Dr. Gary M. Kupfer, MD

When a patient has sufficient blood volume and lacks one or more components, a complete blood count (CBC) test can help determine if a patient requires a transfusion by measuring four blood components: red blood cells, white blood cells, platelets, and hemoglobin. If any of the patient's component counts is significantly below a standard range, the patient will likely need a blood transfusion. The complete blood count test uses a needle to extract a small amount of blood for testing.

Blood transfusion recipients should be tested for their blood type, which is one of four different types: type A, B, AB, or O. Patients with A, B, and O blood can only receive a blood donation matching their blood type or of O blood, which is known as the universal donor. Those with AB blood are considered "universal recipients"; they may receive A, B, AB, or O blood. Further complicating blood types is the presence or absence of the RhD antigen, adding a positive or negative modifier that should also be considered. Incompatible blood donations may cause transfusion sickness, such as a hemolytic reaction, where the body fights the donated red blood cells.

In certain emergency or trauma situations, medical teams often do not perform a complete blood count (CBC) test or blood type test. In those cases, patients are often given O negative blood, which is universally accepted. Some patients have their blood type on a medical card or bracelet, allowing emergency medical teams to issue compatible blood without testing.

Transfusions are performed by inserting a needle attached to an intravenous line (IV) into a vein in the body. This IV line is attached to a bag of blood that steadily dispenses blood into the patient's bloodstream. The type, volume, and components of donated blood depend on the patient's condition and needs. After the transfusion is complete, patients are generally permitted to resume normal activity, unless prohibited by a condition or injury. Some patients may experience bruising or soreness around the area that the needle was inserted.

At times, a second complete blood count test is performed to determine if the transfusion has brought patients' component counts to normal levels. Some patients may require multiple blood transfusions to reach a healthy blood volume and blood component count.

Once patients' blood volumes and components reach sufficient levels, they will generally begin to feel better. Patients of all ages, from newborn infants to elderly adults, can receive a blood transfusion.

Joint problems include bursitis and arthritis. Bursitis is the inflammation of a fluid-filled sac cushion on the outside of a joint, causing symptoms including pain and swelling. Arthritis is the inflammation and damage of a joint due to wear and tear or disease. There are several treatments for arthritis, but if the damage progresses far enough, joint replacement may be necessary. In joint replacement, a metal or plastic implant is surgically placed within the joint to make movement easier.

Bone problems include scoliosis, fractures, and osteoporosis. Scoliosis is a curvature of the spine, making the normally straight spine look like a 'C' or 'S.' It is treated with braces or surgery. Osteoporosis is a disease that causes bones to weaken and break easily. It's most common in women, especially older women. Fully half of all women over 65 have osteoporosis. Fractures are any break in the bone. They can be a simple crack or a severe and complicated shatter. Osteoporosis causes fractures in people who have it, but other causes are trauma (such as a fall) or overuse.

Tendon and ligament problems most often result from injury or overuse. Two good examples are ligament tears and tendonitis. The most common ligament tear is the ACL tear in the knee. This ligament supports and stabilizes the knee and is most often torn during sports activities. Tendonitis happens when a tendon, which connects muscles and bones together, becomes irritated and inflamed. This happens most often in older patients who push their bodies too far, leading to pain and swelling. Treatment for both tendon and ligament problems usually includes rest, ice, and supporting the area to let it heal.

Pain and numbness problems can be caused by overuse, disease, an injury, or a compressed nerve. Lower back pain and carpal tunnel syndrome are two of the most common conditions patients encounter. Lower back pain may be caused by sore muscles that have been overworked, or an injury to the disks separating the vertebrae in the spine. Lower back pain usually goes away on its own within a few days, but it may require medical treatment depending on the cause. Carpal tunnel syndrome occurs when the nerve at the base of the palm becomes trapped or pinched. Symptoms include tingling, pain, numbness, or weakness in the hand. Treatment involves rest and sometimes steroid injections.

Because the musculoskeletal system involves so much of the body, problems here can be incredibly varied in their type and severity. Some musculoskeletal problems will go away on their own or only require rest, while others may require medication, physical therapy, or even surgery.

At the most basic level, nutrition counseling can be simply a talk with a family physician. Doctors receive training in nutrition as part of their education, and they are generally qualified to make recommendations about diet for their patients. Some doctors take a professional interest in nutrition and become experts by taking extra classes or studying nutrition in their practice. In general, however, complex nutrition guidance will be referred to a nutrition specialist, generally a dietitian.

Registered dietitians are nutrition experts that have passed specific higher education, accreditation, and internship requirements. They may work in hospitals, nursing facilities, or private practices to provide nutrition therapy and advise patients about their health and diet. Like dietitians, nutritionists also work to counsel patients about food and health. Some nutritionists have degrees in nutrition or food science, but the title 'nutritionist' is not protected by law. In the United States, anyone is allowed to call themselves a nutritionist, regardless of their education level.

Nutrition counseling can be useful for anyone who is looking to get to a healthy weight, manage a chronic illness through diet, or simply lead a healthier lifestyle. Some examples of issues that benefit from nutrition counseling include:

• Obesity
• Eating disorders
• High cholesterol
• High blood pressure
• Food allergies
• Kidney disease
• Digestive disorders, such as irritable bowel syndrome
• Cancer
• Pregnancy or lactation
• Participation in competitive sports

During a nutrition counseling appointment, the provider -- doctor, nutritionist, or dietitian -- typically will look over a the patient's medical history and talk to them about their current diet, their goals, what kinds of food they like, and any problems that they are currently struggling with in their health or diet. Then the specialist will help the patient set food goals and create a customized plan to help them meet their nutritional needs. Nutrition specialists may also offer classes, workshops, cooking demonstrations, and more. Their role is not to lecture the patient about what one should be eating, but to offer education and resources to make eating healthy foods easier.