Hematologic problems in pediatric patients

OBJECTIVE

To provide a review of the common hematologic disorders of childhood: iron deficiency anemia, aplastic anemia, sickle cell disease, and hemophilia.

DATA SOURCES

Review articles and book chapters pertaining to the care and treatment of children with hematologic disorders.

CONCLUSIONS

These common hematologic disorders of childhood have the potential to cause not only acute illness but chronic medical problems, particularly in the growing child. Anticipating and preventing the long-term effects of the illness and treatment are the primary goals of care.

IMPLICATIONS FOR NURSING PRACTICE

Nursing assessment, patient education, and long-term follow-up are major factors in the care of children with hematologic disorders. Nurse-managed comprehensive care clinics have provided successful programs directed at acute care and maintenance care for these children and their families.

GM-CSF clinical trials: pediatric aplastic anemia and Fanconi's anemia

Two clinical trials were undertaken to evaluate the effect of human recombinant granulocyte-macrophage colony stimulating factor (GM-CSF) in pancytopenic pediatric patients with aplastic anemia and Fanconi's anemia. In the aplastic anemia trial, 9 out of 12 patients had some improvement when treated with GM-CSF. In the Fanconi's anemia trial, 6 of 7 patients showed some improvement when treated with GM-CSF. For both groups, improvement in white blood cell count and absolute neutrophil count were the most common response. Side effects observed during these studies were fever, rash, urticaria, and flu-like symptoms. Nursing care of both groups focused on the effects of pancytopenia, as well as the potential adverse effects of GM-CSF. Patient education focused on teaching drug preparation and storage, subcutaneous injection, and potential side effects.