Peds exam 3.docx - Hematology CBC RBC carry O2 function of...

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,