NCLEX Review Guide: Pediatric Aplastic Anemia

Understanding Aplastic Anemia

• Aplastic anemia is a rare condition where the bone marrow fails to produce adequate blood cells (pancytopenia), affecting red blood cells, white blood cells, and platelets.
• In children, it can be acquired (70-80%) or congenital (20-30%), with acquired forms often triggered by viral infections, medications, or toxins.
• The condition results in a hypocellular bone marrow with fatty replacement of hematopoietic tissue.

Clinical Manifestations

• Bleeding manifestations: Petechiae, ecchymoses, epistaxis, and prolonged bleeding from minor trauma due to thrombocytopenia (platelet count <20,000/μL).
• Anemia symptoms: Progressive fatigue, weakness, pallor, shortness of breath, and decreased exercise tolerance from low hemoglobin levels.
• Infection susceptibility: Recurrent or severe infections, fever, and delayed wound healing due to neutropenia (ANC <500/μL).

Priority Nursing Interventions

1. Infection prevention: Implement strict hand hygiene, private room placement, and limit visitors to prevent opportunistic infections.
2. Bleeding precautions: Use soft-bristled toothbrush, avoid invasive procedures when possible, and monitor for signs of internal bleeding.
3. Activity modification: Balance rest with gentle activity to prevent fatigue while maintaining muscle strength and preventing complications of immobility.
4. Monitor vital signs frequently, especially temperature (early sign of infection) and signs of cardiovascular compromise from anemia.

Treatment Options

• Bone marrow transplantation (BMT): First-line treatment for severe aplastic anemia in children with HLA-matched sibling donor, offering 85-90% cure rate.
• Immunosuppressive therapy: Alternative when BMT unavailable, using antithymocyte globulin (ATG) and cyclosporine to suppress autoimmune destruction of stem cells.
• Supportive care includes packed RBC transfusions for severe anemia and platelet transfusions for bleeding episodes or platelet count <10,000/μL.