What blood components are needed for a patient with severe anemia and thrombocytopenia, and what is the expiration date of donated PRBCs and platelets?

Blood Component Therapy for Severe Anemia and Thrombocytopenia

This patient with severe anemia (Hb 5.0 g/dL) and thrombocytopenia (85,000/μL) requires packed red blood cell (PRBC) transfusion immediately prior to surgery, while platelet transfusion is not indicated at this platelet count level.

Assessment of Laboratory Values

The patient's laboratory values show:

• Hemoglobin: 5.0 g/dL (severely low)
• Hematocrit: 15.0% (severely low)
• RBC Count: 1.6 x 10^6/μL (severely low)
• WBC Count: 7.5 x 10^3/μL (normal)
• Platelet Count: 85,000/μL (mildly low)
• RBC morphology: Hypochromic, normocytic

Red Blood Cell Transfusion Decision

Indications for PRBC Transfusion

• The patient's hemoglobin of 5.0 g/dL is well below the threshold where transfusion is almost always indicated (< 6 g/dL) 1
• The patient is scheduled for surgery tomorrow, which is an additional indication for correction of severe anemia
• Menorrhagia is likely the cause of this iron-deficiency anemia (hypochromic RBCs)

Transfusion Approach

1. Immediate PRBC transfusion is required before surgery due to:

   • Hemoglobin < 6 g/dL, which is universally accepted as requiring transfusion 2, 1
   • Upcoming surgery with risk of additional blood loss
   • Likely symptoms of anemia (though not explicitly stated)

2. Number of units:

   • Initial transfusion of 2 units of PRBCs is appropriate
   • Each unit of PRBCs typically raises hemoglobin by approximately 1 g/dL 3
   • Patients with lower starting hemoglobin may have a greater rise per unit 3
   • Reassess hemoglobin after initial transfusion to determine if additional units are needed

Platelet Transfusion Decision

Current Guidelines for Platelet Transfusion

• For surgical procedures, prophylactic platelet transfusion is generally indicated when platelet count is < 50,000/μL 2
• For neurosurgery or ophthalmic surgery, a higher threshold of 100,000/μL is recommended 4

Recommendation for This Patient

• Platelet transfusion is not indicated at the current count of 85,000/μL for vaginal hysterectomy
• Monitor platelet count during and after surgery, as there may be consumption during the procedure
• If platelet count drops below 50,000/μL or if there is excessive bleeding, consider platelet transfusion

Blood Product Expiration

For the donated blood from the patient's brothers:

• PRBCs have a shelf life of 35-42 days when stored at 1-6°C, depending on the preservative solution used 2
• This applies to the autologous donation from her brothers
• All cellular products for this patient must be leukoreduced to prevent febrile non-hemolytic transfusion reactions 2

Special Considerations

Perioperative Management

• Ensure blood is properly crossmatched and compatible
• Monitor for signs of transfusion reactions during administration
• Transfuse one unit at a time with clinical reassessment between units 1
• Complete transfusion within 4 hours of removing blood from storage 2

Post-Transfusion Care

• Check post-transfusion hemoglobin to confirm adequate response
• Monitor for signs of volume overload, especially if multiple units are given
• Consider iron supplementation post-surgery to help rebuild iron stores

Common Pitfalls to Avoid

1. Delaying transfusion when hemoglobin is critically low (< 6 g/dL) before surgery
2. Unnecessary platelet transfusion when counts are > 50,000/μL for most surgeries
3. Failure to monitor for transfusion reactions during administration
4. Not addressing the underlying cause of anemia (which will be addressed by the hysterectomy in this case)
5. Transfusing too rapidly in patients with severe chronic anemia (consider rate of 1-3 mL/kg/hr) 5

By following these evidence-based guidelines, the patient can be appropriately prepared for her surgical procedure with minimal risk of complications related to her anemia and mild thrombocytopenia.