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Moses' hemogram is not completely explainable on the basis
of malaria.
- His anemia perhaps, but not the rest.
- Thrombocytopenia is common with malaria,
but counts rarely go below 100,000/cumm.
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- Moses' hemogram:
- Hbg = 4.5 gm%
- Platelets = 75,000/cumm
- WBC = 1,900/cumm
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- The WBC count is very concerning. Usually it's
elevated in cases of malaria.
- This pancytopenia should raise the HIV
flag. Do an ELIZA.
- If the HIV is negative, then he will need a
bone marrow to rule out marrow related causes, such as aplasia, leukemia,
lymphoma, metastatic carcinoma, etc.
His hemoglobin is pretty low, what about a
transfusion?
- No, he's not really symptomatic enough.
True, the first patient in this unit got a transfusion, but she was markedly
symptomatic. Keep in mind:
- In Kenya, the blood supply is limited. (In the
case of the other patient, family had to be called in, and then the blood was
stolen!)
- HIV transmission is a real concern. Units are
screened for HIV and hepatitis B, but not hepatitis C. Would you accept
such a transfusion?
- Given that in some areas close to 1/3 of the
population is HIV positive, transfusions are used for life-threatening
situations only.
Moses' ELIZA was positive for HIV, in fact, he'd
been pancytopenic for 6 months.
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