An 86-year-old male presented to the emergency room with dizziness and was admitted to the ICU for dehydration. Medical workup showed malignant neoplasms, hypovolemia, pancytopenia, and a bloodstream infection. Laboratory results indicated anemia, thrombocytopenia, and abnormalities consistent with liver and kidney disease. Stool and blood cultures grew Clostridium difficile and Escherichia coli. The patient was diagnosed with myelodysplastic syndrome and received multiple blood transfusions.

1. Sunny Schemery
Professor Tiffany Gill
MLT 2015
Decemeber 15, 2014

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

6. 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

7. 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

8. 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

10. 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

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 – 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

14. 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

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

20.  Transfusions to EPO
RBCs
 30 to 40% of cases lead to acute leukemia

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.