Peds ch 27:2
What are the early symptoms of leukemia? Select all that apply.
Pallor; Low-grade fever; Enlargement of lymph nodes (Leukemia is associated with increase in the number of immature white blood cells resulting in the disruption of bone marrow. Pallor, low-grade fever, joint pain, abdominal pain, and enlargement of the lymph nodes are the symptoms of the early phase of leukemia. As the disease progresses, the patient may have liver and spleen enlargement. Therefore, these symptoms do not occur in the early phase of leukemia.)
The nurse is collecting the data on a child with iron-deficiency anemia who has been prescribed oral ferrous sulfate (Feosol). What instruction will the nurse give to the child's parents to ensure the safe administration of the medication?
"Administer it with orange juice." (Vitamin C increases the absorption of the iron supplements such as ferrous sulfate (Feosol) and helps to increase the iron level in the blood. Citrus fruits such as orange are a rich source of vitamin C, so the nurse may instruct the child's parents to administer ferrous sulfate (Feosol) to the child with orange juice to increase the absorption of the medication. The nurse will not instruct the parents to administer the medication with milk, because milk interacts with the iron supplements and decreases the absorption of the medication. The iron supplements cause nausea and vomiting and may interact with food. Therefore, the nurse should suggest the parents to administer the medication between meals, but not directly following meals. In general, medication should not be administered with cold water because it decreases the absorption and the metabolism of the medication. Therefore, the nurse will not instruct the patient to administer the medication with cold water.)
The nurse is teaching safety measures to the parents of a child with sickle cell anemia to prevent sickle cell crises. Which statement will the nurse include in the teaching?
"Avoid traveling with your child in an unpressurized air plane." (The child with sickle cell anemia has the risk of sickle cell crises due to hypoxia, dehydration, and infection. The nurse should suggest that the parents avoid traveling in an unpressurized airplane in order to prevent hypoxia. The nurse should advise the parents to give the child plenty of fluids to prevent dehydration. Iron supplements are of no use in the child with sickle cell anemia. Therefore, the nurse will not advise to give sickle iron supplements to the child. The child should not be encouraged to do excessive physical activity because it causes dehydration. Therefore, the nurse will not suggest that the parents encourage the child to do aerobics daily for two hours.)
The parents of a preschooler inform the nurse, "After the death of my elder son in a car accident, my younger son started blaming himself for it." What will be the best advice given by the nurse to the child's parents?
"Listen to your child and give him reassurance." (A preschooler does not understand the phenomenon of life and death and considers death as a temporary phase of life. The child may blame himself or herself for the death of his or her sibling. The nurse should advise the child's parent to listen to the child and provide reassurance. This intervention helps to prevent depression and to enhance the child's self-esteem. Involving the child in games and encouraging him or her to spend time with peers may distract the child for some time, but does not reduce the child's guilt. The child may develop distrust towards the parent if they give false assurance to the child. So, the nurse should not advise the parents to provide false assurance to the child by saying that his brother will be back soon. pg.638 health promotion)
The nurse is interacting with the parents of a child who is in the last stage of cancer. What can the nurse advise the parents to do to help reduce the family's anxiety? Select all that apply.
"You should ensure that your family tries to follow its normal routine."; "You should invite your child's friends over and encourage them to play."; "You should try meditation or guided imagery sessions." (Coping with a child in the last stages of a fatal illness can be overwhelming for a family. The family may find some comfort in trying to follow a normal routine to whatever degree that is possible. Inviting the child's friends to play may make the child happy, which can help relieve the family's distress and reduce anxiety. Attending meditation and guided imagery therapy may also bring stress relief for some people. The parents of the child have immense grief and anxiety due to the child's condition and it is important for the family to share this with one another. The nurse should not advise the family to be strong and hide their emotions as this will increase anxiety and distress. It is also important for the family to be honest with grandparents and other extended family about the child's condition as they may rely on the extended family for emotional support and help with day-to-day activities such as caring for the patient's siblings.)
The nurse is caring for a school-age patient whose sibling has died recently. Which instructions should the nurse give the parents to help this child cope with the loss? Select all that apply.
