aplastic anemia

 Aplastic Anemia

Aplastic anaemia occur due to marked reduction in precursor stem cells resulting in production of inadequate number of erythrocytes, leucocytes, and platelets.

Etiology

Aplastic anemia can be hereditary or acquired. Hereditary form of aplatic anemia called Fanconi's anemia.

1. Autoimmune suppression of blood cell production.

2. Toxin agent; benzene, insecticides, arsenic

3. Pharmacologic agent; 

Antibiotics; chloramphenicol, sulphonamide 

Anti-inflammatory agents

Anticonvulsants; phenytoin, carbamazepine

Antimalarials;quinine 

Oral hypoglycemic agent; tolbutamide

Pathophysiology

In fetus, hematopoiesis occurs in liver and spleen and after birth in bone marrow.

In bone marrow, stem cells differenciated in various types of blood cells. 

Any abnormalities in stem cells lead to pancytopenia (Decreased or Absent RBC, WBC, Platelets).

Clinical features

Occuring due to reduction in leucocytes, erythrocytes, Platelets.

1. Increase susceptibility to infections due to decreased WBC count.

2. Pallor, weakness, breathing difficulty due to decrease RBC count.

3. Increased brushing or long time to clot bleeding due to decreased platelet count.

Diagnostic Evaluation

1. History of children

2. Peripheral blood film

3. Complete Blood count

4. Bone marrow biopsy

Management

1. To provide symptomatic treatment

a. Platelet transfusion; if platelet count below 10, 000 cell/μl.

b. Paced red cells; if severe anaemia

c. Antibiotics; if infection occur due to decrease WBC count

2. Restore bone marrow function

3. Bone marrow transplantation or replacement; replace pathological bone marrow with normal tissue.

Nursing Management

Aim of nursing care; 

1. Prevent Bleeding and infection.

2. Manage problem related to anaemia.

A.Prevention of Bleeding 

1. Main skin integrity and prevent pressure sores

2.  Minimize venipuncture site,  collect all samples in one chance, using samall gauges needle.

3. Check platelet count before any invasive procedure.

4. Avoid intramuscular injection

5. Prevent Bleeding;

Keep mouth clean and remove debris, use of soft brush or mouth wash.

Avoid administration of rectal drug and avoid taking rectal temperature.

To stop bleeding from lips or nares; use of topical thrombin or epinephrine.

B. Prevention of Infection

Use barrier nursing technique

Limit the number of visitors

Strict hand washing practice before handling of children.

Infected person not handle the child.

C. Management of problems associated with anemia

Administred oxygen, if required

Administerd Packed red cells, if prescribed

Monitor the child's hemoglobin level.

Normal value of hemoglobin;

6-12years; 11.2-14.5g/dl

In adult male; 13.8 - 17.2g/dl

In adult female; 12.1-15.1g/dl

Monitor growth and development of children

Prode adequate rest and sleep.