Chapter 27: Blood, Lymphatic & Hematologic Disorders

Blood, Lymphatic & Hematologic Disorders educational summary explores the complex nursing care required for pediatric patients with disorders of the blood, blood-forming organs, and lymphatic system, providing a deep dive into hematological pathophysiology and essential clinical interventions. The chapter begins by outlining the components of the hematological system, including the formation of erythrocytes, leukocytes, and thrombocytes via hematopoiesis, and transitions into the management of anemias. It details the prevalence and prevention of iron-deficiency anemia, emphasizing the role of nutritional counseling and the proper administration of iron supplements to avoid staining teeth or interfering with absorption. Significant attention is given to Sickle Cell Disease, an inherited defect in hemoglobin formation that causes red blood cells to clump and obstruct vessels; the summary covers the various types of crises—such as vasoocclusive, splenic sequestration, and aplastic crises—and critical nursing priorities including hydration, oxygenation, pain management (specifically noting the contraindication of meperidine), and the use of hydroxyurea. The text then examines Thalassemia, specifically Thalassemia Major or Cooley's anemia, describing the characteristic skeletal changes caused by marrow expansion and the management of hemosiderosis through chelation therapy. The discussion moves to coagulation disorders, detailing the X-linked recessive nature of Hemophilia A and B, the hallmark symptom of hemarthrosis (bleeding into joints), and the administration of Factor VIII or IX. Platelet disorders such as Idiopathic Thrombocytopenic Purpura (ITP), an autoimmune response leading to petechiae and purpura, and Henoch-Schönlein Purpura are also reviewed. The chapter further addresses pediatric oncology, focusing on Leukemia—the most common form of childhood cancer—where uncontrolled proliferation of immature white blood cells (blasts) leads to neutropenia, anemia, and thrombocytopenia. Key nursing challenges such as infection control, bleeding precautions, and chemotherapy management are highlighted alongside Hodgkin's disease, which is identified by the presence of Reed-Sternberg cells. Finally, the summary encompasses the psychosocial aspects of caring for the chronically ill and dying child, utilizing Kubler-Ross’s stages of dying (denial, anger, bargaining, depression, acceptance) to guide nurses in providing compassionate, developmentally appropriate support to both the child and their grieving family.