•Circulatory overload, infection, symptoms of transfusion reaction: chilling, fever, agitation, anxiety, nausea, vomiting, headache, possibly signs of shock

Prophylactic Care

•Adapting physical activities to the situation

•In the case of dizziness: getting up and walking about only with accompaniment

•Adapting visiting times of relatives to allow patient enough rest and sleep

Treatment

•Depending on symptoms and condition of child, a transfusion of red blood cells needs to be performed (generally at a hemoglobin level less than 7 g/dL)

•Indication for transfusion of red blood cells by the physician

•Transfusion reaction comprises hemolytic transfusion reaction, reactions against HLA-antigens, leukocyte, or platelet antigens

•Filtering of erythrocyte concentrates: transfusion bags are equipped with special transfusion devices to remove leukocytes (special filters can reduce the leukocyte content of transfused blood by more than 99%)

•Irradiation of blood supplies: for immunosuppressed patients, blood donations should be irradiated before administration to avoid graft versus host reactions. Donor lymphocytes are thereby prevented from attacking and damaging the cells of the recipient

19.2.5Loss of Appetite

•Loss of appetite is a common and transient symptom. It may be associated with the primary disease or with the side effects (such as stomatitis, nausea and vomiting, and changes in taste)

•During treatment in particular, sufficient and balanced nutrition is of special importance: balanced nutrition high in protein, vitamins, and calories protects against weight loss and imparts energy. Correct nutrition strengthens the organism and alleviates side effects

of the treatment

•Start nutritional therapy before appearance of first signs of undernourishment

19.2.5.1Causes

•Psychological (anxiety, nervousness)

•Drugs such as some chemotherapeutic agents, analgesics

•Stomatitis

•Pain

•Fever

•Nausea

•Constipation

•Malignancy

19.2.5.2Prophylactic Care

• Despite loss of appetite, encouragement to eat