Hematologic disorders

- “blood dyscrasias”
- Occurs when components of the blood are formed incorrectly or
either increase or decrease in amount beyond normal range.
- Most blood dyscrasias in children originated in the bone marrow,
where the blood cells where formed.
Hematological system
- Consists of the blood, spleen, liver and bone marrow. Blood delivers
oxygen and nutrients to all tissues, removes wastes, and transports
gases, blood cells, immune cells, antibodies and hormones
throughout the body.
Function of hematological system
- Transport of:
o Gases, nutrients, waste products
o Processed molecules
o Regulatory molecules
- Regulation of ph and osmosis
- Maintenance of body temperature
- Protection against foreign substances
- Clot formation
The blood
1. Rbc
- Erythrocytes is the most common blood cells
- No nucleus
- Generally 6 to 8mm in diameter
- Takes about 20 secs to make a complete loop from the heart, to
tissue, back to the heart
- Their life span is about 100 to 120 days (they go to the speen to be
filtered)
2. Wbc
 - Leukocytes is one of the body’s defense
1. Neutrophils
2. Eosinophils
3. Basophils
4. Lymphocytes
5. Monocytes
3. Plasma
- Made of 90% of water, in which blood is suspended
- Allows the blood cells to travel through vessels
- Made up of minerals, nutrients, and electrolytes
- Platelets are cells critical for blood clotting
The blood volume
- 85 ml/kg at birth
- 75 ml/kg at 6 months of age
- 70 ml/kg after the first year.
Diagnostic test
1. Bone marrow aspiration
- It provides samples of bone marrow so the type and the quantity of
cells being produced can be determined.
- In children, the aspiration site used are the iliac crest and spine
- In neonates, the anterior tibia can be used as an additional site.
Bone Marrow Aspiration Procedure:
1. Following conscious sedation, a child lies prone on a hard surface
2. Topical anesthesia maybe applied to help reduce pain
3. Clean the area of aspiration with antiseptic solution and draped
4. The overlying skin is infiltrated with local anesthetic and then a large bore
needle and stylus is introduced through the overlying tissue in the bone
5. When the marrow cavity is reached, the stylus is removed, a syringe is
attached to the needle, and bone marrow is aspirated
 6. The syringe is then removed, and the marrow obtained is expelled onto a
slide, sprayed with preservative, and taken to the laboratory for analysis.
7. Apply pressure for 5 to 10 mins on the puncture site

Nursing Management of Bone Marrow Aspiration

I. FOR CONSCIOUS SEDATION
a. Monitor vital signs until the child is fully awake
b. Monitor pulse and blood pressure and observe the dressing every 15
mins for the first hour
c. Keep the child fairly quiet for the first hour by plying a quiet game or
other activity
d. Allow young children an opportunity for therapeutic play with a doll
and syringe to help them express their feelings

II. FOR AN AMBULATORY PROCEDURE

a. Instruct the parents to take the child’s temperature 12 and 24 hours
after the procedure to detect infection.
2. Blood Transfusion
- Transfusion of blood or its products are commonly used in the treatment of
blood disorders, and may include whole blood, packed RBCs, plasma,
plasma factors, platelets, WBCs, and albumin.
- Blood products are commonly infused wit isotonic solution (normal saline)
- PRBC are the most common form of transfusion used with children because
they help minimize the risk for fluid overload
BEFORE TRANSFUSION
a. Ensure a signed consent form is obtained that respects sociocultural or
religious beliefs.
b. Obtain a vital signs to establish a baseline and monitor these about every 15
mins in the first hour and then every 30 mins for the remainder of the
transfusion
c. Keep the infusion rate slow for the first 15 mins; then if no reaction occurs,
increase the rate to about 10ml/kg/hr or otherwise as prescribed.
d. Think of and provide an enjoyable activity for children during transfusion