Aplastic Anemia: Management (Pediatric Nursing)

by Paula Ruedebusch

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    00:00 How do we manage this? Well, blood transfusions.

    00:03 The treatment of aplastic anemia usually involves blood transfusions to control bleeding and relieve the anemia signs and symptoms.

    00:10 Blood transfusions aren't a cure, they can relieve the signs and symptoms by providing these cells that your bone marrow isn't producing.

    00:18 A blood transfusion can include packed red blood cells and this is transfusion of red blood cells to raise the red blood cell count.

    00:25 This is gonna help relieve the symptoms of anemia and fatigue.

    00:29 Platelets. Transfusions of platelets help prevent the excessive bleeding.

    00:33 Wwhile there's generally no limit to the amount of transfusions that can be given, there is a risk to receiving multiple transfusions.

    00:40 Transfused red blood cells contain iron that can accumulate in your body and can damage your vital organs with iron overload.

    00:46 Medications called chelating agents can help your body get rid of this excess iron.

    00:51 Over time, your body can also develop antibodies to these transfused blood cells making them less effective at relieving symptoms.

    00:58 The use of immunosuppressive medications can make this complication less likely.

    01:03 A stem cell transplant in patients with severe aplastic anemia.

    01:07 A stem cell transplant can offer the only successful treatment option.

    01:11 A stem cell transplant is also called a bone marrow transplant and this is generally the treatment of choice for patients who are younger and have a matching donor, most often a sibling If a donor is found, the diseased bone marrow is first depleted with radiation or chemotherapy.

    01:26 Healthy stem cells from the donor are filtered from the blood and these healthy stem cells are injected intravenously into the bloodstream where they can migrate to the bone marrow cavities and start making new blood cells.

    01:37 This procedure requires a lengthy hospital stay.

    01:40 After a transplant, the patient will continue to receive drugs to prevent rejection from these donated stem cells.

    01:46 Immunosuppressants.

    01:47 If a patient's aplastic anemia is due to an autoimmune disorder, or for patients who are not candidates for a bone marrow transplant, immunosuppression is used.

    01:57 These drugs suppress the activity of the immune cells that are damaging your bone marrow.

    02:01 This helps your bone marrow recover and generate new blood cells.

    02:05 These medications can be very effective at treating aplastic anemia but they can further weaken the immune system.

    02:11 It's possible for aplastic anemia to return once the patient stops this immunosuppressive therapy.

    02:17 Bone marrow stimulants.

    02:19 Certain drugs including colony-stimulating factors can help stimulate the bone marrow to make new cells.

    02:24 Growth factors are often used in combination with these immunosuppressive medications.

    02:30 Antibiotics and antivirals.

    02:32 Remember aplastic anemia weakens your immune system because of the decreased white blood cells.

    02:37 This leaves the patient susceptible to infections.

    02:40 Patients with severe aplastic anemia can take preventative antibiotic and antiviral medications.

    02:47 Patients with aplastic anemia need to make some lifestyle modifications.

    02:51 This includes resting when they need to.

    02:53 Remember anemia can cause fatigue and shortness of breath with even mild exertion.

    02:58 Encourage your patients to take a break and rest.

    03:02 Avoiding contact sports.

    03:04 Because of the risk of bleeding associated with the low platelet count, patients with aplastic anemia should avoid activities that can result in a cut and injury or a fall that might cause internal bleeding.

    03:15 Protecting themselves from germs.

    03:17 Patients can reduce the risk of infection through frequent handwashing and avoiding sick contacts.

    03:23 Complications of aplastic anemia are vast and include infections, bleeding due to the decreased platelet count, haemochromatosis because these patients are receiving frequent blood transfusions.

    03:36 This is when the extra iron builds up in the body and remember it can deposit in the liver, the heart and the endocrine system.

    03:42 Graft-versus-host disease.

    03:44 This is a common complication of the bone marrow and stem cell transplant.

    03:48 Now, graft-versus-host disease occurs when the donor's immune cells - so the graft actually attacks the recipient which is the host.

    03:56 The graft contains donor white blood cells called lymphocytes which distinguish between the cells in the body.

    04:02 During graft-versus-host disease, the new transplanted stem cells will believe that the host tissues are foreign.

    04:08 The new stem cells will go on the offense within the host body and will try to destroy the host tissues.

    04:14 Remember the recipient's immune system has been suppressed so that they can receive these transplanted cells, so the defenses are gone.

    04:22 The new stem cells can damage organs such as the liver skin or bowel.

    04:26 This is managed with corticosteroids such as prednisone and this will further suppress the immune system.

    04:32 Other immunosuppressants such as cyclosporin can be given This can help prevent and treat graft-versus-host disease.

    04:38 After the transplant, a child will take cyclosporin for about 6 months and these levels need to be monitored.

    04:44 Methotrexate. This is gonna stop the cells from dividing and making new cells.

    04:49 Methotrexate is used to prevent graft-versus-host disease following a bone marrow or stem cell transplant.

    04:55 Children who receive stem cells or bone marrow cells from a donor can receive 3 or 4 doses of methotrexate.

    05:01 Since this medication can cause mouth sores called stomatitis, good mouth care is important.

    05:07 Now here's an image of what actually happens in graft-versus-host disease.

    05:11 We see the donor has given their stem cells and these are the graft.

    05:15 These are gonna be transplanted into the recipient and they're going to start attacking the recipient's tissues, this includes the liver, the bowel and the skin.

    05:25 Patients with aplastic anemia can also have serious complications resulting in death.

    05:31 So what is the nursing management of aplastic anemia? Well, certain nursing diagnoses can be watching for the risk of injury or infection and helping your patient with their activity tolerance.

    05:43 The nursing care. You're going to administer medications.

    05:46 This may be blood transfusions or immunosuppressants You're gonna help your patient prevent infection, you're going to use aseptic technique when necessary and watch for bleeding.

    05:56 And you're gonna also educate your patient about potential complications.

    About the Lecture

    The lecture Aplastic Anemia: Management (Pediatric Nursing) by Paula Ruedebusch is from the course Blood Disorders – Pediatric Nursing. It contains the following chapters:

    • Management
    • Complications
    • Nursing Management

    Included Quiz Questions

    1. Blood transfusions
    2. Stem cell transplant
    3. Bone marrow stimulants
    4. Immunosuppressants
    5. Kidney transplant
    1. Rest when able
    2. Avoid contact sports
    3. Perform frequent handwashing
    4. Prevent dehydration
    5. Avoid people who are sick
    1. Hemochromatosis
    2. Pancytopenia
    3. Polycythemia
    4. Extracellular fluid

    Author of lecture Aplastic Anemia: Management (Pediatric Nursing)

     Paula Ruedebusch

    Paula Ruedebusch

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