 Hello and welcome to nursing school explained. Today's topic are different anemias that we will be seeing in the pediatric setting. They will cover iron deficiency, sickle cell anemia and also hemophilia. So let's get started with iron deficiency anemia. Iron deficiency anemia is usually caused in infants by intake of cow's milk instead of breast milk. So unfortunately this happens mostly in patients of lower socioeconomic status where the mother might not be producing enough milk and they might not be able to afford formula and therefore feed the child cow's milk but this will deplete the iron stores and unfortunately lead to iron deficiency anemia. Keep in mind that cow's milk should be fed to children only after the age of 12 months. Iron deficiency can also be caused because of loss during growth periods and a big one here is lead poisoning. Unfortunately this is again mostly prevalent in children of lower socioeconomic status and lead still exists in pain in certain pipes and so forth and children that live in those kind of environments are more prone to iron deficiency anemia. And in adolescents unfortunately they have poor diets or they tend to have poor diets so sometimes that can also lead to iron deficiency. In terms of labs if we do suspect iron deficiency anemia certainly we'll want to monitor the hemoglobin and hematocrid, MCB and MCH to see how big those blood cells are and then ferritin and total iron binding capacity. Those are very specialized tests to assess specifically for iron deficiency anemia. Now what do we do if the patient is iron deficient? So first of all we need to increase dietary sources that should always be your number one treatment because we don't want to unnecessarily give the patient medication when it can just be solved with diet. If it's caused by cow's milk and the child is less than a year old certainly we want to provide some education to the parents to make sure and explain to them why cow's milk is not ideal for their infants and provide them with alternatives. Now iron-rich foods that's anything beef dark green leafy vegetables for children there is a lot of variety of enriched rice cereals with that are iron fortified so those are some good options. Now if it's not sufficient to replace the iron deficiency with dietary sources the patient will need to get iron supplements and iron supplements there are basically three to four things to consider. First of all they need to be taken on an empty stomach for best absorption and they cannot be taken within one to two hours of any other medications specifically not any other electrolytes such as calcium. We want to divide the doses for maximum absorption and that's true for most minerals and vitamins because our bodies can only absorb so much at a time so it's always best to give the iron supplements BID rather than just once a day. We want to give it with a source of vitamin C to increase absorption. If there's not enough vitamin C in the diet or at the time that the patient takes the iron supplement only a very low percentage of iron will be absorbed and the easiest way in children is to give it to them with a glass of orange juice. I wrote here with with an exclamation mark teeth staining because in the pediatric population we do administer medications mostly in liquid form and it's a black kind of a thick charcoally kind of a medication so if they drink that then it can cause some teeth staining so we want to advise the parents to have the child drink through a straw to kind of bypass the oral cavity and avoid the teeth staining. Side effects of iron supplements include constipation and black soles so this is something that we want to educate the parents on so in order to avoid constipation make sure your child stays hydrated as well as increase the fiber in their diet and then we want to educate them about the black stools because that might scare them because sometimes that can mean that there's bleeding in the GI tract but that's a common side effect of iron supplements and certainly if the cause for the iron deficiency anemia was lead poisoning we want to remove the lead from the environment. Moving on to sickle cell anemia so sickle cell anemia is a genetic disorder and I've drawn out the normal red blood cell and the sickle blood cell so a normal red blood cell is nice and round and it's kind of very pliable it's able to fit through tight spaces and blood vessels where the sickle cell is kind of a half moon shape as you can see here the other interesting thing about sickle cells is their lifespan is much much shorter so a typical red blood cells lifespan is about 120 days three months where some sickle cells might only have a lifespan of about 10 days and then what happens these sickle cells this is a blood vessel and they all clump together and they're not very pliable so they're very stiff and so they can cause an occlusion of the blood vessel and this occlusion puts the patient increased risk for any of those things that can cause problems when there's occlusion so that would be pulmonary embolus stroke myocardial infarction and any problems with any circulation anywhere also in the peripheries or the lower extremities they can have peripheral vascular issues and sores because of poor circulation there so this is something that we need to always think of and then