Question

Patient is a 68 year old male with hx of CVA (no residuals), HTN, IDDM (type 2), COPD, asthma, CHF, CKD (stage 3), last seen in the ED on 10/4/20 for evaluation of altered mental status. He was admitted with dx of right foot gangrene. He was discharged in 10/20/20. On 10/22/20 the patient presented to ED again via AMR from restorative care center for complaints of SOB, hypoxia, and was found to have evidence of pneumonia. He was placed on oxygen 2L via nasal cannula at facility with O2 sat in the 80's. Started on diuretics. Pt was downgraded on 10/29, upgraded on 10/31 due to acute hypoxic hypercapnic respiratory failure and increasing anemia (hgb <7).

Physical findings: Pt is 253 lbs. VSS. On telemetry reading 109-111 HR. Falls precaution. Bedside commode with assist. Scrotal swelling. Skin is cool, dry; 2+ bilateral LE edema, bilateral lower extremity cellulitis, right lower extremity wound--  pressure ulcer to right heel extending unto left posterior ankle with good granulation tissue, no purulent drainage; pressure ulcer to left posterior calf with good granulation tissue, also no purulent drainage. Dressings changed per orders. On q2hr turn. Respirations labored. Crackles to all lobes, decreased breath sounds to right lower lobe. Pt has intermittent coughing, small, clear sputum (uses yankauer suction independently). Encouraging pt to deep breathe and cough. On consistent carb diet (chopped).

Medications:

Budenoside INH

Novolog Flx Pen (None were administered throughout shift; providers parameter)

Levalbuterol HCL Nebulizer

Tamsulosin HCL PO daily

Potassium Chloride PO daily

Furosemide IV daily

Levoflaxicin PO Q48hr

Guaifenesin PO BID

Pantoprazole PO BID

Zinc Oxide 1 applic. TP BID to sacrum

Febuxostat PO daily

Nystatin PO QID (swish and swallow)

Labs: (only noted the abnormal)

WBC: 3.16L

Hgb: 8.0L

Hct: 27.1L

MCH: 25.3L

MCHC: 29.5L

RDW: 19.9H

Neutrophils: 74.9H

Lymph: 12.3L

Mono: 10.6H

ABG PO2: 78L

BUN: 42H

Creatinine: 1.95H

AfAM 40L

NonAfAM 34L

Glucose: 166H (Average: providers parameter)

Calcium: 8.4L

Platelet count: 292 (normal)

Question

- Discussed how the labs relates to the patient’s specific condition. Be specific.

Answer 1

Answer:

◆  According to lab results of the patient there may be mainly one severe disease condition that is blood cancer (Leukemia).

● Explanation: 1. As patient's WBC count is low as normal WBC count is 4.5-11.0 L. Low level of WBC's in blood indicates blood cancer (Leukemia) and decreased bone marrow function.

2. As patient's MCH count is low as normal MCH count in blood is 27.5-33.2 picograms. Low or decreased level of MCH's in blood indicates iron deficiency anemia and it can be the cause of bone marrow dysfunction caused by leukemia.

3. As anemia is the disease caused by low production of hemoglobin by bone marrow and bone marrow dysfunction may be the cause of blood cancer (Leukemia).

4. As patient's MCHC level is low 29.5 g/dL as normal MCHC count in blood is 33-35.5 g/dL. Low MCHC indicates microcytic anemia due to decreased size of red blood cells.

5. As patient's hemoglobin level is low 8 gm/dL as normal level of hemoglobin in blood is 12-15 gm/dL. It is also caused by bone marrow dysfunction by blood cancer (Leukemia).

6. As patient's neutrophil, lymphocytes & monocytes levels increased. So that increase in all these levels in the blood directly indicates blood cancer (Leukemia).

◆ Conclusion: Patient's all lab results directly indicates blood cancer (Leukemia).

Thank You