PBL Sessions: Hematology Organ System - 2

Page 8

History of Present Illness:

A decision is made to treat with an allogeneic peripheral blood stem cell transplantation.

She inquires what the transplant procedure will entail, because she has a low pain threshold. She recounts prior episodes of hospitalizations in which she becomes anxious about procedures being performed. She vividly recalls the last time in hospital, when a student in training was performing phlebotomy and was having difficulty obtaining blood, and the procedure went on for 20 minutes, and she developed a painful hematoma in her right arm.

What can be done to help the patient alleviate her anxiety?

The stem cells are infused, and engraftment occurs on post-transplant day 13.

A CBC shows the following a month later: WBC count 5510/microliter, Hgb 10.7 g/dL, Hct 31.6%, MCV 79 fL, and platelet count 92,000/microliter. There was normal expression of CD55 and CD59 antigens by flow cytometric analysis of peripheral blood cells.

Tasks

• Why do you think the stem cell transplant worked?

• What is the prognosis?

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