This document provides information about megaloblastic anemia in children through a seminar presentation. It begins with an overview of hematology and the components of blood. It then discusses the causes of megaloblastic anemia as deficiencies in vitamins B12 and folic acid. The pathophysiology is described as impaired cell division leading to enlarged red blood cells called megaloblasts. Clinical manifestations include weakness, pale skin, and neurological issues. Diagnostic tests include blood counts and smears to examine red blood cells. Management involves vitamin B12 or folic acid supplementation through oral or injectable routes. Nursing care focuses on risks of ineffective tissue perfusion and activity intolerance due to anemia.
hemolytic disease of new born is an aquire alla immune hemolytic anemia characterize by production extravascular destruction of RBC within the spleen of new born baby resulting anemia, positive coomb,s test
hemolytic disease of new born is an aquire alla immune hemolytic anemia characterize by production extravascular destruction of RBC within the spleen of new born baby resulting anemia, positive coomb,s test
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Before transfusing blood in a newborn, we have to understand the basic physiology and unique features of newborn blood groups. This presentation aims to simplify the same.
Hemophilia is a genetic bleeding disorder in which body loses the ability to stop bleeding due to low levels or absence of proteins known as ‘’clotting factors’’ which are necessary for clotting of blood. Hemophilia leads to excessive bleeding.
Aplastic anemia is one of the stem cell disorder which leads to pancytopenia in the peripheral blood and decrease production of all cell line in bone marrow. it require bone marrow transplantation to cure the patient.
A presentation made about Sickle cell disease by Yara Mostafa, Yasser Osama, Yaser Mostafa ,Ain shams university, Medicine faculty, first year students.
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the practice of training people to obey rules and behave well.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
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Normal defecation is painless, resulting in passage of soft, formed stool
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Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
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FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
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VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
2. HEMATOLOGY
• Study of blood and blood forming
tissues
• Key components of hematologic
system are:
– Blood
– Blood forming tissues
• Bone marrow
• Spleen
• Lymph system 2
5. ERYTHROCYTES / RED BLOOD CELLS
• Composed of hemoglobin
• Erythropoiesis = RBC production
– Stimulated by hypoxia
– Controlled by erythropoietin (Hormone synthesized in
kidney)
• Hemolysis = destruction of RBCs
– Releases bilirubin into blood stream
– Normal lifespan of RBC = 120 days
9. BONE MARROW
– Soft substance in core of bones
– Blood cell production (Hematopoiesis): The production of all
types of blood cells generated by a remarkable self-regulated
system that is responsive to the demands put upon it.
• RBCs
• WBCs
• Platelets
9
10. LIVER
Receives 24% of the cardiac output
(1500 ml of blood each minute)
Liver has many functions
Hematologic functions:
– Liver synthesis plasma proteins including clotting factors and
albumin
– Liver clears damaged and non-functioning RBCs/erythrocytes
from circulation
11. SPLEEN
• Located in upper L quadrant of abdomen
• Functions
– Hematopoietic function
• Produces fetal RBCs
– Filter function
• Filter and reuse certain cells
– Immune function
• Lymphocytes, monocytes
– Storage function
• 30% platelets stored in spleen
12. DETERMINATION OF RBC INDICES
• RBC count (RBC) - RBC’s / 100 mL of Blood = 4.5-5.0 Million / 100 mL
• Hematocrit (Hct) - % of (RB) Cells By Volume = 36-45%)
• Hemoglobin (Hgb) - mg / 100 ml of Blood = 13-15 mg/dL)
• Mean Corpuscular Volume (MCV)
– Hct/RBC - Normal = 90 (+- 10) cubic microliter
• Mean Corpuscular Hemoglobin (MCH)
– Hgb/RBC - Normal = 30 (+- 3) picograms
• Mean Corpuscular Hgb Concentration (MCHC)
– Hgb/Hct - Normal = 33 (+- 2) %
13. INTRODUCTION
• In megaloblastic anemia,
there is a decrease in red
blood cells.
• The cells are too large and
may be abnormally shaped.
