Sunny Schemery

Professor Tiffany Gill

MLT 2015

Decemeber 15, 2014

86 year old male came to ER

Dizziness

Patient was admitted to ICU

Dehydration

Malignant neoplasm of descending colon and

rectosigmoid and kidney past 7 years

Hypovolemia (Blood Volume Depletion)

Pancytopenia

Bloodstream infection due to central venous

catheters

EDTA- CBC/Differential

EDTA- Type and screen- Blood Bank

Sodium Citrate- Coagulation

Urine- urinalysis

Serum Separator tube- comprehensive

metabolic panel

Blood culture bottles- Microbiology

Sodium Heparin- Arterial blood gas

1

3

5

7

9

11

13

15

17

19

11-Sep

12-Sep

20-Sep

21-Sep

HBG 13.5-17.5

RBC 4.50-5.70

WBC 4.6-11.0

Sep 11 Sep 12 Sep 20 Sep 21

Neutrophils

40-75%

56% 59% 72% 86% H

Lymphocytes

20-50%

21% 25% 14% 7% L

Atypical

Lymphocytes

2% 2%

Monocytes

2-9%

16% H 12% H 11% 7%

Eosinophils

1-5%

5% 2% 2%

1+

Polychromasia

1+

Polychromasia

1+ Microcytes 1+ Ovalocytes

1+Ovalocytes

1+ Burr cells

35.7

24.3 24.9

52.3

28.8

46.3

0

10

20

30

40

50

60

15-Sep 18-Sep 19-Sep

PT 0-17 sec PTT 0-35 sec

Sep 7 Sep 20 Sep 22

pH

7.35-7.45

7.34 7.34 7.49

PCO2

35-45 mmHg

23.0 28.7 31.3

PO2

80-100 mmHg

90 68 100

HCO3

22-26 mmol/L

12 16 24

O2 sat

94-100%

98 93 99

Sep 11 Sep 12 Sep 13 Sep 14

Total

Protein

4.6 L 5.0 L 5.3 L 4.6 L

Albumin 1.8 L 2.1 L 2.0 L 1.9 L

Calcium 7.0 L 7.3 L 7.4 L 7.6 L

TBilirubin 1.0 1.5 H 1.5 H 1.3 H

ALT 13 13 13 11 L

AST 35 H 37 H 40 H 35 H

Glucose 94 105 148 H 82

BUN 32 H 29 H 27 H 28 H

Creatinine 2.4 H 2.4 H 2.3 H 2.5 H

Sodium 135 L 135 L 134 L 138

Chloride 101 104 104 110 H

CO2 27.9 25.5 21.1 20.5 L

Total Protein Low – malabsorption

Total Bilirubin High- liver disease

Calcium Low- Vitamin D deficinecy

Chloride High- Intake IV

Sodium Low- renal loss

Albumin low- liver disease, nephrotic syndrome

AST High- liver disease

BUN High- kidney disease

Creatinine High- kidney disease

Sep 6 Sep 8 Sep 18

Color Yellow Yellow Amber

Clarity Slightly cloudy Clear Slightly cloudy

Bilirubin

Negative

Negative Negative Small

Ketones

Negtaive

Negative Negative Trace

Blood Negative Large Moderate Moderate

Protein

Negative

Negative Negative 30 mg/dL

RBC

0-5 hpf

10-14 hpf 1-4 hpf 5-9 hpf

WBC

0-10 hpf

10-14 hpf 1-4 hpf 5-9 hpf

Bacteria

Negative

present OCC OCC

Sep 7- Positive for Toxigenic Clostridium

difficile

Frequent cause of nosocomial infections

Sep 9, Sep 12- Positive for Escherichia Coli

Causes nosocomial infections

Both cause diarrhea

All blood cultures after no growth in 5 days

Urine cultures Negative

Tamsulosin- Enlarged prostate

Calcium Carbonate- When calcium in diet is not enough

Albuterol- Increase airflow to lungs

Albumin human- Low protein levels

Cefepime- Drug resistant bacteria

Cholecalciferol- Form of vitamin D

Epoetin Alfa- Treat anemia

Loperamide- Used against diarrhea

Heparin- cause longer PTT

Type: O POS

Screen: Negative

Sep 12- 1 unit 250 mL RBCs Leuko-Reduced

Sep 19- 3 units; 230mL, 326 mL, 250mL

Thawed FP24

Sep 22- 2 units RBCs Leuko-Reduced

Sep 22- 1 unit 200 mL platelets

Administered for Low Hgb, Low platelet and

High PT PTT

Primary: Myelodysplastic Syndrome

Unspecified

-Clonal Stem cell disorder

-Share features of all MDSs

-Secondary related to prior therapy

Secondary: Metabolic acidosis

Transfusions to EPO

RBCs

30 to 40% of cases lead to acute leukemia

Blaney, K., & Howard, P. (2013). Blood Component Preparation and Therapy. In Basic & applied concepts of blood banking and transfusion practices (3rd ed., p. 312,313,316,317). St. Louis, Mo.: Mosby.

Carr, J., & Rodak, B. (2009). Myelodysplastic Syndromes, Diseases affecting Erythrocytes. In Clinical hematology atlas (3rd ed., pp. 177-185, 119-134). St. Louis, Mo.: Saunders Elsevier.

Ciesla, B. (2007). The Myleodysplastic Syndromes, Abnormalities of White Blood Cells: Quantative,Qualitative, and the Lipid Storage Diseases. In Hematology in practice (2nd ed., pp. 223-227, 143-155). Philadelphia: F.A. Davis.

Engelkirk, P., & Engelkirk, J. (2008). Gram-negative Bacilli: The Family Enterobateracea, Anaerobic Bacteria. In Laboratory diagnosis of infectious diseases: Essentials of diagnostic microbiology (pp. 303-305, 421,422). Baltimore: Wolters Kluwer Health/Lippincott Williams & Wilkins.

Polansky, V. (2014). Clinical Chemistry Review. In Quick review cards for medical laboratory science (pp. 69-133). S.l.: F A Davis.

RxList - The Internet Drug Index for prescription drugs, medications and pill identifier. (2014, January 1). Retrieved December 14, 2014, from http://www.rxlist.com/script/main/hp.asp

Strasinger, S., & Lorenzo, M. (2008). Chemical examinaton of Urine. In Urinalysis and body fluids (5th ed., pp. 53-75). Philadelphia: F.A. Davis.

Sunheimer, R., & Graves, L. (2011). Blood Gases, pH and Acid-Base Balance. In Clinical laboratory chemistry (1st ed., p. 296,297,300). Boston: Pearson.