"You should respond to the security needs of the child."; "You should encourage your child to communicate."; "You should use simple terms to explain death to your child." (A school-age child who has recently lost a sibling may realize that death is final and may start fearing death, so it's important for the parents to respond to reassure the child and respond to the child's emotional security needs. A school-age child should be encouraged to communicate and share his or her feelings, which helps the child cope with the loss and reduce depression. A school-age child has the ability to understand the concept of death and the parents should be encouraged to discuss the topic with the child, but in simple terms a child can understand. Attending the funeral of a sibling is appropriate for a school age child and may be important in helping the young patient accept the loss, so the child should not be protected from the funeral. Routines bring comfort to children, but it may be difficult or impossible to completely maintain the child's normal routine following the death of a sibling. For a short time it may be more beneficial to allow the child to miss school and stay close to the parents so they can tend to his or her emotional and security needs immediately following the death.)
After studying the diagnostic reports of a child with sickle cell anemia, the nurse feels the child may require transfusion of freshly packed red blood cells (RBCs). Which type of sickle cell anemia did the nurse find in this child?
Aplastic crises (Based on the pathological cause, the symptoms and treatment of sickle cell anemia is classified into four types. Aplastic crises are associated with reduced bone marrow functioning resulting in the decreased production of red blood cells. Therefore, the child with aplastic crises has the risk of anemia and may require the transfusion of freshly packed red blood cells (RBCs). Vasoocclusive is associated with the obstruction of blood flow due to vasospasm. The child with vasoocclusive has severe abdominal pain and joint pain. Hemophilia is not a type of sickle cell anemia. Hemophilia is associated with the deficiency of clotting factors, but is not associated with a decrease in red blood cells. Splenic sequestration is a condition where a lot of sickle red blood cells get trapped in the spleen, which leads to increase in the size of the spleen. p625 27-1)
What is the classic symptom of idiopathic (immunologic) thrombocytopenia purpura (ITP)?
Bruising (The classic symptom of ITP is easy bruising, which results in petechiae and purpura. Approximately 30% of the patients also have nosebleeds. There may be recent history of rubella, rubeola, or viral respiratory infection.)
What are the signs and symptoms of transfusion reaction that a nurse should monitor as a patient undergoes a blood transfusion? Select all that apply.
Chills; Itching; Headache (The patient who undergoes blood transfusion may develop transfusion reaction due to antigen and antibody interaction. The signs and symptoms of transfusion reaction are chills, itching, and headache, and if these signs are detected the nurse should clamp off the tubing immediately. Dyspnea and dry cough are the symptoms of circulatory overload and are not caused by antigen and antibody reaction.)
The nurse is monitoring a child who is receiving packed red blood cells. The child develops headache, chills, itching, back pain, and fever. What is the priority nursing action in this situation?
Clamp off the tubing. (The child who is undergoing a blood transfusion may develop a transfusion reaction due to immunogenic response. The presence of symptoms such as headache, chills, itching, back pain, and fever indicate that the child has transfusion reaction. On observing these symptoms, the nurse should immediately clamp off the tubing to stop further transfusion and to prevent complications. Only after the tubing is clamped off should the LPN notify the registered nurse on duty. Methotrexate (MTX) is an anti-cancer medication which can be prescribed to treat leukemia, but it does not alleviate the symptoms of transfusion reaction. Flushing the tubing with saline helps to maintain an intact intravenous (IV) line, but this should be done only after the transfusion is stopped by clamping down the tubing.)
Which are characteristics of sickle cell anemia?
Clinical symptoms present around 1 year of life; Chronic anemia; Pale and tires easily; Potentially fatal crises can occur (Sickle cell disease symptoms do not appear until about 1 year of life. The child will have the characteristic, chronic anemia characterized by pale color and tiring easy. Sickle cell disease is a genetic defect, which cannot be prevented. It is identified early, and symptoms are treated. It is not caused by any trauma or hemorrhage.)
The nurse is collecting data on a child with thalassemia and learns that the child has to undergo frequent blood transfusions. Which medication would benefit this child?
Deferoxaminemesylate (Desferal) (Repeated blood transfusion causes excessive deposition of iron in the tissues and results in hemosiderosis. Deferoxaminemesylate (Desferal) increases the elimination of iron and prevents hemosiderosis, so the nurse may see this added to the child's prescription. Meperidine (Demerol) is an analgesic and it does not alleviate the side effects caused by frequent blood transfusion. Phenylbutazone (Butazolidin) does not eliminate the excess iron deposited in the body. Desmopressin acetate (DDAVP) is a nasal spray and is useful for increasing clotting factor VIII in the blood. It can be prescribed to a child with hemophilia, but not to this patient with thalassemia.)
