Question

john a four years old boy is admitted to the pedoatric ward with a temperature of 38 degrees celsius, RDT, pallor, Hb level 4.5g/dl.

1)what will be ypur diagnoses?

2)describe the care from admission to discharge

3)how can his condition be prevented generally?

Answer 1

1. The child is suffering from aplastic anemia, is a disease in which patient has peripheral blood pancytopenia(decrease of all blood cells including RBCs, WBCs, platelets)ad hypocellular bonemarrow. It can manifest abruptly (over days) or insidiously over weeks to months and can vary from mild to severe. General manifestations such as fatigue, dypnea, pallaor and other cardiovascular as well as cerebral responses may be seen. The patient with neutropenia (low neutrophil count) is susceptible to infection and is at risk of septic shock and death. Even a low grade fever above 100.40 F or 38 degree clesius is considered to be a medical emergency

2.Management of aplastic anemia is based on identifying and removing the causative agents and providing the supportive care until the pancytopenia reverses

The diagnosis is confirmed by laboratory studies . Because all marrow elements are affected, hemoglobin, WBC, platelet values are often decreased in aplastic anemia. Other RBC indices are generally normal therfore classified as normocytic normochromic anemia. The reticulocyte count is low. Bleeding time is prolonged

Medical management includes

Hemopoetic Stem Cell Transplantation(HSCT) and immunosuppresive therapy with antithymocyte globulin (ATG) and high dose cyclophosphamide or cyclosporine

patient who need ongoing supportive blood transfusion should be on an iron-binding agent to prevent iron overload

Caring for patients with neutropenia

• All members of the health care team have important roles in preventing infection in the patient with neutropenia
• Careful handwashing is an important preventive measure and should be done before,during and after patient care by everyone caring for the patient
• Determine the type of isolation precautions that need to be initiated if any
• Assess patient for subtle signs of infection such as confusion or fatigue
• Screen visitors for infectious diseases
• Communicate with nutrition services to eliminate undercooked meats form patient diet
• Teach the caregivers about how to avoid infection, including the need for skin care and oral hygiene
• Administer antibiotics and hematopoetic growth factors as prescribed
• Check the skin, oral mucosa , and perineal area for signs of infection
• Teach the caregivers about signs and symptoms of infection and to report promptly to a health care facility if it occurs

To preserve energy

• Encourage alternate rest and activity periods to provide activity without tiring the patient
• Monitor cardiorespiratory response to activity such as dyspnea, diaphoresis,pallor to evaluate activity intolerance

3.There are two types of aplastic anemia- congenital and acquired

Acquired aplastic anemia occurs due to exposure of certain chemical agents and toxins (benzene,insecticides, arsenic and acohol) and radiations, usage of certain medications such as alkylating agents, antisezuire drugs, antimetabolites, antimicrobials,gold), due to certain viral infections (hepatitis and parvovirus)

By avoiding exposure to radiations, medications and viral infections one can prevent this disease