Case Study 5  

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Ms. Arnold, age 86, has had a history of gastritis for 40 years.  Hematocult checks are negative.  No history of renal or liver dysfunction. She is admitted with the following lab values:

RBC     3.2 MCH    29
Hct       28% MCV    110
Hgb       9.1 Retic     1.2
 
  1. Using the indices, how would you classify her anemia.  What clue in the short synopsis supports this type of anemia?
  1. What laboratory/diagnostic procedures do you believe will be ordered next?
  1. Her LDH and serum bilirubin are elevated. Why?

 

Ms. Engles, age 40, goes to her health care provider for her yearly check up.  Weight 68 kg. Height 32.4 cm  Laboratory test results:

 

RBC     3.5 MCH           26     Retic             1% Na          142  
Hct       33%    MCV           81 TIBC          450 K            4.5
Hgb      10 MCHC       32 Albumin       5 Cl         103
Plt        adeq WBC      10,000 Serum enzymes normal
  1. Classify her anemia.
  2. What 3 additional factors in health history would be most important to check on?

 

Mr. Lookout, age 72, is started on iron replacement.
Lab values before treatment:

RBC  3.0    MCH       24
Hct    25%  MCV      75
Hgb      8.2 Retic      1.2%

  1. After 3 weeks of iron therapy, which of the following laboratory changes would you expect to find that support he is responding to therapy? 

A.   Hct 42%
B.  MCV 80
C.   Reticulocytes 3%
D.  TIBC 400 mcg/dl
E.   Folate 4 ng/dl

 
  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?

 

  1. 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
Thrombin         60
Factor V  20

          

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

 
  1. 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?  Can the heparin be discontinued so the patient may go home?