The nurse is caring for a toddler with chronic illness. Which behavior does the nurse anticipate to observe in the toddler due to illness? Select all that apply.
Delay in toilet training; Impaired language skills; Decreased self-confidence (A toddler suffering from a chronic illness may have a delay in toilet training due to weakness and lethargy. Due to physical restrictions and reduced interaction with the people, the child may have impaired language skills. A child with a chronic illness may develop fear and anxiety that may decrease the child's self-confidence. Unlike an adolescent, the infant does not feel loss of control and may not have decreased compliance. Unlike the school-age child, the toddler may not have a sense of accomplishment and independence. Therefore, the nurse does not expect to find decreased compliance and a sense of accomplishment in the toddler due to illness.)
Upon reviewing the laboratory reports of a patient, the nurse finds that the patient has deficiency of clotting factor VIII. Which medication does the nurse expect to be prescribed for the patient?
Desmopressin acetate (DDAVP) (Desmopressin acetate (DDAVP) increases the factor VIII in the blood and prevents the risk of bleeding. Therefore, the nurse expects that the primary health care provider will prescribe Desmopressin acetate (DDAVP) to the patient. Aspirin (Acuprin) decreases the platelet count and increases the risk of bleeding. Meperidine (Demerol) is an analgesic that helps to relieve pain. It does not increase the clotting factors, nor does it prevent bleeding. Deferoxamine mesylate (Desferal) enhances the elimination of excess iron from the body and alleviates the symptoms of hemosiderosis. It does not reduce the risk of bleeding in the patient.)
A child's parents report to the nurse that their child has severe bruising from a minor injury. The laboratory reports of the child indicate a prolonged partial thromboplastin time and normal platelets count. Which medication does the nurse expect to be prescribed for the child?
Desmopressin acetate (DDAVP) (The presence of severe bruising from minor injuries indicates that the child has impaired clotting. The clotting process may be hindered either due to decrease in the platelets or deficiency of the clotting factors. Here, the child has prolonged partial thromboplastin time, which indicates that the child has deficiency of the clotting factor VIII and has hemophilia A. Desmopressin acetate (DDAVP) is a nasal spray that increases the levels of the clotting factor VIII in the blood and prevents bleeding. Therefore, the nurse expects that the primary health care provider will prescribe Desmopressin acetate (DDAVP) to the child. Meperidine (Demerol) is an analgesic which does not prevent bleeding. Methotrexate (Trexall) is an antimetabolite which helps to treat cancer, but not bleeding disorders such as hemophilia A. It does not increase the clotting factors or prevent the risk of bleeding. Deferoxamine mesylate (Desferal) eliminates excess of iron from the body, but does not increase the clotting factor VII in the body. Therefore, the primary health care provider will not prescribe Deferoxamine mesylate (Desferal) to the child.)
Between which two ages does the highest incidence of iron-deficiency anemia occur?
Desmopressin acetate (DDAVP)9 and 24 months (The highest incidence of iron-deficiency anemia occurs from the ninth to the 24th month. During this rapid growth period, the infant outgrows the limited iron reserve that was in the body; in addition, iron-fortified formula and infant cereals may have been eliminated from the diet.)
The positron emission tomography (PET) scan of a patient with Hodgkin's disease reveals enlarged lymph nodes on both the sides of the diaphragm. This finding tells the nurse the patient is in which stage of the disease?
III (The stage of Hodgkin's disease should be determined before planning the treatment. Stage III disease is characterized by enlargement of lymph nodes on both sides of the diaphragm. The patient who is in Stage I of Hodgkin's disease is usually asymptomatic. Stage II is characterized by enlargement of lymph nodes on the same side of the diaphragm. Stage IV Hodgkin's disease is the enlargement of multiple lymph nodes in the body. pg633)
While caring for a preterm infant, the nurse determines that the infant has a risk for bacterial infection. Which finding would support the nurse's concern?
Immature T-cell activity (T-cells or T-lymphocytes play an important role in the immune system and protect the body from infections. The immune system of the preterm infant is not well developed however, resulting in immature T-cell activity, which increases the risk of infection. Therefore, the presence of immature T-cell activity would tell the nurse that the infant has a risk for infection. Vitamin K plays a role in clotting, but does not prevent infection, so a low vitamin K level would not tell the nurse the infant has an increased infection risk. Hemoglobin and RBCs help to carry oxygen to different organs, but they do affect immunity, so increased amounts of these substances do not increase the risk of infection.)
