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Mlt 2015 clinical case study updated
- 1. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 2. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 3. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland 67-year-old Male Patient admitted through Emergency Room via ambulance from home After medical work-up patient was admitted to Medical- Surgical unit Length of stay: 10/14/2015 -10/17/2015
- 4. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 5. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Advanced Alcoholic Cirrhosis • Currently on the liver transplantation lists Type 2 Diabetes Mellitus • Insulin required Chronic Kidney Disease • Probable Stage III History of esophageal varices • Banding Procedure History of Iron Deficient Anemia
- 6. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 7. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Mental Altered Status and Lethargy Pale Completions Significant Ascites Noted Lower Extremities Edema
- 8. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Afebrile, none of the following symptoms: Shows no signs of chills, nausea, vomiting, diarrhea, rectal bleeding, melena or hematoemesis No Respiratory discomfort • No SOB, pleurisy, cough, wheezing No known Cardiac involvement • No chest pain, irregular palpitation, dizziness, syncopal episodes No headache, blurred vision, double vision, sore throat, or tinnitus
- 9. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Significant ascites Noted chronic lower extremity edema Oxygen saturation with in normal limits on room air Mucous membranes appears somewhat dry No evidence of scleral icterus involvement Does not smoke Continuation abstinence from alcohol since 2003
- 10. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 11. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Pre-Analytical Work-up Patient Verification Process Blood culture • Microbiology-yellow top Sodium citrate tubes • Coagulation assay-blue top- PT PTT/INR Heparin tubes- • Chemistry analysis -SST- Light green/Red top (clot activator) -BMP, CMP, Lactic acid, CTNI, Ammonia)
- 12. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland K3EDTA Tube • Hematology and Blood Bank-confirmation- lavender top K2 EDTA Tube • Blood Bank -ABORH, T & S, major crossmatch units requested- pink top Sodium oxalate/fluoride Tube • Respiratory department-lactic acid on ice-gray top- no tourniquet used Specimen Transportation to Laboratory • Proper Inversion Performed • Ammonia and lactic acid on ice
- 13. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 14. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 15. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 16. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland ↑ Monocytes- • Severe Alcohol Cirrhosis ↓ WBC’s, RBC’s, HGB, HCT, MCV, MCH, and Platelets Indicative of Microcytic, hypochromic Anemia Pancytopenia • ↓in WBC’s, RBC’s, Platelets in peripheral blood
- 17. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 18. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 19. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 20. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland ↑Glucose • Type 2 Diabetes Mellitus ↑Bun • Severe renal impairment ↑Creatinine • Impaired renal function ↓ Sodium ↓ Calcium • Metabolic & electrolyte imbalance ↓ Total Protein ↓ Albumin • Acute, Severe, Chronic Liver & Kidney disease ↓ Magnesium • hypomagnesemia ↑ Lactic Acid • Liver and Kidney Damage ↑ Ammonia- • Advance Liver Disease and Renal failure ↓ Ferritin • Iron deficiency Anemia
- 21. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 22. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland ABO/RH Type A pos Antibody Screen Positive Antibody Panel Identification Anti-E, Panagglutinin, Warm autoantibody, Muliple Antibody, Postive autoantibody Antigen E Type Negative AHG/Direct Combs Testing IgG Positive Elution Panel Studies (done by ARC) Panaggltuinin, Warm autoantibody ABORH TYPE AND ANTIBODY PANEL RESULTS TESTS RESULTS Cross-Matched Packed RBC's Cell Transfusion Record Date and Time 10/14/2015 10/14/2015 10/16/2015 Tranfusion Reaction Started 1330 Started 1810 Started 1215 None Stopped 1625 Stopped 2100 Stopped 1458 None Amount Given 350 mL 350 mL 350 mL
- 23. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Cross-Matched Packed RBC's Cell Transfusion Record Date and Time 10/14/2015 10/14/2015 10/16/2015 Tranfusion Reaction Started 18102110 Started 1330 Started 1215 None Stopped 21100 Stopped 1625 Stopped 1458 None Amount Given 350 mL 350 mL 350 mL Typed and Major Crossmatch Compatible • 4 units of A Negative and 2 units of A positive Anti-E Negative, Antigen E Negative 3 Units Transfused
- 24. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 25. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland ↑Prothrombin Time • Chronic Liver Cirrhosis/Severe hepatocellular disease