• Having too little of the
vitamins folic acid or B-12 are
common causes of
megaloblastic anemia.
14. DEFINITION
• Megalosblastic anemias are
characterized by the
presence of enlarged red
cells (megaloblasts) due to
the impaired cell division.
Because the erythrocytes
that reach the circulation are
enlarged, a macrocytic and
normochromic anemia
results.
15. CAUSES
There are many causes of megaloblastic anemia. The most
common cause in children is LACK OF FOLIC ACID OR
VITAMIN B-12. Other causes include:
Digestive diseases. These include celiac disease, chronic
infectious enteritis, and enteroenteric fistulas. Pernicious anemia
is a type of megaloblastic anemia. It’s caused when the body
can't absorb vitamin B-12..
Inherited congenital folate malabsorption. A genetic problem
in which infants can’t absorb folic acid.
16. CONT….
• Medicines. Certain medicines, like those that prevent
seizures, can interfere with how folic acid is absorbed.
• Diet. Certain restrictive diets can lead to low levels of folate or
B-12 because the child does not get enough of these
nutrients.
17. PATHOPHYSIOLOGY
Mitosis or cell division can’t occur
the marrow precursors remain enlarged which are termed as MEGALOBLASTS.
Mitosis in the progenitor lines is suppressed
Hyperplasia occurs
Due to Vitamin B12 and Folic acid deficiency
Erythrocyte’s DNA synthesis is affected
19. VITAMIN B12 DEFICIENCY
• Vitamin B12, also known as cobalamin, is not synthesized
in the tissues.
• Thus, the body relies on the dietary intake of meat, liver,
seafood and dairy products to supply our needs.
• The body stores more than a 3-year supply of vitamin B12
in the liver.
20. CLINICAL MANIFESTATIONS
• Weakness
• Listless
• Pale
• Smooth sore red tongue and diarrhea
• Neurologic manifestations (confusion, paresthesia, paralysis,
severe neuropathy)
21. CONTI…
• Pale or yellow skin
• Fast heart beat
• Shortness of breath
• Lack of energy, feeling tired
• Decreased appetite
• Irritability or fussiness
• Hair color changes (rare)
• Stomach upsets, nausea,
diarrhea, gas, constipation
• Trouble walking
• Numbness or tingling in
hands and feet
• Smooth and sore tongue
• Weak muscles
23. • Hemoglobin and hematocrit. This is often the first screening
test for anemia in children. It measures the amount of
hemoglobin and red blood cells in the blood.
• Complete blood count, or CBC. A complete blood
count checks the red blood cells, white blood cells, blood
clotting cells (platelets), and sometimes, young red blood cells
(reticulocytes). It includes hemoglobin and hematocrit and
more details about the red blood cells.
• Peripheral smear. A small sample of blood is examined under
a microscope. Blood cells are checked to see if they look
normal or not.
• Other blood tests. For example, your child may need bilirubin
or other liver tests, folate and B-12 blood tests, and iron
tests.
24. MANAGEMENT
• Vitamin B12 replacement
• Oral supplementation if the cause is inadequate cobalamin intake.
• In cases of defective absorption or absence of intrinsic factor, replacement
is by intramuscular (IM) injection of Vitamin B12.
25. FOLIC ACID DEFICIENCY
Folic Acid is another vitamin that
is necessary for normal red blood
cell production.
It is stored in the body as folates.
The dietary sources of folate are
meats, eggs and leafy vegetables.
Body stores of folic acid provide a
five-month period of tolerance
from proven deficient folic acid in
the diet.
26. COMPLICATIONS
• Problems with growth and development
• Fatigue
• Poor exercise tolerance
• An enlarged heart or heart failure, if the
anemia is severe
27. NURSING MANAGEMENT
• Risk for ineffective tissue perfusion (peripheral) related to decreased
Hb concentration in the blood as manifested by decreased
hemoglobin
• Activity intolerance related to insufficient oxygen delivery to the body
parts secondary to production of abnormally large RBC as evidenced
by body weakness
• Knowledge deficit related to lack of information resources as
manifested by verbalization of situation reflecting ignorance.