What is the most common form of childhood cancer?
Leukemia (Leukemia is the most common form of childhood cancer. It was considered fatal in the past, but the prognosis has improved greatly with modern treatments and medication. Approximately 2000 new cases of childhood leukemia are diagnosed in the United States every year.)
Which body part is primarily involved in the production of red blood cells in the fetus before birth?
Liver (Erythropoietin is a hormone that regulates the production of the red blood cells (RBCs). Before birth, it is mainly produced in the liver and promotes erythropoiesis. Therefore, the liver is the organ which is primarily involved in the production of the red blood cells in the fetus. During childhood, the red blood cells are produced by the bone marrow of the long bones such as the tibia and femur. After birth, the erythropoietin production occurs predominantly in the kidneys and is involved in the formation of the red blood cells.)
The primary health care provider prescribes meperidine (Demerol) to a child to relieve abdominal pain. During data collection, the nurse finds that the child has sickle cell anemia. After being notified of this, the primary health care provider instructs the nurse to avoid meperidine (Demerol). What could be the reason for such instruction?
Meperidine (Demerol) causes seizures (The patient with sickle cell anemia will have severe abdominal pain. The other symptoms include leg pains and swollen joints. Meperidine (Demerol) is a pain reliever, but it should not be given to a child with sickle cell disease because it induces seizures. Fever, diarrhea, and weight gain are not the side effects of meperidine (Demerol).)
The nurse is caring for a 5-year-old child with leukemia admitted to the hospital with the primary diagnosis of pneumonia. What does the nurse suspect as most likely cause of this child's pneumonia?
Neutropenia (Four priority challenges in the care of leukemic children are complications of anemia from decreased red blood cell infection, infection from neutropenia, bleeding from decreased platelets, and fractures resulting from the involvement of the bone marrow. p.631 nursing tip)
What are the symptoms of thalassemia minor? Select all that apply.
Pale color; Mild anemia; Enlargement of the spleen (Thalassemia is a hereditary blood disorder, which is associated with the rapid destruction of the abnormal red blood cells and the deficiency of hemoglobin. Thalassemia minor is associated with mild anemia due to which the patient has symptoms such as pale color of the skin, mild anemia, and enlargement of the spleen. Unlike thalassemia major, thalassemia minor is not associated with the increase in bile functioning and dental disorders. Therefore, jaundice and protrusion of the teeth are the symptoms of thalassemia major, but not thalassemia minor.)
The nurse is collecting data on a child who is undergoing a tonsillectomy. Upon reviewing the child's medical history, the nurse finds that the child has sickle cell disease. Which medication would the nurse likely see as part of the patient's treatment regimen?
Penicillin (Pen-Vee K) ( A child with sickle cell disease has impaired immune functioning and has an increased risk of infections. Therefore, before performing invasive procedures like a tonsillectomy, the primary health care provider would prescribe antibiotics like penicillin (Pen-Vee K) to the child to prevent risk of bacterial infection. Meperidine (Demerol) should not be prescribed for the child with sickle cell disease because it increases the risk of seizures. Aminocaproic acid (Amicar) is an antifibrinolytic agent and controls bleeding. It is prescribed to patients with hemophilia, but not sickle cell anemia. Deferoxaminemesylate (Desferal) decreases the iron levels by increasing the elimination of iron through the kidneys, and it therefore, should not be prescribed to the child with sickle cell anemia.)
The nurse is collecting data on a child with acute lymphoid leukemia (ALL) who is on chemotherapy. The nurse observes the child has a moon-like face and confirms with the child's parent that this is not how the child normally appears. Which medication does the nurse expect to cause this symptom in the child?
Prednisone (Deltasone) (Prednisone (Deltasone) is a corticosteroid which is prescribed for the treatment of acute lymphoid leukemia (ALL). It causes accumulation of fluids and gives a moon-shaped appearance to the child's face. Methotrexate (Trexall) and 6-mercaptopurine (Purinethol) are antimetabolites that help to treat cancer by preventing excess cell division. These may cause anuria, anemia, and bone marrow, but do not cause the accumulation of fluids and moon-shaped face in the child. Vincristine sulphate (Vincrex) prevents the formation of the immature white blood cells and alleviates the symptoms of ALL. Its side effects are nausea, vomiting, and alopecia.)
