Question

Patient Case Question 7. Identify three clinical blood test results from Table 89.2 that were elevated and briefly explain why they are elevated.

The patient has sickle cell anemia

Patient Case Table 89.2 Laboratory Blood Test Results
Na 141 meq/L	Hct 28.1%	Bilirubin—total 1.4 mg/dL
K 3.6 meq/L	Plt 225 ? 103/mm3	Bilirubin—indirect 0.9 mg/dL
Cl 101 meq/L	WBC 7.0 ? 103/mm3	Alb 3.7 g/dL
HCO3 22 meq/L	MCV 82.1 fL	Protein—total 6.3 g/dL
BUN 13 mg/dL	Retic 6.4%	Ca 9.3 mg/dL
Cr 1.2 mg/dL	AST 25 IU/L	Mg 1.9 mg/dL
Glu, fasting 87 mg/dL	ALT 22 IU/L	PO4 4.0 mg/dL
Hb 10.9 g/dL	Alk phos 75 IU/L	Folic acid 515 ng/mL

Patient Case Question 7. Identify three clinical blood test results from Table 89.2 that were elevated and briefly explain why they are elevated.

Answer 1

the elevated values in the above table are as follows:

S.no	Lab value	Normal value	Patient value	Inference
1.	Recti count	0.5% to 2%	6.4%	Reticulocyte count will be higher in sickle cell anemia patient. This is a measure of immature red blood cells circulation. When patient is presenting with worsening anemia- there is increasing erythropoietin stimulation, the bone marrow releases reticulocytes at an earlier stage before their maturation. it is elevated with acute red blood cells destruction which leads to vaso- occlusive crisis
2.	Bilirubin – indirect	0-0.4 mg/dl	0.9 mg/dl	1. In sickle cell anemia, chronic extravascular hemolysis where by macrophages of reticulo endothelial system phagocytes the damaged RBCs. 2. These macrophages metabolize hemoglobin to unconjugated bilirubin that is released into the plasma. 3. Unconjugated bilirubin is often mildly elevated at baseline in sickle cell patients
3.	Folic acid	2-20 ng/dl	515 ng/dl	sickle cell anemia patient is deficient with folic acid Sickle cell anemia is recommended with higher doses of folic acid to help improve the RBCs. An elevated level is due to higher dose of folic acid intake than the recommended value.