DOCSLIB.ORG

Common Laboratory Values

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Common Laboratory Values COMMON LABORATORY VALUES STEPHANIE ZIELINSKI, CPNP, DNP COMMON LABORATORY VALUES • Laboratory tests are an integral part of every day practice within health care. • Lab work can help assess and diagnose patients with both acute and chronic illness. COMMON LABORATORY TESTS • Complete Blood Count with Differential • Basic Metabolic Profile • Iron Studies (TIBC, Ferritin) • Thyroid Studies (TSH, Free t4) • Vitamin D • Lipid Panel COMMON LABORATORY TESTS • Complete Blood Count with Differential aka “CBC with Diff” • Components of a CBC with differential: • Total red blood cell count (RBC) • Hemoglobin (Hgb) • Hematocrit (Hct) • Mean Corpuscular volume (MCV) • Red blood cell distribution width (RDW) • Total white blood cell count (WBC) • A count (%) of each type of white blood cell (Neutrophils, Lymphocytes, Monocytes, Eosinophils, Basophils) • Platelet count (The Mayo Clinic, 2016; Up to Date, 2016) COMMON LABORATORY TESTS • What does each finding mean? • Total red blood cell count (RBC)- The count of the number of circulating red blood cells in 1 mm3 of peripheral venous blood. • Hemoglobin (Hgb)- The measure of the amount of Hgb in the blood. Hgb constitutes over 90% of red blood cells. COMMON LABORATORY TESTS • A decrease in Hgb concentration means the patient is anemic. • Anemia can be due to iron/B12/folate deficiency, blood disorders or other underlying pathology. • And increase in Hgb concentration means the patient is polycythemic. • Polycythemia can result from a large number of causes, including cancer, lung disease, heart defects and other underlying pathologies. Smoking and many lung conditions can cause an elevated Hgb due to chronic hypoxia. COMMON LABORATORY TESTS • Hematocrit- The measure of the percentage of the total blood volume that is made up by the red blood cells. • Mean corpuscular volume (MCV)- a measure of the average size of a red blood cell. The MCV is important in classifying anemias: • Normal MCV = normocytic anemia • Decreased MCV = microcytic anemia • Increased MCV = macrocytic anemia COMMON LABORATORY TESTS • Red blood cell distribution width- An indication of the variation of the red blood cell size (anisocytosis). • In general an elevated RDW (more variation in the size of the RBC’s) is associated with anemias with various deficiencies such as iron, B12 or folate deficiencies. COMMON LABORATORY TESTS • What does each type of anemia mean? Macrocytic Anemia- • In adults, common causes of macrocytic anemia are: • Medications (ex: Zidovuidine, Hydroxyurea), folate deficiency, abnormal RBC maturation (Ex: Leukemia), alcohol abuse, liver disease and hypothyroidism • In children common causes of macrocytic anemia are: • Medications (anticonvulsants, Zidovudine and immunosuppresents), Vitamin B12 and folate deficiencies, liver disease and hypothyroidism COMMON LABORATORY TESTS • What does each type of anemia mean? Microcytic Anemia- • In adults, common causes of microcytic anemia are: • Reduced iron availability (iron deficiency, copper deficiency), Alpha or beta thalassemia and anemia of inflammation (chronic disease). • In children common causes of microcytic anemia are: • Iron deficiency and thalassemia COMMON LABORATORY TESTS • What does each type of anemia mean? Normocytic Anemia- • In adults, common causes of normocytic anemia are: • Systemic disorders, chronic renal disease • In children common causes of normocytic anemia are: • Hemolytic disease, blood loss, infection and medication COMMON LABORATORY TESTS • Testing for iron deficiency: Total Iron Binding Capacity (TIBC)- Will be elevated when a patient is anemic. Ferritin- The cellular storage protein for iron. Iron deficiency results in a low ferritin level. Iron deficiency is the only clinical situation in which extremely low values of serum ferritin are seen COMMON LABORATORY TESTS • White Blood Cells- • Lymphocytes- Comprise about 30-40% of circulating white blood cells. • Atypical and an elevated number of lymphocytes can often be seen following viral infections. • Other causes of atypical lymphocytes or lymphocytosis can be lymphoma or leukemia. • If a patient has lymphocytosis in addition to thrombocytopenia, neutropenia or anemia, this is concerning for malignancy. Patient should be referred immediately for hematology/oncology evaluation. COMMON LABORATORY TESTS • Neutrophils- 40-60% of circulating