- 26. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 27. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 28. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland ↑ Hyaline cast Granular casts • Urinary stasis
- 29. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 30. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland GI Track/ Esophageal variceal suspected Blood Culture • No growth after 48 hours Peritoneal Fluid • No Growth after 72 hours OCCULT BLOOD STOOL TEST TEST 10/14/2015 Performed in ER by Physician 10/14/2015 @ 2326 Negative POSITIVE
- 31. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 32. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland IV Solutions and Drugs Dextrose 50% -Fluid and nutrient replenish Naloxone HCL -Opioid antagonist Ondansetron (zofran) -Anti-nausea Rocephin -Antibiotic Insulin Glucagon (IM) Insulin Lispro Insulin Detemir (IM) Oral Vitamins Folic acid Magoxide (magnesium oxide) Vitamin B-1 Sublinqual Nitroglycerin Sublingua -Nitrates
- 33. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 34. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Hepatic Encephalopathy • Advance Liver Cirrhosis Prerenal etiology • Chronic Diuretic Use Acute Kidney Injury • Sudden decrease kidney function within a few hours Pancytopenia • Aplastic anemia GI Track Bleed • Underlying Varices bleeding Hypomagnesemia • ↓Magnesium
- 35. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 36. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Very good, 80% to 90% survival rate IF liver transplantation occurs Very poor, death will be imminent if liver transplantation does not occur Possible kidney dialysis and/or eventually a kidney transplant
- 37. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland
- 38. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Blaney, K., & Howard, P. (2013). Basic & Applied Concepts of Blood Banking and Transfusion Practices (3rd ed.). St. Louis, Missouri: Elsevier Mosby. Blood Bank Guy.(1998-2015).Panagglutinin. Retrieved December 2, 2015, from http://www.bbguy.org/education/glossary/index.aspx?alphabet=p&id=190 Betty, C. (2012). Normochromic Anemia: Biochemical, Membrane, and Miscellaneous Red Blood Cell Disorders. In Hematology in Practice (2nd ed., pp. 98-109). Philadelphia, Pa 19103: F.A Davis Company. Drugs.Com.(2000-2015). Dextrose 50 % Injection. Retrieved December 2, 2015, from http://www.drugs.com/pro/dextrose-50-injection.html Drugs.Com. (2000-2015). Glucagon. Retrieved December 2, 2015, from http://www.drugs.com/mtm/glucagon.html
- 39. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Drugs.Com. (2000-2015). Insulin-determir. Retrieved December 2, 2015, from http://www.drugs.com/mtm/insulin-detemir.html Drugs.Com. (2000-2015). Insulin-lispro. Retrieved December 2, 2015 from http://www.drugs.com/mtm/insulin-lispro.html Drugs.Com. (2000-2015).Magnesium oxide. Retrieved December 2, 2015 from http://www.drugs.com/search.php?searchterm=magnesium+oxide&a=1 Drugs.Com.(2000-2015). Naloxone HCL. Retrieved December 2, 2015, from http://www.drugs.com/mtm/naloxone.html Drugs.Com. (2000-2015). Nitroglycerin Sublingual. Retrieved December 2, 2015, from http://www.drugs.com/mtm/nitroglycerin.html
- 40. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Drugs. Com. (2000-2015). Ondansetron . Retrieved December 2, 2015, from http://www.drugs.com/.ondansetron.html Drugs. Com. (2000-2015).Rocephin. Retrieved December 2, 2015, from http://www.drugs.com/rocephin.htm Drugs. Com.(2000-2015). Vitamin B-1. Retrieved December 2, 2015, from http;//www.drugs.com/mtm/vitamin_B-1.html LabCE.(2015).Granular Casts. Retrieved December 2, 2015, from https://www.labce.com/spg30119_granular_casts.aspx McCall, R., & Tanhersley, C. (2012). Phlebotomy Essentials (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins, A Wolters Kluwer business
- 41. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland McClain, C. (2002). Monocyte activation in alcoholic liver disease. Retrieved December 3, 2015, from http://www.alcoholjournal.org/article/S0741-8329 (02)00212- 4/abstract Medline Plus (n.d). Magnesium Oxide. Retrieved December 2, 2015, from https://www.nlm.nih.gov/medlineplus/druginfo/meds/a6010 74.html National Kidney Foundation.(2015). ACUTE KIDNEY INJURY (AKI). Retrieved December 3, 2015, from https://www.kidney.org/atoz/content/AcuteKidneyInjury
- 42. Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland Renee Backen MLT-2015 Date: December 3, 2015 Professor Tiffany Gill College of Southern Maryland NIH U.S National Library of Medicine. (2015). Hepatic encephalopathy. Retrieved December 3, 2015, from https://www.nlm.nih.gov/medlineplus/ency/article/0003 02.htm Strasinger, S., & Di Lorenzo, M. (2008). Urinalysis and Body Fluids (5th ed.). Philadelphia, Pa 19103: F.A. Davis Company. Sunheimer, R., & Graves, L. (2011). Clinical laboratory chemistry. Boston: Pearson.
