A 22 year old woman has brusing and fatigue. A CBC of 9.0g/dl, hct 275, WBC 15,

Question

A 22 year old woman has brusing and fatigue. A CBC of 9.0g/dl, hct 275, WBC 15, 000 and platelet count of 15,000. The hematologist plans to perform a bone marrow biopsy and aspiration.

1.What blood component is (are) indicated? why?

2. Describe how the dose is calculated. What laboratory test is desired?

3. The patient receives chemotherapy, and two weeks later the hemoglobin is 7.0g/dl and the hematocrit is 21%. The patient complains of shortness of breath when hurrying to the bus stop. The physician decides to order RBC transfusion. What dose of RBC's is indicated? How is this determined?

Explanation / Answer

1. The normal values for hemoglobin for an adult woman are 13.5 to 15.5 g/dl (dl = 100 ml). The normal hematocrit values is 35 - 44.5%, normal WBC count is 3,500 - 10,500 cells/microliter, and normal platelet count is 150,000 to 450,000/ microliter.

It can be seen that the person has extremely low platelet count and an increased WBC count. The condition of having low platelet count is "Thrombocytopenia." The condition results into bruising or bleeding.

A high WBC count and a low platelet count indicates Leukemia.

3. The patient experiences debility due to anemia. Anemia resulted from chemotherapy and red cell concentrates (RCC) are generally transfused to increase the supply of oxygen to tissues. For an adult woman of 40-50 kg body wieght, an RCC transfusion of one unit increases the HB concentration by 1g/dL . The hematocrit increases by about 3%. To bring hematocrit and hemoglobin to normal range, the patient can be given 6 units of RCC, so that the hematocrit is brought to 39% and hemoglobin percentage be raised to 13%. This restores normal oxygen supply to tissues.

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