Question

A 45-year old woman complains of tiredness and weakness. She appears pale. Laboratory results are as follows: hemoglobin 6.2 g/dL, hematocrit 20%, MVC 75 fL, MCHC 28%. On further questioning, she reports excessive menstrual bleeding, sometimes lasting for several weeks.

1. Does this patient need a transfusion? Why or why not?

2. If the intern decides to give 1 unit of RBC's, what would be the resulting hemoglobin and hematocrit levels?

A 22 year old woman presents with easy bruising and fatigue. A complete blood count reveals hemoglobin 9 g/dL, hematocrit 27%, WBC 15,000/uL and platelet count 5,000/uL. The hematologist plans to perform a bone marrow biopsy and aspiration.

1. What blood component(s) is (are) indicated? Why?

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

3. The patient receives chemotherapy and 2 weeks later the hemoglobin is 6.8 g/dL and the hematocrit 20%. The patient complains of shortness of breath when hurrying to the bus stop. The physician decides to order RBC transfusion. What dose of RBCs is indicated? Hos is this determined?

Answer 1

1.The patient needs a transfusion because it is indicated when the haemoglobin is below below 7mg/dL .In 6mg/dL the patient will start having symptoms like dyspnea, fatigue, dizziness even on slight activity.To prevent further complications a transfusion is needed for this patient.

2.1 unit of RBC has the capacity to increase 1gm/dl of haemoglobin and about 1.9% _1.2% of hematocrit level.Even though transfusion is necessary until the haemoglobin is above 8mg/dL to prevent complications

1.The laboratory report clearly inducated the patient is

• Anemic (9g/dL)
• Thrombocytopenia (5,000/uL)
• Infection (incresed WBC)

The patient needs an immediate platelet transfusion to prevent bleeding and bruising because it is a peculiar symptom of very low level platelet. This is indicated because it is an anticoagulant and prevents bleeding

2.Approximately 1 apheresis unit of platelet product can raise up to 30000/ul to 40000/.ul.To prevent major bleeding during a procedure at least 50000/.uL is needed in a patient. In case of surgery the recommended value is above 1,00,000 units litre.To prevent bleeding this patient needs at least 3 platelet pints. (To reach approximately 90,000 to 1,20,000 /uL

The patient has all threes blood cells on lower level ,the diagnosis could be Pancytopenia.The results like very low level of this can be seen from the biopsy and an accurate diagnosis by differentiation can be done.