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Hematologic Disorders

Tracie Kirkland, DNP, RN, ANP-BC,


CPNP

Anemia

•  Anemia ê in
circula,ng RBCs
•  ê RBC
produc,on
•  Abnormali,es
of RBCs itself
•  ê RBC lifespan

Image obtained from


Medscape
Anemia
•  Classifica,on
•  Microcy,c
•  Iron deficiency
•  Thalassemias
•  Sickle cell
•  Epidemiology
•  Iron deficiency most common
•  Thalassemias (inherited disorders
commonly seen in pediatric anemias
•  Workup for anemia
•  Clinical suspicion (Hx/PE)
•  Laboratory tes,ng (CBC, RBC indices,
RDW, ferri,n, re,culocyte)

Anemia
•  Iron deficiency
•  Most common anemia
•  Decrease in hgb •  Clinical manifesta,ons
•  May occur secondary to •  Pallor
lead poisoning •  + guaiac stools
•  Decreased Fe+ stores •  CV symptoms
•  Heavy menstrual bleeding •  Irritability
risk •  Fa,gue
•  Poor dietary intake of Fe+ •  Diagnos,c test
rich foods •  See reference chart
•  Obesity
•  Premature birth
Anemia
•  Management
•  Fe+ supplementa,on •  Classifica,on
3–6 mg/kg/day •  Major
Divided doses •  Minor
•  Recheck hgb/hct and re,culocyte
•  Con,nue tx for 3–6 months •  Clinical findings
•  Dietary counseling •  Asymptoma,c
•  Pa,ent educa,on
•  Management
•  Thalessemia •  No specific treatment
•  Hereditary
•  Hypochromic anemia
What Are Anemia Risk Factors?
•  Poor diet
•  Pica
•  Pagophagia
Lead Poisoning
• Lead-based homes
Paint • Window sills
•  Risk factors
•  Laboratory tests
• Paint chips
•  Complica,ons • Clay
Dirt • Outdoor play near
construc,on sites
• Window sills

• City/county
Water • Wells

Retrieved from: hYp://www.cdc.gov/features/leadpoisoning/leadpoisoning_456v2px.jpg


Sickle Anemia
•  Complex chronic gene,c
disorder
•  Commonly found AA
•  Neonatal screening
•  Clinical manifesta,ons
•  Fa,gue
•  Pain crisis
•  Dactyli,s
•  Bacterial infec,ons
•  Lung/heart injury
•  Priapism
•  Splenic involvement
Image retrieved from CDC.gov
Sickle Cell Anemia
•  Management
•  Hydra,on
•  Immuniza,on
•  PCN VK prophylaxis
•  Folic acid 1 mg/day
•  Crisis management
•  Pa,ent family/management
Leukemias
•  Incidence
•  Type of cancers
•  Clinical manifesta,ons
•  Management
•  Role as NP
Clinical Findings
•  Leukemia
•  Fever
•  Weight loss
•  Epistaxis
•  Petechiae
•  Enlarged lymph nodes
•  Hepatosplenomegaly
•  Bone/joint pain
Clinical Pearls
•  Referral based
•  Clinical trials
•  Specialty services
•  Longevity; extended care plan
Lymphoma
Hodgkin Non-Hodgkin
•  Malignancy of the •  Solid tumors of lymph form
re,culoensothelial/lympha,c from T and B cells
systems
•  Commonly found in the
•  Involves B cells intes,nal tract
•  Hallmark painless lymph node
•  Acute abdomen, pain,
•  Chronic cough disten,on, fullness, and
•  Fever, ê appe,te, ê weight, cons,pa,on
night sweats
•  Nontender lymph node
•  CBC, sed rate, CRP, ferri,n
enlargement
level
•  CBC, les, uric acid, CMP
•  U/A
•  MRI,CXR,CT, MRI, PET •  CT or MRI imaging

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