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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.