Low Blood Count

Red Blood Cells - RBCs - Anemia
White Blood Cells - WBCs - Leukopenia
Platelets - PLTS - Thrombocytopenia

Red Blood Cells
Red blood cells give color to our skin and carry oxygen to all parts of our body. Oxygen is needed to supply the body with energy. When your red blood cell count or hemoglobin (Hgb) is low, your body tissues do not get enough oxygen to do their work. This is called anemia. Hematocrit (Hct) is another indicator of RBC count. Hemoglobin and hematocrit values are included in a CBC (complete blood count)

Values:
Normal - Hgb=10.5 to 14.5; Hct=31% to 43%
Adequate/acceptable - Hgb=Greater than 8.0; Hct=Greater than 30%
Watch closely - Hgb=Less than 8.0; Hct=Less than 25%

Signs and Symptoms of Low Hemoglobin or Hematocrit:
• Shortness of breath
• Fatigue
• Paleness
• Chilliness
• Dizziness
• Irritability
• Headache

Special Care for a Low Hemoglobin or Hematocrit:

At Home:
• Provide frequent rest periods
• Provide good nutrition

At the Hospital:
• Transfuse with packed red blood cells (PRBCs)
• Bed rest

White Blood Cells
While blood cells protect the body by fighting the germs that cause infection. The WSC count indicates the total number of WBCs (white blood cells) present in the blood. The differential count lists the different types of WBCs and indicates the percentage of each type. These counts are included in a complete blood count or CBC. Leukopenia is a common term to describe a low WBC count. A normal WBC count ranges from I- 0,000/MM3 (5.0 - 10.0). Children receiving chemotherapy often have a lower normal range for a WBC count (2 - 5,0001mm3) (2.0 - 5.0).

Differential White Blood Cell Count Normals

• neutrophils 60% - 70% (segs and bands)
• lymphocytes 20%-40%
• monocytes 2% -4%
• eosinophils 1%- 4%
• bascohils .5%- 1%

SEGS
Segs (also called PMNs or polys) and bands are special WBCs which fight infections. These WBCs are called neutophils. The Absolute Neutrophil Count or ANC indicates how many white cells in the WBC count are neutrophils, This gives us an idea of how much protection your child has against a bacterial infection. The ANC is figured using the following equation:

ANC = total WBC count x (% of bands + % of segs)

Example
WBC (10.0) = 10,000; ANC = 10,000 x (70% + 5%)
Segs 70 ANC = 10,000 x 75%
Bands 5 ANC = 10,000 x .75
Lymphs 20 ANC = 7,500
Mono 5

Knowing how to figure out your child's ANC is very important. The doctor's and nurses will use this number to decide when to start and stop treatment and when she/he is a particular risk for infection.

Signs and Symptoms of a Low ANC:

There are no signs and symptoms of a low ANC (<500). A blood count is required so necessary information is available to calculate the ANC.

Platelets
Platelets help blood to clot and prevent bleeding. Platelet (PLT) counts are a measurement of the body's clotting ability. Platelet counts are included in a CBC or complete blood count.

Values: Normal=150,000 - 400,000
Adequate/Acceptable=Greater than 50,000
Watch closely=Less than 50,000

Signs and Symptoms of a Low Platelet Count:
• Bruises
• Petechiae (flat pinpoint red or purple spots on skin)
• Bleeding gums
• Wounds bleeding longer than normal
• Nose bleeds

Special Care of a Low Platelet Count

At Home:
• Do not take aspirin or drugs containing aspirin or drugs containing lbuprofen (Advil or Naprosyn)
• Call the doctor if you observe excessive bruising, bleeding from gums or nose bleeds that are not stopped easily (after 10 minutes of nose pressure)
• Treat nosebleeds by applying firm pressure on both sides of the nose for 15 minutes or until bleeding stops.
• No rectal temperatures, suppositories, or enemas
• Avoid contact sports and activities such as biking, horseback riding, skateboarding on or jumping off high objects (i.e., beds)

At the Hospital:
• Transfuse with platelets if active bleeding present
• Check urine, stool, emesis for blood
• Restrict to sedate activities