The nurse is collecting data on a patient who has undergone treatment for breast cancer. The nurse finds that the patient has a recurrence of breast cancer. Which component of chemotherapy does the nurse expect to be initiated for the patient?
Reinduction therapy (Chemotherapy includes five components that include induction period, prophylaxis, maintenance, reinduction therapy, and extramedullary disease therapy. Reinduction therapy is initiated for the treatment of the recurrence of the cancer. During this therapy, the primary health care provider prescribes two or more chemotherapeutic agents to provide synergistic effect and to alleviate the symptoms of cancer. In the maintenance phase, the primary health care provider prescribes medications to reduce the risk of recurrence. The induction period is initiated for the remission of the early symptoms of breast cancer, but not the relapse of the cancer. The primary health care provider will prescribe extramedullary disease therapy if the patient has myeloma cells outside the bone marrow.)
A child with acute lymphoid leukemia (ALL) is on chemotherapy. During the follow-up visit, the nurse finds that the child is not responding to the chemotherapy. Which of these will be the best treatment strategy for the child?
Transplanting hemopoietic stem cell (Transplantation of hemopoietic stem cells may be the best treatment strategy for a child with ALL who is unresponsive to chemotherapy. The hemopoteic stem cell has the ability to transform itself into any of the blood cells and improves the functioning of the bone marrow, so it helps to alleviate the symptoms of ALL. Anti-D antibody prevents immunogenic responses, but does not alleviate the symptoms of ALL. Procarbazine hydrochloride (Matulane) and a combination of cyclophosphamide and vincristine (Oncovin) are effective for the treatment of Hodgkin's disease, but they do not prevent the formation of immature white blood cells in a patient who is resistant to chemotherapy.)
While collecting data on a child the nurse observes that the patient has abdominal distention, abnormal facial contours, protruding teeth, pale skin, and shows signs of anorexia. The laboratory reports indicate that the child has liver and spleen enlargement. Which disorder does the nurse expect to find in the child?
Thalassemia (Thalassemia is a hereditary blood disorder that is associated with the destruction of abnormal red blood cells (RBCs). Abdominal distention, changes in facial contour, protruding teeth, anorexia, and pale skin are signs and symptoms of thalassemia. Thalassemia also causes enlargement of the liver and spleen. Leukemia is a malignant disease of the blood-forming organs of the body that is associated with uncontrolled growth of immature white blood cells (WBCs). Petechiae, purpura, vomiting, weight loss, and dyspnea are the signs and symptoms of leukemia. Hemosiderosis is caused by excessive deposits of iron in the organs and tissues. Hodgkin's disease is a malignancy of the lymph system, which is marked by sudden weight loss, night sweats, general malaise, rash, and itching.)
Which condition is associated with the destruction of abnormal red blood cells (RBCs)?
Thalassemia (The RBCs of patients with thalassemia are abnormally sized and shaped and, as a result of the abnormality, they're rapidly destroyed by the body. Anemia is associated with a decrease in hemoglobin levels due to the deficiency of iron, but this condition does not cause the destruction of RBCs. Leukemia is a malignant disease that is associated with uncontrolled growth of immature white blood cells (WBCs), but is unrelated to red blood cells. Hemophilia is a hereditary disease that is associated with a deficiency of clotting factors but it does not cause the destruction of RBCs. p627 pic)
The nurse is collecting the data on a child who has severe abdominal pain and convulsions. The nurse finds that the child has muscle spasms, swollen joints, and stiffness. The laboratory reports of the child show that hematuria and hemoglobin level is 7 g/dL. What does the nurse infer from these findings?
The child has sickle cell anemia. (Sickle cell anemia is an inherited disorder which is characterized by abnormal, rigid, and sickle-shaped red blood cells along with hemoglobin. Muscle spasms, swollen joints, hematuria, stiff neck, and convulsions are the symptoms of sickle cell anemia. The patient with sickle cell anemia may have severe abdominal pain and hemoglobin levels less than 9 g/dL. Hemophilia A is caused by the deficiency of the clotting factor Vlll. Christmas disease or hemophilia B is associated with the deficiency of the clotting factor IX. Thrombocytopenia purpura is a bleeding disorder that is associated with the destruction of the platelets caused due to an immunogenic reaction. Therefore, these disorders are not associated with any decrease in the hemoglobin levels.)
