Question

Heidi M., a 22-year-old female prospective donor who is a college-athlete, presented with the following physical examination and relevant questions from the medical history:

Donor Name – Heidi M.
Last Donation:	None, first-time donor
Hemoglobin:	13.0 g/dL
Hematocrit:	39.2%
Pulse:	45 beats/min
Blood Pressure:	130/80
Weight:	112 pounds
Temperature:	98.5°F

Heidi had been taking Accutane ( isotretinoin) for acne but had taken her last dose three weeks ago. She had a baby six months ago and was transfused with one unit of red cells the day the baby was born. She had jaundice as a baby but there is no documentation of viral hepatitis.

Given the information on this case, provide your viewpoint (opinion) for each of the follow questions/statements below (each is worth 20 points):

1. Do any values in the physical examination or answers to the questions in her medical history fall outside of established acceptable limits? If so, how many AND list the value or criteria and the acceptable limit. ( Answer the question and then explain your answer)

2. Based on your answers to question one, what do you do next with the donor? What do you tell her? ( Answer the question and then explain your answer)

3. Would Heidi be accepted, temporarily deferred, or permanently deferred? If deferred for a certain period of time, how long? ( Answer the question and then explain your answer)

4. If all the sudden Heidi needed a transfusion of 4 units of RBCs and her HgB was 9g/dL at that time, what should her HgB be after the 4 RBC units were transfused assuming there were no other medical issues that may not allow her to get an expected increase in HgB? What would her platelet count be if she started with a platelet count of 50,000 and was transfused with 3 apheresis platelets?

Answer 1

1) One result is not within the guidelines. The pulse rate  is 45 beats/min,it should be between  50 to 100 beats/min as per the guidelines

2) it is normal for young people ,people who exercise daily and athletes to have low pulse rate and experience no symptoms. Ask Heidi if she experiences any symptoms of low heart rate. if yes send her for proper medical examination . If she does not have any symptom , it is absolutely normal.

3) Heidi would be temporarily deferred for 6 months. . Acutane is the ist reason, person can donate blood at least after 1 month of taking the last dose of acutane. Secondly,  Heidi has had blood transfusion only six month ago. As per guidelines, person can donate blood after 12 months of having a blood transfusion.

4) Each unit of packed RBCs is expected to increase the circulating hemoglobin by 1g/dl. So, Heidi's Hgb should be 13g/dl after receiving 4 units of RBC transfusion.

One apheresis product is equivalent to 6 to 8 random donor platelet concentrates. A dose of 1 random donor platelet concentrate is expected to increase the platelet count by 5000/uL. Therefore 1 apheresis platelets increases the platelet count by 30,000/uL to 40,000/uL. That mean 3 apheresis platelets will increase the platelets by 90,000 to 120,000. The platelet count of Heidi shouldbe between 140,000 to 170,000.