white blood cells. • Neutrophils mature in the following order: Myeloblast -> promyelocyte -> myelocyte -> metamyelocyte -> band -> mature neutrophil. CBC/blood smear results with any cells seen that are less mature than a myelocyte are almost always associated with hematological malignancy. This warrants immediate hematology/oncology referral. An increased number of bands is called a “left shift” and is often associated with infection. COMMON LABORATORY TESTS • A low level of neutrophils is Neutropenia. A low level of neutrophils can increase the risk of infection. • Neutropenia can be caused by malignancy, immunosuppression or be idiopathic. • An elevated Neutrophil count (Neutrophilia) is most commonly seen with infections, stress, smoking and after exercise. COMMON LABORATORY TESTS • Basophils- Comprise <1% of total WBC. An elevated basophil count is most commonly associated with myeloproliferative disorders, hypersensitivity or inflammatory reactions, hypothyroidism, and certain infections. • Eosinophils- Normally present in small numbers (< 5% of WBC’s). Elevated level can indicate allergic state or parasitic infection. Less commonly it can indicate a malignancy. • Monocytes- The largest of the WBC’s. Elevated monocyte level is most commonly associated with infections, autoimmune disorders, malignancy and blood disorders. COMMON LABORATORY TESTS Platelets • Thrombocytopenia- (low platelet count)- Most commonly seen due to medications (antibiotics, antiepileptics), infection, blood disorders and liver disease. • The presence of a very high platelet count, extremely large platelets, and/or megakaryocyte fragments is abnormal and often associated with an underlying malignancy. COMMON LABORATORY TESTS • Basic Metabolic Profile • Comprised of: • Sodium (Na) • Potassium (K) • Chloride (Cl) • Carbon Dioxide Content (CO2) • Blood Urea Nitrogen (BUN) • Serum Creatinine (Cr) • Serum Glucose (Glu) • Total Calcium (Calcium) COMMON LABORATORY TESTS • Sodium (Na) • Hyponatremia- Sodium is low. This is not a common finding and is often associated with heart failure, burns, malnutrition and severe diarrhea. • Hypernatremia- Sodium is elevated. This is commonly associated with three main issues: • Un-replaced water loss- diarrhea/vomiting, excessive sweating, diabetes insipidus, diabetic ketoacidosis • water loss into cells- usually transient, typically induced by severe exercise or electroshock induced seizures. • sodium overload- salt poisoning, hypertonic saline administration COMMON LABORATORY TESTS Potassium (K) Hypokalemia- A low level of potassium. Hypokalemia is most commonly caused by the use of diuretics, severe burns, Cushing’s syndrome, acute GI illness, hyper-aldosteronism, and renal disease. COMMON LABORATORY TESTS Potassium (K) Hyperkalemia- Elevated potassium, caused by three main mechanisms: ●Excessive increase in potassium intake ●Trans-cellular movement of intracellular potassium into the extracellular space ●Decreased renal excretion of potassium COMMON LABORATORY TESTS Potassium (K) ●Excessive increase in potassium intake- typically caused by a high potassium containing medication or IV fluid. ●Trans-cellular movement of intracellular potassium into the extracellular space- metabolic acidosis or breakdown of normal tissue or rapid cell lysis causing potassium to be released into the extracellular space; ex. Renal failure, tumor lysis, rhabdomyolysis. ●Decreased renal excretion of potassium- Kidney disease COMMON LABORATORY TESTS Potassium (K) *Remember: In children, psuedohyperkalemia can occur due to the small needle size which can cause the blood sample to hemolyze resulting in a falsely elevated potassium level. COMMON LABORATORY TESTS • Chloride • Elevated Chloride Level- Dehydration, excessive salt intake, kidney disease, hyperparathyroidism • Low Chloride Level- occurs when there is too much water in the body (ex: syndrome of inappropriate antidiuretic hormone), Addison’s disease, Metabolic Alkalosis, heart failure. COMMON LABORATORY TESTS • Carbon Dioxide Content (CO2)aka “bicarb” -Bicarbonate is an electrolyte, a negatively charged ion that is used by the body to help maintain the body's acid-base (pH) balance. -Acidosis and alkalosis describe the abnormal conditions that result from an imbalance in the pH of the blood caused by an excess of acid or alkali (base). -Any disease or condition that affects the lungs, kidneys, metabolism, or breathing has the potential to cause