COMPLETE BLOOD COUNT (CBC) is a term used to describe a combination of labs including:

Red Blood Cells (RBC's)

• Cells that pick up oxygen from the lungs and carry it to all parts of the body.

Hemoglobin (HGB)A way to measure the amount of RBC's in the body, normally is greater than 12

When HGB is low (less than 10)

• May need to transfuse with RBC's.
• Watch for increased tiredness and irritability.

Platelets (PLTS)Normal 150,000 to 400,000

• Small cells which help to control bleeding by forming clots.

When platelet count is low (less than 15,000)

• May need to transfuse with platelets.
• Watch for signs of bleeding (nose, urine, stool). For nose bleeds, apply pressure, may need to pack nose with salt pork.
• Provide safe play activities.

WHITE BLOOD CELLS (WBC)
Normal 5,000 to 10,000

A group of cells that help fight different kinds of infections.

Neutrophils (ANC)

• Includes metamyelocytes, band neutrophils and mature neutrophils.
• A type of WBC that is the body's main defense to fight bacterial infections.

Lymphocytes

• Responsible for GvHD, graft rejection.
• A type of WBC that helps protect the body against organisms by making antibodies and regulating the immune response. May take months-to-years for these cells to regenerate.

Other types of WBC's

• Monocytes
• Eosinophils
• Basophils

When WBC is low (less than 1,000).

• Watch for signs of infection.
• Report fever.
• Keep child away from anyone who is ill.

Transfusions
Your child may need blood and platelet transfusions frequently. Generally, when your child's Hgb drops below 9, your child will receive packed red blood cells. When your child's platelet count drops below 15,000, your child will receive a platelet transfusion. When your child is transfused may be different than other patients, depending on the child's condition (e.g., a child having frequent nose bleeds may need to have their hemoglobin greater than 12 and a platelet count greater than 40,000).

With all transfusions there is the potential of having a transfusion reaction. To prevent this, all patients will receive tylenol and benadryl before the transfusion. The blood product is irradiated and filtered through a leukodepletion filter to decrease the likelihood of a transfusion reaction. If your child has had a transfusion reaction in the past, please inform your nurse. If at any time during or after a transfusion your child feels warm, has shortness of breath, is dizzy, itches, or you notice bumps on your child's skin (hives), notify your nurse immediately.

WBC Drop
We expect to see your child's WBC count gradually drop as they complete chemotherapy and radiation treatments. Generally, the white blood cell count will fall below 1,000 by a day or two before the scheduled transplant. Blood cultures will be drawn and three IV antibiotics are started to help protect your child from infections caused by bacteria. Temperature spikes are common during this time and blood cultures may be drawn once every 24 hours if your child's temperature goes above 38.5°C.

Blood Chemistry Lab Values

Potassium (K+)
Normal 3.5-5.0

• Potassium maintains the balance of fluids in and out of the cells.
• Medications may cause an increased loss of potassium in the urine.
• Potassium may be lost with vomiting and diarrhea.
• IV or oral supplements may be needed to replace lost potassium.

Carbon Dioxide (CO2), Bicarb
Normal 24-32

• Control the pH (acid-base balance) of the plasma.
• Medications and diarrhea can effect the level.
• Oral or IV supplements may be needed.

Calcium (Ca)
Normal 8.5-10.5

• Calcium is important in the transmission of nerve impulses.
• Calcium functions to maintain muscle contractility, and plays a role in blood clotting and enzyme activity.
• Medications may cause excessive loss of calcium.
• IV and oral supplements may be needed.

Glucose
Normal 65-110

• Glucose is the type of sugar found in the blood.
• Glucose is a major source of energy.
• The glucose level may be elevated due to high dose steroids. Insulin infusions may be used to treat high glucose levels, but this is generally only temporary.
• Low glucose levels are rare, but if they occur, your child may need to drink some juice or may need IV fluids.

Magnesium (Mg+)
Normal 1.5-2.9

• Magnesium is found in bones and cells. It is essential for normal neuromuscular function.
• Magnesium is needed for clotting and helps maintain balances of sodium, potassium and calcium levels.
• Loss of magnesium occurs in the urine and stool.
• Medications may effect the loss of magnesium.
• Supplements may be necessary.

Blood Urea Nitrogen (BUN)Normal 5-20

• Urea is the by-product of metabolism. BUN is a screening test to determine how well the kidneys are functioning.
• Many conditions may cause the BUN to rise, and medications that have side effects on the kidneys may cause a rise in the BUN.

Creatinine
Normal 0.7-1.4

• Creatinine is removed from the body by the kidneys.
• Creatinine production is not affected by factors such as protein intake, water intake or rate of urine production. It is a valuable measure of kidney function.
• Some medications may cause kidney damage, therefore having an effect on creatinine. The doses of some medications may be reduced depending on the measure of creatinine.

Creatinine clearance

• Creatinine clearance is a test done on the urine which is collected over 24 hours.
• Creatinine clearance is a more accurate test to determine how well the kidneys are working.
• Creatinine clearance is helpful in determining and adjusting some medications doses.

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