Anne L., a 48-year-old woman (5 ft 4 in, 125 lb), reported to her gynecologist
that she had been extremely tired, physically weak, and did not have the
energy to do her job. Upon questioning, she noted having very heavy
menstrual periods lasting for 1 1/2 to 2 weeks. Her hemoglobin was 6.1 g/dL;
hematocrit, 19%; MCV (mean corpuscular volume), 70 fL; MCHC (mean
corpuscular hemoglobin concentration), 27 g/dL.
4. If Anne is transfused, what would be the recommended component
and how many?
5. a. If she is transfused with 3 U of packed cells, what would
you estimate her hemoglobin and hematocrit to be following
b. Would you expect the elevation to be slightly higher or
lower than normal based on her size?
Carl M., a 50-year-old man, was scheduled for a colon resection. The preop
orders included a CBC and crossmatch for 2 U. The CBC report was white
blood cells (WBCs), 14.5 x 109/L; hemoglobin, 14.0 g/dL; hematocrit, 43%;
platelet count, 19,000/uL. The blood bank technologist typed him as 0 positive
and cross-matched 2 U of 0-positive packed cells.
6. Is additional component therapy other than the 2-U crossmatch
7. How many units of the second component should be ordered?
8. Calculate the approximate platelet count following transfusion,
assuming a 70-kg man.
9. a. If Carl’s 1-hour post-transfusion platelet count is
40,000/uL, what is his corrected count increment (CCI)?
(Assume a body surface area of 1.5 m2.)
b. Is it normal, higher, or lower than expected?
c. What does this indicate?
10. What are the storage temperature and shelf-life of platelets?
Melissa G., a 20-year-old woman who had been diagnosed with von Willebrand’s disease, was
scheduled for elective surgery. Her physician wanted to stabilize her von Willebrand’s factor (vWF)
before surgery and ordered a therapeutic trial of l-deamino-8-D-arginine vasopressin (DDAVP)
(Stimate [desmopressin]), a non-blood treatment that increases the release of vWF from storage
sites (endothelial lining of blood vessels). She was a weak responder, and her vWF levels did not
increase adequately; therefore, the next option was to use blood component therapy. Melissa had
approximately 20% of the normal concentration of vWF.
11. What would you expect Melissa’s results to be on the following coagulation
tests (increased, normal, or decreased)?
a. Prothrombin time (PT)
b. Activated partial thromboplastin time (APTT)
c. Platelet count
d. Bleeding time
f. Ristocetin-induced platelet aggregation (RIPA)
12. Why did the physician try nonblood treatment before ordering blood component
13. What is/are the component(s) of choice for stabilizing the concentration of vWF?
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