What do the original hematology and chemistry lab values and clinical exam indicate about the patient’s current hematology clinical picture?

A newly diagnosed sickle cell patient has been admitted to the hospital in crisis. Mindy Jones is a 3 -year

old female who presented to the emergency room with severe abdominal pain and pain in her lower left

leg. Lab values indicated a critically low hemoglobin (6.5 g/dL) and Hematocrit (19%). Her peripheral

blood smear showed moderate polychromasia, mild to moderate drepanocytes, mild target cells, and 8

nRBCs/100 WBCs counted. Additional abnormal findings include her chemistry panel with elevated LDH

(450 IU/L) and direct bilirubin (2.5 mg/dL). Her physical exam revealed splenomegaly and mild

respiratory distress. The parents both indicated that she had never been hospitalized or treated with

transfusions. The admitting physician ordered the following additional labs: Reticulocyte count,

Hemoglobin Electrophoresis, Type and Screen, and a Crossmatch for 1 unit.

Q1. What do the original hematology and chemistry lab values and clinical exam indicate about the

patient’s current hematology clinical picture?

Q2. Why did the physician order each of the additional labs mentioned?

Q3. The patient’s absolute reticulocyte count was elevated at 90.3 x 10^9/L. What does the information

contribute to the hematologic picture?

Q4. The hemoglobin electrophoresis revealed 90% HbSS, 7% HbF, and 3% HbA2. Does this confirm the

original diagnosis? How did you reach your conclusion?

The physician wrote an order to transfuse the patient with one unit of pRBCs and begin 15mg/kg per day

hydroxyurea. Her hemoglobin responded appropriately and she appeared to be responding positively to

therapy. On her fourth day of admission, he ordered for one more unit of pRBC to be transfused prior to

discharge. The blood bank requested another type and screen.

Q5. Why did the blood bank request another sample?

An hour after receiving the sample, the blood bank called the floor informing them that there would be

a delay due to a positive antibody screen. Refer to the pdf attachment with patient results. Complete

the ID and answer the following questions.

Q6. How did the patient become sensitized to develop an antibody?

Q7. What antibody did you identify?

Q8. Were you able to rule-out all other antibodies with two “double-dose” cells?

Q9. What cells did you use to rule-in according to the 3×3 rule?

Q10. Why are cells #1, 6, and 11 weaker than the other positive reactions on Panocell-16?

Q11. What information does the auto-control run as “PC” on the Panocell-16 provide concerning the

type of antibody that that the patient is exhibiting? Why is this important?

Q12. The blood bank was able to find a compatible unit for the patient. What special requirements

should this patient have taken into consideration when selecting the best unit for transfusion? Consider

both her diagnosis and antibody status.

Q13. The physician decided to add Mindy Jones to their hospital’s Sickle Cell Transfusion Protocol.

Which sample should the bloodbank choose to perform an extended phenotype, the one drawn on

3/9/16 or the second one drawn on 3/13/16?

Q14. What type of panel cell should be selected for a positive control for the anti-sera used to perform

the extended phenotype? Single- or double-dose? Why is this important?

Q15. What is the purpose of finding phenotype-matched blood for chronically transfused patients?

Q16. Referring to the attached phenotype, do these results confirm the identified antibody?

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