Question

A 38-year-old white woman was treated in the emergency department for severe lacerations and possible abdominal injuries sustained in an automobile accident. She was admitted to the hospital for observation and further evaluation. On admission, a complete blood count (CBC), urinalysis, and radiograph series were ordered.

■ Laboratory Data Her CBC results were as follows:

Hemoglobin 10.5 g/Dl

Hct 34% RBC 3.8 × 1012/L

WBC 12.0 × 109/L

The RBC indices were as follows:

MCV 89.6 fL

MCH 27.6 pg

MCHC 31 g/dL

The peripheral blood smear showed essentially normal RBC morphology and platelet distribution. Forty-eight hours after admission, a stat repeat CBC was ordered.

The results were as follows:

Hemoglobin 8.0 g/dL

Hct 26% RBC 2.9 × 1012/L

WBC 15.5 × 109/L

The RBC indices were all within their normal ranges. A peripheral blood smear showed normal RBC morphology, although some polychromatophilia was noted. The distribution of platelets had increased. A follow-up platelet count was 0.60 × 1012/L. Subsequently, the patient was typed and cross-matched for 6 units of blood. Two units of whole blood cells were administered immediately. An emergency laparotomy revealed that the patient had injuries to both the liver and spleen.

■ Questions 1. Why was the patient’s hemoglobin and hematocrit nor-mal on admission but decreased after 48 hours?

2. What is the significance of this patient’s increased leukocyte (WBC) and thrombocyte (platelet) count?

3. What is the reason for the polychromatophilia noted on the 48-hour peripheral blood film?

Answer 1

Maturation of red blood cells and storage of RBCs are the main functions of spleen. The RBC s are released from spleen into circulation during emergency conditions like hemorrhage. This might be the reason for normal level of hemoglobin on admission. Liver stores vitamin B12 necessary for erythropoesis and iron necessary for synthesis of hemoglobin.As the liver gets injured the erytropetic function and hemoglobin production gets affected and results in anemia.

2 The main function of platelets is formation of blood clots to prevent bleeding. In this situation, the patient is experiencing bleeding. So to tackle the situation the level of platelets is increased.WBC level will increase after a certain stimuli like surgerybecause of the large bone marrow storage and intravasularly marginated pools of neutrophils.

3. Polycromatophilic means slightly immature, non nucleated red cells. Under normal condition these young red cells remain in the bone marrow one or two days before release into bloodstream . however, when the bone marrow is stressed due to blood loss, these cells are prematurely realeased into the blood.