acidosis or alkalosis. COMMON LABORATORY TESTS • Carbon Dioxide Content (CO2)aka “bicarb” - Elevated CO2 can be caused by: Dehydration, Chronic diarrhea, kidney disease, Addison’s disease, Diabetic Ketoacidosis -Low CO2 can be caused by: severe prolonged vomiting, lung disease (ex: COPD), heart failure, kidney disease COMMON LABORATORY TESTS • Blood Urea Nitrogen (BUN) • Urea is formed in the liver as the end product of protein metabolism and is transported to the kidneys for excretion. • Nearly all renal diseases can cause an inadequate excretion of urea, which causes the blood concentration to rise above normal (thus an elevated BUN). • The BUN is interpreted in conjunction with the creatinine test – these tests are referred to as “renal function
Load more

Recommended publications
  • Mass Cytometric Functional Profiling of Acute Myeloid Leukemia Defines Cell-Cycle and Immunophenotypic Properties That Correlate with Known Responses to Therapy
    Published OnlineFirst June 19, 2015; DOI: 10.1158/2159-8290.CD-15-0298 ReseaRch aRticle Mass Cytometric Functional Profiling of Acute Myeloid Leukemia Defines Cell-Cycle and Immunophenotypic Properties That Correlate with Known Responses to Therapy Gregory K. Behbehani1,2,3, Nikolay Samusik1, Zach B. Bjornson1, Wendy J. Fantl1,4, Bruno C. Medeiros2,3, and Garry P. Nolan1 Downloaded from cancerdiscovery.aacrjournals.org on September 25, 2021. © 2015 American Association for Cancer Research. Published OnlineFirst June 19, 2015; DOI: 10.1158/2159-8290.CD-15-0298 abstRact Acute myeloid leukemia (AML) is characterized by a high relapse rate that has been attributed to the quiescence of leukemia stem cells (LSC), which renders them resistant to chemotherapy. However, this hypothesis is largely supported by indirect evidence and fails to explain the large differences in relapse rates across AML subtypes. To address this, bone mar- row aspirates from 41 AML patients and five healthy donors were analyzed by high-dimensional mass cytometry. All patients displayed immunophenotypic and intracellular signaling abnormalities within CD34+CD38lo populations, and several karyotype- and genotype-specific surface marker patterns were identified. The immunophenotypic stem and early progenitor cell populations from patients with clinically favorable core-binding factor AML demonstrated a 5-fold higher fraction of cells in S-phase compared with other AML samples. Conversely, LSCs in less clinically favorable FLT3-ITD AML exhib- ited dramatic reductions in S-phase fraction. Mass cytometry also allowed direct observation of the in vivo effects of cytotoxic chemotherapy. SIGNIFICANCE: The mechanisms underlying differences in relapse rates across AML subtypes are poorly understood.
    [Show full text]
  • A Comparative Study of Murine Mast Cell Progenitors
    Virginia Commonwealth University VCU Scholars Compass Theses and Dissertations Graduate School 2001 A Comparative Study of Murine Mast Cell Progenitors Shirley K. DeSimone Follow this and additional works at: https://scholarscompass.vcu.edu/etd Part of the Other Medicine and Health Sciences Commons © The Author Downloaded from https://scholarscompass.vcu.edu/etd/4529 This Dissertation is brought to you for free and open access by the Graduate School at VCU Scholars Compass. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of VCU Scholars Compass. For more information, please contact [email protected]. Virginia Commonwealth University School of Medicine This is to certifythat the dissertation prepared by Shirley K. DeSimone entitled "A Comparative Study of Murine Mast Cell Progenitors" has been approved by her committee as satisfactory completion of the disse1tation requirement for the degree of Doctor of Philosophy. Francine M. Marciano-Cabral, Ph.D., School of Medicine Jack L. Haar, Ph.D., Dean, School of Graduate Studies A Comparative Study of Murine Mast Cell Progenitors A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy at Virginia Commonwealth University By Shirley K. DeSimone Director: Thomas F. Huff, Ph.D. Professor, Microbiology and Immunology Virginia Commonwealth University Richmond, Virginia May, 2001 11 Acknowledgments I wish to thank my advisor, Dr. Thomas F. Hufffor his insight, guidance, and patience. also which to acknowledge the invaluable, unwavering, and loving support of my husband, friend and companion, Dr. John A. DeSimone. Thanks are also due to the consistently helpful graduate students of Dr.
