Why was the patient’s hemoglobin and hematocrit normal on admission but decreased after 48 hours? What is the significance of this patient’s increased leukocyte (WBC) and thrombocyte (platelet) count? What is the reason for the polychromatophilia noted on the 48-hour peripheral blood film?
A 38-year-old white woman was treated in the emergency department for severe lacerations and 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.
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.
- Why was the patient’s hemoglobin and hematocrit normal on admission but decreased after 48 hours?
- What is the significance of this patient’s increased leukocyte (WBC) and thrombocyte (platelet) count?
- What is the reason for the polychromatophilia noted on the 48-hour peripheral blood film?
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