The nurse is collecting data on a child who is presenting with severe headache, vomiting, and disorientation. The laboratory reports show a deficiency of coagulation factor VIII. What will the nurse anticipate from these findings?
The child may have cranial bleeding. (Deficiency of coagulation factor VIII indicates that the child has hemophilia A and increased risk of bleeding. Severe headache, vomiting, and disorientation indicate that the child has cranial bleeding. Petechiae, purpura, vomiting, weight loss, and dyspnea are signs and symptoms of leukemia. The signs and symptoms of Hodgkin's disease are presence of painless lump on the back, low-gradefever, anorexia, unexplained weight loss, night sweats, and general malaise. Therefore, the nurse does anticipate that the child has leukemia or Hodgkin's disease. If the child has paralysis then the nurse would anticipate that the child has spinal column bleeding.)
The primary health care provider prescribes recombinant coagulation factor IX (Rixubis) for a 17-year-old patient. What does the nurse understand as the reason for prescribing this medication?
The patient has hemophilia B. (Hemophilia B is a bleeding disorder associated with the deficiency of the clotting factor IX. The recombinant coagulation factor IX (Rixubis) increases the level of the clotting factor IX and helps to prevent bleeding in the patient with hemophilia B. It is prescribed only to the patient who is older than 16 years. The primary health care provider will not prescribe the recombinant coagulation factor IX (Rixubis) to a patient with leukemia because it does not affect the number of the white blood cells. A patient with Hodgkin's disease does not have deficiency of the clotting factor IX, so the recombinant coagulation factor IX (Rixubis) will not be prescribed for the patient. Recombinant coagulation factor IX (Rixubis) does not increase the iron levels, so the primary health care provider will not prescribe it to a patient with iron-deficiency anemia.)
Where do red blood cells (RBCs) form in a child? Select all that apply.
Tibia; Femur (During childhood, the RBCs form in the bone marrow of long bones, such as the tibia and femur, because these bones contain stem cells for RBCs. During adolescence, the RBCs form in the bone marrow of the ribs, sternum, and vertebrae and other sites such as the pelvis, skull, clavicle, and scapulae. These physiological differences occur due to the development of the skeletal system in adolescents. p 621 27-2)
The nurse is preparing for the transfusion of packed red blood cells (RBCs) to a child with severe internal hemorrhage. The nurse places the bag of packed RBC in the blood warmer for a few minutes. What is the rationale behind this intervention?
To prevent cardiac dysrhythmia (The blood bags are stored in extreme cold conditions to prevent deterioration of the blood. While transfusing blood in emergency conditions, the nurse should place the blood bag in the blood warmer to prevent hypothermia and irregular heartbeats. Therefore, the purpose of placing the blood bag in blood warmer is to prevent cardiac dysrhythmia in the patient. Transfusion reaction is an immunogenic reaction that occurs due to the antigen and antibody interaction. Placing the blood bag in the blood warmer will not prevent immunogenic reaction. Placing the blood bag in the blood warmer will not improve respiratory functioning and does not prevent respiratory depression. Placing the blood bag in the warmer will not destroy the pathogens and will not prevent blood-borne infections.)
A patient with sickle cell anemia has severe abdominal pain, dactylitis, and joint pain. The primary health care provider prescribes intravenous morphine (Avinza) to the patient. Which type of sickle cell anemia does the patient have?
Vasoocclusive (The sickle cell anemia is identified as four different types based on the pathological cause, symptoms, and the treatment. The presence of abdominal pain, dactylitis, and joint pain indicates that the patient has vasoocclusive sickle cell anemia. It is associated with the obstruction of blood flow due to infraction and vasospasm and causes severe pain. Therefore, the primary health care provider prescribes intravenous morphine (Avinza) to relieve pain in the patient with vasoocclusive sickle cell anemia. Aplastic crises are associated with the reduced production of the red blood cells by bone marrow resulting in the decrease in the number of reticulocytes and infections. Hyperhemolytic sickle cell anemia is associated with hemolysis, reduced spleen functioning, and increased risk of infection but not severe pain. Splenic sequestration is associated with abdominal pain along with circulatory collapse and shock.)