certainly when this is happening when this blood vessel gets acutely occluded it's going to cause a lot of pain as for lab tests there's a special test called the sickle turbidity test and hemoglobin electrophoresis sickle cell disease is one of those things that is typically tested for in the very early postnatal period so that we can find out if this child is at risk or if the parents are known to be carriers then certainly this is something that would need require genetic counseling before the parents decide to have a child now treatment and nursing considerations so if the patient is in an acute sickle cell crisis so now the sickle cells they've clumped together they've caused this occlusion the best management is IV fluids to kind of dilute this clot and cluster of blood cells that we have here give them fluids make them flow long provide oxygen because again there is no blood flow this this told to that occlusion so we want to provide oxygen to get some more oxygen into the cells and then pain management remember we said there's a lot of pain involved when there's a blood vessel occluded because again there's ischemia and then eventually there will be tissue infarction when there when the blood flow completely seizes as for teaching that's those are important nursing considerations in patients with sickle cell anemia they want to avoid extreme temperatures cold or hot as well as dehydration for obvious reasons it makes the sickle cells more prone to clumping together they should also avoid tight clothing or jewelry to make sure that that doesn't occlude the blood vessels strenuous exercise although so they can still participate in sports and activities that are not necessarily strenuous are still very much encouraged just like in any child that does not have sickle cell disease smoking certainly we should avoid that because it causes a base of constriction could cause some problems here and then high altitudes because there is just less oxygen available and that can make them prone to having a crisis as for medical treatment there is a medication called hydroxyurea that the patients sometimes get prescribed they might need a bone marrow transplant and they might also need transfusions because we know that that lifespan is so much shorter than of a regular red blood cell now if we move on over here to hemophilia so hemophilia is a disorder that affects the clotting factors and most common clotting factor deficiency is factor eight remember from your pathophysiology background that there's several different clotting five clotting factors that help in the coagulation cascade and that's the intrinsic and extrinsic pathway and when we're missing these clotting factors we're going to be prone to bleeding so hemophilia also is a genetic disorder and certainly we already talked about that for labs we want to assess the clotting factors so how which ones do they have and how much of them and then we want to check the coagulation times by checking the pro-thrombin time and then their aptt and certainly also the inr because we want to see how are they clotting and how is that going to play a role in them to be able to stop the bleeding if they're now in a hemophilic crisis nursing considerations so when a patient with hemophilia is admitted we want to avoid punctures for IVs, IMs and lab draws so they might need a central line where we can access this line for multiple purposes rather than puncturing the skin every single time we need a drop of blood from this child because that might they might not stop bleeding due to the deficiency of the clotting factors now then we're going to have to replace the clotting factor and I wrote in parenthesis here it is a blood product so all the measures that you would take for blood transfusion would would definitely play a role be a consideration here as well and then children with hemophilia we want to tell them to avoid activities that increase their risk of bleeding certainly that makes common sense we want to make sure that this is not necessarily a rugby player or somebody who likes to play football or ride motocross where there's a high risk for injury high risk for collision because if that happens they might they might have very poor consequences from traumatic injury and then certainly want to handle them very gently for all those reasons that we already talked about now for hemophilia what can happen children tend to play and run around and fall so sometimes they fall and they injure a joint most likely it's going to be a knee and then what happens that joint capsule on the inside kind of bursts and there's a little bit of bleeding not generally it would cause a little bruising a little swelling in a normal child but in a child with hemophilia that can certainly cause this joint to be extremely swollen and the blood basically just escapes there's some bleeding inside the joint and then the treatment for that is that you want to immobilize that in that joint with let's say a knee mobilizer for the knee and certainly do all those other measures that you would do for for an injury so wrist, eyes, compression and elevation so thank you for watching this review of the different pediatric anemias I hope it has helped you get a better understanding of this topic and I will see you next time thanks for watching nursing school explained