2. 86 year old male came to ER
๏ Dizziness
Patient was admitted to ICU
๏ Dehydration
3. ๏ Malignant neoplasm of descending colon and
rectosigmoid and kidney past 7 years
๏ Hypovolemia (Blood Volume Depletion)
๏ Pancytopenia
๏ Bloodstream infection due to central venous
catheters
4. ๏ 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
11. 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
12. Total Protein Low โ 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
16. ๏ 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
17. ๏ 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
18. 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
19. ๏ Primary: Myelodysplastic Syndrome
Unspecified
-Clonal Stem cell disorder
-Share features of all MDSs
-Secondary related to prior therapy
๏ Secondary: Metabolic acidosis
21. ๏ 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.
22. ๏ 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.
Editor's Notes
High monocytes indicate Bone marrow failure, malignancies
High neutrophils; malignancies, physical conditions
Ciesla, 2007, p. 224
High monocytes indicate Bone marrow failure, malignancies
High neutrophils; malignancies, physical conditions
Ciesla, 2007, p. 144-145
PT and PTT elevated (increased clotting times, slowly decreases Ciesla, 2007, p. 233-245