Editor's Notes
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- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html
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- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html McCall, R., & Tanhersley, C. (2012). Phlebotomy Essentials (5th ed.). Baltimore, MD: Lippincott Williams & Wilkins, A Wolters Kluwer business.
- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html
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- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html
- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html Bottom graphic image take from LabCE.(2015).Granular Casts. Retrieved December 2, 2015, from https://www.labce.com/spg30119_granular_casts.aspx http://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html Strasinger, S., & Di Lorenzo, M. (2008). Urinalysis and Body Fluids (5th ed.). Philadelphia, Pa 19103: F.A. Davis Company. LabCE.(2015).Granular Casts. Retrieved December 2, 2015, from https://www.labce.com/spg30119_granular_casts.aspx (graphic image)
- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html
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- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html Drugs.Com.(2000-2015). Dextrose 50 % Injection. Retrieved December 2, 2015, from http://www.drugs.com/pro/dextrose-50-injection.html Drugs.Com. (2000-2015). Glucagon. Retrieved December 2, 2015, from http://www.drugs.com/mtm/glucagon.html Drugs.Com. (2000-2015). Insulin-determir. Retrieved December 2, 2015, from http://www.drugs.com/mtm/insulin-detemir.html Drugs.Com. (2000-2015). Insulin-lispro. Retrieved December 2, 2015 from http://www.drugs.com/mtm/insulin-lispro.html Drugs.Com. (2000-2015).Magnesium oxide. Retrieved December 2, 2015 from http://www.drugs.com/search.php?searchterm=magnesium+oxide&a=1 Drugs.Com.(2000-2015). Naloxone HCL. Retrieved December 2, 2015, from http://www.drugs.com/mtm/naloxone.html Drugs.Com. (2000-2015). Nitroglycerin Sublingual. Retrieved December 2, 2015, from http://www.drugs.com/mtm/nitroglycerin.html Drugs.Com. (2000-2015). Ondansetron . Retrieved December 2, 2015, from http://www.drugs.com/.ondansetron.html Drugs.Com. (2000-2015).Rocephin. Retrieved December 2, 2015, from http://www.drugs.com/rocephin.htm Drugs.Com.(2000-2015). Vitamin B-1. Retrieved December 2, 2015, from http;//www.drugs.com/mtm/vitamin_B-1.html
- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html
- NIH U.S National Library of Medicine. (2015). Hepatic encephalopathy. Retrieved December 3, 2015, from https://www.nlm.nih.gov/medlineplus/ency/article/000302.htm National Kidney Foundation.(2015). ACUTE KIDNEY INJURY (AKI). Retrieved December 3, 2015, from https://www.kidney.org/atoz/content/AcuteKidneyInjury Ciesla, B. (2012). Hematology in practice (2nd ed). Philadelphia, Pa.: F.A. Davis Company. Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html
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- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html
- Graphic image on top Download Power Point. (n.d.). Best Test Tube PowerPoint. the template. Retrieved December 3, 15, 2015, from Templateshttp://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html Bottom graphic image take from LabCE.(2015).Granular Casts. Retrieved December 2, 2015, from https://www.labce.com/spg30119_granular_casts.aspx http://www.downloadpowerpointtemplates.com/Medical/Blue-test-tube-Medical-Powerpoint--the-Templates.html Strasinger, S., & Di Lorenzo, M. (2008). Urinalysis and Body Fluids (5th ed.). Philadelphia, Pa 19103: F.A. Davis Company.
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