemic blast cells in blood, bone marrow, or tissue.
• Radiographs show bone changes, and spinal taps assess CNS involvement.
• Kidney/liver function studies are needed.

Treatment of Leukemia

• Radiation and chemotherapy target specific cells.
  • Induction
  • CNS prophylaxis
  • Maintenance
  • Reinduction (relapse)
  • Extramedullary disease therapy

Side Effects of Chemotherapy

• Steroids mask infection, cause fluid retention, induce personality changes, and affect facial appearance.
• Other chemotherapy agents cause nausea, diarrhea, rash, hair loss, fever, anuria, anemia, and bone marrow depression.
• Peripheral neuropathy may present with severe constipation.

Nursing Care of a Child with Leukemia

• Encourage emotional expression.
• Observe frequently for infection.
• Monitor vital signs and bleeding tendencies.

Hodgkin Disease (Hodgkin Lymphoma)

• Lymph system malignancy, primarily in lymph nodes.
• Possible metastasis to spleen, liver, bone marrow, lungs, or other sites.
• Diagnosed by Reed-Sternberg cells.
• Rare before 5, peaks in adolescence and early adulthood. Twice as common in boys.

Treatment of Hodgkin Lymphoma

• Radiation and chemotherapy, tailored to disease stage.
• Cure primarily related to diagnosis stage, improving long-term outlook.

Nursing Care of Patients with Hodgkin Lymphoma

• Focus on symptomatic relief of radiation/chemotherapy side effects.
• Patient and family education.
• Malaise, fatigue, anorexia, and skin sensitivity are common.

Emotional Support of Hodgkin Lymphoma Patients

• Age-appropriate support.
• Activity regulation based on patient's tolerance.
• Potential for delayed puberty and sterility.

Chronic Illness in Children

• Behavior issues lessen with open communication and understanding.
• Adolescents may fear forced dependence, body invasion, mutilation, rejection, or loss of face.
• Support their self-determination.

Developmental Disabilities

• Overprotection, limited peer relationships, and potential family crisis surrounding emerging sexuality.

Care of the Chronically Ill Child

• Focus on abilities, successful experiences, family involvement.
• Integration into community. Wellness is central.

Nursing Care of the Dying Child

• Understanding cultural, personal views of grief, parents' loss, and children's perceptions.
• Sensitivity, nonjudgmental approach, compassion, and open communication about grief processes are needed.

Stages of Dying (and the nurse's role)

• Stages: denial, anger, bargaining, depression, acceptance
• Nurse's role: listening, providing privacy, therapeutic interventions, and information using sensitive phrases.

Physical Changes of Impending Death

• Cool, mottled, cyanotic skin; slowing body processes.
• Loss of consciousness, but possible hearing retention.
• Rales (lung congestion) are possible.
• Decreasing movement/neurologic signs.

Child's Reaction to Death

• Cognitive development, not age, influences response.
• Children <5 have separation and abandonment concerns.
• Preschool children use fantasy, while older children begin to develop a more realistic concept of death.

Test your knowledge on the lymphatic system, blood composition, and anemias. This quiz covers essential concepts such as lymphadenopathy, the function of spleen and blood components, including erythrocytes and leukocytes, as well as conditions like splenomegaly and anemia.