prostate CA patient

[zacarias, ASN, RN]

Hey all,

I'm a student nurse who had a metastasized prostate CA (femur etc...) patient last week in clinical and have a few questions. He has a couple things going on that are confusing; the doc I believe is even confused according to the progress notes.

So he had a HCT of like 24 and was getting PRBCs when I was there. The next day HCT was up to 37. Ok, so looking at the notes, the doc said that he did folic acid, Epo, and B12 tests and then ordered two units. Are blood transfusions given just because those values are low? I'm trying to figure out what is causing the low HCT. He doesn't have leukemia, but maybe the spread cancer is suppressing his bone marrow?? But then why does he have high WBCs (next part.

His WBCs are 15 and he's in left shift with bands and metamyelocytes. He has wounds in his foot and cellulitis but the doc says they are nontoxic. Yet he has the patient cefazolin and bacitracin and polysporin. Is he just giving those just in case there is some infection he's not finding in the body? The doc also says maybe the high WBCs are just from the advanced cancer and his pain (this is personally what I think is going on.) If he is having cellulitis without infection, the WBCs would go up right or no. See how it's confusing? The doc doesn't even really know so I guess as a student nurse I shouldn't lose sleep over it but I'd like to figure out as much as I can. I know 15 is high for WBC but it isn't THAT high. Does left shift normallly occur at 15 or do you think that the presence of immature neutrophils is making the total WBC count SEEM high. Any ideas???? Thanks!

Z