Case Studies 3

 

Copy and paste this to your computer. Complete the assignment and send as an email attachment to skumm@kumc.edu

1. Kenny Danniels, age 10, fell and lacerated his left leg while climbing a fence. In the ED no signs of neurovascular damage were detected and the leg wound was sutured. One hour later, the dressing was saturated with blood. He was taken to the OR where the wound was explored. No arterial lacerations were found. The wound was oozing from the edges. Dressings saturated with agents to promote clotting were applied and extensive labs were drawn.

Lab results: 

RBC    3.8 WBC                6500 Ivy bleeding time       8.5 min
Hgb     9.4 Platelets      200,000 Clot retraction test     normal
Hct      28% PT                        11 Fibrinogen                       280
MCH   85 INR                     1.0 D-dimer                           0.3
MCH   29 APTT                   62 FSP/FDP                        2.0
MCHC 34 Factor VIII      10% Factor IX                     80%
Blood type  O+

                                    

What do the labs indicate?  What treatment do you anticipate?

 

2. Amy Granger, age 10, is brought to the ED with general malaise, low-grade fever, and purplish discoloration on her face, trunk and extremities. The discoloration developed rapidly during the time from when she left home to the time she arrived at the ED. Blood cultures and labs were drawn and she was admitted to the intensive care unit.

Lab results:

RBC   3.6  WBC    11.3 Na        134 PT/INR      18/1.0
Hgb     10.8 Neut       35  K             4.8 APPT               87.9
Hct      30.9 Bands    52 Creat       3.6 Fibrinogen       110
Platelets  58,000 Lymph   10 Glucose    51 FSP/FDP       100
Amylase 249 Plasminogen     40
Schistocytes present Thrombin         60
Factor V  20

          

What do the labs indicate?  What treatment do you anticipate?

 

3. Mark Miller, age 74, is receiving heparin therapy after a right total hip replacement. He has previously had a St. Jude mitral valve replacement. Coumadin therapy was started 3 days ago.

 Lab results:

RBC    3.6 WBC     9.3 Na           134 PT              26.4
Hgb     10.8 Neut        85 K             4.8 APPT               87.9
Hct      30.9  Bands      2 Creat       3.6 INR                    2.2
Lymph   10 Glucose    51

What do the labs indicate?  What treatment do you anticipate?