Hematology CBC: RBC- carry O2, function of bone marrow (stimulated by erythropoietin in kidneys) HGB/HCT- gives rbc its color, decreased hgb = more pink, hct 3x hgb MCV- avg size of RBC, low = microcytic size RDW- red cell distribution, thick = avg size of all rbcs Reticulocyte Count- immature RBC Differential Segs or Polys- neutrophils, attack bacteria Stabs or bands- immature neutrophils Lymphocytes- viral inf Eosinophils- allergies Basophils- prolonged inflammation Monocytes- phagocytic **Normal RBC, HGB, HCT count varies by age Pediatric Differences: fetal hgb has a high affinity for O2, takes moms O2 like magnet, higher erythropoietin at birth helps stimulate RBC production, platelet counts lower at birth to prevent clotting in utero or during birth- vit K admin at birth Anemia : rbc or hgb decreased, o2 carrying capacity decreased, increase in blood volume to the heart DX: hgb below 10 S&S: pallor, fainting, sob, pica, fatigue, lightheaded TX: underlying cause, blood products, O2, bedrest, IVF Care: assessment, diet, decrease O2 demand, iron rich foods, Normocytic Anemia : low rbc, normal size and shape, pale in center (low MCHC) CC; bleeding, trauma, inflammation TX: stop bleed, epo Aplastic Anemia: congenital- rare, fanconi syndrome, acquired- total bone marrow failure, leukemia, chemo, hpv, radiation, may have pancytopenia TX: identify and treat cause, O2, bedrest Iron Deficiency Anemia: common in 6-36 mo, high risk with bowel issue, vegetarian, enzyme deficiency, decreased income S&S: growth probs, developmental delay, systolic murmur, nail bed deformities DX: low hgb, mcv, mchc, rbcs microcytic and hypochromic TX: blood loss, nutritional assessment, oral supplementation (black tarry stools, stains, constipation) Sickle Cell Anemia: autosomal recessive, hgb a is replaced by hgb s, afro Americans, mediterranean, hispanic Patho: cells destroyed by sickling, hgb elongated, obstruction in capillary blood flow, tissue hypoxia, increased sickling, larger infarctions, kids have smaller vessels Triggers: trauma, fever, inf, dehydration, stress, hypoxia, vasoconstriction DX: low rbc, high mcv, normal mch, high reticulocytes, newborn screening- cord blood, hgb electrophoresis, genetic counseling, sickle cell turbidity test Complications: Vaso Occlusive Crisis: distal ischemia and pain, most common, priapism Sequestration Crisis: pooling of blood in liver and spleen (high vascularized), life threatening hypovolemia, splenectomy, CVA Acute Chest Syndrome : life threatening, occlusion in pulmonary vasculature- infarcted lung tissue S&S: pulmonary htn, o2, chest pain, fever, cough, resp distress TX: daily meds- iron, folic acid (build new Rbc), hydroxyurea (boost production of hgb F), penicillin prophylaxis 2 mo to 5 yrs, hematopoietic stem cell transplant, chelation therapy Crisis TX: O2, IVF (bolus + maintenance 150-200), oral hydration, abx, bedrest, splenectomy, blood transfusion, exchange transfusion (similar to dialysis) Prevention: prophylactic abx, immunizations, folic acid, prevent dehydration, manage stress, parent teachings, psychosocial needs
Prognosis: no cure! supportive, bacterial inf r/t immunocompromised, strokes in 5-10%, neurodevelopmental delay,
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- Spring '17
- The Maids, Cortisol, Bone marrow, dx, wt loss