Question

Blood Bank Case#2

Patient 1

Cathy, a small, 35-year old woman, reported to her primary care physician that she was tired, physically weak, and had low energy. Upon questioning, she noted having heavy menstrual periods lasting for 1 ½ to 2 weeks. Her hemoglobin was 6.1 g/L; hematocrit, .19I/L; MCV 70 fL; MCHC, 27 g/dL.

1. Does Anne need a transfusion? Explain why or why not.

2. Support the viewpoint opposite to the one you expressed in question 1. Give a reason why a physician would take this stand.

3. What type of anemia is indicated by Anne’s complete blood count (CBC) and medical history?

4. If Anne is transfused, what would be the recommended component and how many?

5. If she is transfused with 3 U of packed cells, what would you estimate her hemoglobin and hematocrit to be following transfusion?
6. Would you expect the elevation to be slightly higher or lower that normal based on her size?

Patient 2

Ken, a 45-year-old man, was scheduled for abdominal surgery. The physician ordered a CBC and a crossmatch for 2 U. The results of the CBC is below:

WBCs: 14.5x10⁹/L

Hemoglobin: 140 g/L

Hematocrit: 0.43L/L

platelet count: 19,000/μL.

The blood bank technologist typed him as O positive and cross-matched 2 U of O-positive packed cells.

1. Is additional component therapy other than the 2-U crossmatch indicated? Why?

2. How many units of the second component should be ordered given the fact he will be undergoing an invasive procedure?

3. Calculate the approximate platelet count following transfusion, assuming a 70-kg man.

4. If Kens 1 hour post-transfusion platelet count is 10,000/μL, what does this indicate?

5. What are the storage temperature, storage conditions and shelf-life of platelets?

Patient 3

Lulu, was scheduled for elective surgery however she has von Willebrand’s disease (not really, just for the purposes of the case study). Her physician ordered a therapeutic trial of 1-deamino-8-D-arginine vasopressin (DDAVP). She was a weak responder, and her vWF levels did not increase adequately; therefore, the next option was to use blood component therapy. Brittney had approximately 20% of the normal concentration of vWF.

1. What is another name for DDAVP? How does it work?
   1. Desmopressin (Stimate)
   2. Releases vWF from endothelial cells
2. What would you expect Brittney’s results to be on the following coagulation tests (increased, normal, or decreased)?

1. Prothrombin time (PT):
2. Activated partial thromboplastin time (APTT):

3. Platelet count:
4. Bleeding time:

5. Factor VIII:C:
6. Ristocetin-induced platelet aggregation (RIPA):

2. Why did the physician try DDAVP treatment before ordering blood component replacement therapy?

3. What is/are the component(s) of choice for stabilizing the concentration of vWF?

Answer 1

1. Patient 1 : 35 year old Anne should recieve blood transfusion because menustuation lasts usually for 3-5 days. In this case she is suffering from menorrhagia( excessive menustual bleeding). If she is not receiving blood transfusion,it will leads to severe iron deficiency anemia which ultimately into heamorragic shock.

Anne is suffering from iron deficiency anemia ,she should receive one packed red blood cells along with prescribed medications. I dont think that 3 unit of blood will releive her symptoms because of heavy bleeding so she should receive blood component along with some medication like anticoagulants. If she receive one packet red blood cells the heamoglobin level will slightly than the present range .

2.Patient 2 :In additional component therapy other than the 2-U of packed cell , we need to arrange platelet (RDP/SDP) and crossmatch for platelet too because the patient is having thrombocytopenia. He should arrange 12 units of RDP / 2 units of SDP if he is going for invasive surgery.

A 70 year old man is expected to increase his platelet count by 30,000 /ul to 60000/ul following transfusion .

If Kens 1 hour post-transfusion platelet count is 10,000/μL, which indicates severe thrombocytopenia and need immediate medical attention

The platelets sould store at a room temperature of 22 degree celcius not exceeding 96 hours because of the risk of bacterial growth and lose of platelet functionality.

3. patient 3 : Another name for DDAVP is Desmopressin. Desmopressin works by limiting the amount of water that is eliminated in the urine. Patients with von Willebrand disease shows normal prothrombin time and a variable prolongation of partial thromboplastin time. Platelet count might be normal and deficiency of vWF can then lead to a reduction in factor VIII levels.

Physician try DDAVP treatment because it can induce release of normal VWF from cellular compartments.For stabilizing the concentration of vWF the physician supposed to give FFP(fresh frozen plasma)