PEDI | Hematology P1 (NO Drugs)

1. Major Hematologic Disorders• Iron Deficiency Anemia: The most common anemia in children, often caused by excessive milk intake (>24 oz/day) displacing iron-rich foods. ◦ Management: Administer iron supplements (give with Vitamin C/juice, avoid milk) and limit milk intake. Stools may turn tarry green.• Sickle Cell Disease (SCD): Genetic disorder where HgbS replaces normal HgbA, causing RBCs to sickle, obstructing blood flow. ◦ Crisis Management: Prioritize hydration (1.5–2x maintenance), oxygenation, and pain control (opioids, NSAIDs). Medical emergency: Acute chest syndrome or splenic sequestration.• Hemophilia: X-linked recessive clotting deficiency (A=Factor VIII, B=Factor IX). ◦ Safety: Prevent bleeding (no contact sports, soft toothbrush). Treat bleeds with RICE (Rest, Ice, Compression, Elevation) and factor replacement.2. Pediatric OncologyUnlike adult cancers (epithelial/environmental), childhood cancers are largely embryonal (tissue-based), grow rapidly, and are highly responsive to treatment.• Leukemia (ALL/AML): The malignancy of bone marrow/blood. ALL is the most common. Diagnosis via bone marrow biopsy; lumbar puncture checks CNS involvement.• Solid Tumors: ◦ Wilms Tumor: Renal tumor. Never palpate the abdomen pre-op to prevent rupture/metastasis. ◦ Neuroblastoma: Neural crest tumor, often presents as an abdominal mass crossing the midline. ◦ Retinoblastoma: Signaled by "cat's eye reflex" (whitish glow in pupil).3. Critical Pharmacology & SafetyChemotherapy requires specialized handling due to toxicity.• Vincristine: A mitotic inhibitor. ◦ FATAL WARNING: For IV use only. Fatal if given intrathecally. ◦ Side Effects: Peripheral neuropathy (foot drop), constipation, vesicant (extravasation risk).• Methotrexate: Folate antimetabolite. ◦ Risks: Myelosuppression, hepatotoxicity, mucositis, renal failure (requires hydration/alkalinized urine). ◦ Rescue Agent: Leucovorin is used to neutralize toxic effects.• Daunorubicin/Doxorubicin: Anthracyclines. ◦ Risks: Severe cardiotoxicity (lifetime cumulative dose limits apply) and red/orange urine.• Etoposide: Topoisomerase inhibitor. ◦ Admin: Watch for hypotension during rapid infusion (infuse over 30–60 mins).• Prednisone: Corticosteroid used for induction/palliation. ◦ Side Effects: Hyperglycemia, mood changes, immunosuppression, Cushing’s syndrome. Must taper to avoid adrenal insufficiency.• Mesna: A cytoprotectant agent. ◦ Use: Must be given with Ifosfamide or Cyclophosphamide to prevent hemorrhagic cystitis (bladder bleeding).4. Nursing Priorities• Neutropenia: Infection is the leading cause of death. Calculate ANC; implement protective isolation if ANC <500. No fresh flowers/fruit; monitor temp closely.