    [Show full text]
  • Non-Commercial Use Only
    only use Non-commercial 14th International Conference on Thalassaemia and Other Haemoglobinopathies 16th TIF Conference for Patients and Parents 17-19 November 2017 • Grand Hotel Palace, Thessaloniki, Greece only use For thalassemia patients with chronic transfusional iron overload... Make a lasting impression with EXJADENon-commercial film-coated tablets The efficacy of deferasirox in a convenient once-daily film-coated tablet Please see your local Novartis representative for Full Product Information Reference: EXJADE® film-coated tablets [EU Summary of Product Characteristics]. Novartis; August 2017. Important note: Before prescribing, consult full prescribing information. iron after having achieved a satisfactory body iron level and therefore retreatment cannot be recommended. ♦ Maximum daily dose is 14 mg/kg body weight. ♦ In pediatric patients the Presentation: Dispersible tablets containing 125 mg, 250 mg or 500 mg of deferasirox. dosing should not exceed 7 mg/kg; closer monitoring of LIC and serum ferritin is essential Film-coated tablets containing 90 mg, 180 mg or 360 mg of deferasirox. to avoid overchelation; in addition to monthly serum ferritin assessments, LIC should be Indications: For the treatment of chronic iron overload due to frequent blood transfusions monitored every 3 months when serum ferritin is ≤800 micrograms/l. (≥7 ml/kg/month of packed red blood cells) in patients with beta-thalassemia major aged Dosage: Special population ♦ In moderate hepatic impairment (Child-Pugh B) dose should 6 years and older. ♦ Also indicated for the treatment of chronic iron overload due to blood not exceed 50% of the normal dose. Should not be used in severe hepatic impairment transfusions when deferoxamine therapy is contraindicated or inadequate in the following (Child-Pugh C).
    [Show full text]
  • Hemolytic Disease of the Newborn
    Intensive Care Nursery House Staff Manual Hemolytic Disease of the Newborn INTRODUCTION and DEFINITION: Hemolytic Disease of the Newborn (HDN), also known as erythroblastosis fetalis, isoimmunization, or blood group incompatibility, occurs when fetal red blood cells (RBCs), which possess an antigen that the mother lacks, cross the placenta into the maternal circulation, where they stimulate antibody production. The antibodies return to the fetal circulation and result in RBC destruction. DIFFERENTIAL DIAGNOSIS of hemolytic anemia in a newborn infant: -Isoimmunization -RBC enzyme disorders (e.g., G6PD, pyruvate kinase deficiency) -Hemoglobin synthesis disorders (e.g., alpha-thalassemias) -RBC membrane abnormalities (e.g., hereditary spherocytosis, elliptocytosis) -Hemangiomas (Kasabach Merritt syndrome) -Acquired conditions, such as sepsis, infections with TORCH or Parvovirus B19 (anemia due to RBC aplasia) and hemolysis secondary to drugs. ISOIMMUNIZATION A. Rh disease (Rh = Rhesus factor) (1) Genetics: Rh positive (+) denotes presence of D antigen. The number of antigenic sites on RBCs varies with genotype. Prevalence of genotype varies with the population. Rh negative (d/d) individuals comprise 15% of Caucasians, 5.5% of African Americans, and <1% of Asians. A sensitized Rh negative mother produces anti-Rh IgG antibodies that cross the placenta. Risk factors for antibody production include 2nd (or later) pregnancies*, maternal toxemia, paternal zygosity (D/D rather than D/d), feto-maternal compatibility in ABO system and antigen load. (2) Clinical presentation of HDN varies from mild jaundice and anemia to hydrops fetalis (with ascites, pleural and pericardial effusions). Because the placenta clears bilirubin, the chief risk to the fetus is anemia. Extramedullary hematopoiesis (due to anemia) results in hepatosplenomegaly.
    [Show full text]
  • Section 8: Hematology CHAPTER 47: ANEMIA
    Section 8: Hematology CHAPTER 47: ANEMIA Q.1. A 56-year-old man presents with symptoms of severe dyspnea on exertion and fatigue. His laboratory values are as follows: Hemoglobin 6.0 g/dL (normal: 12–15 g/dL) Hematocrit 18% (normal: 36%–46%) RBC count 2 million/L (normal: 4–5.2 million/L) Reticulocyte count 3% (normal: 0.5%–1.5%) Which of the following caused this man’s anemia? A. Decreased red cell production B. Increased red cell destruction C. Acute blood loss (hemorrhage) D. There is insufficient information to make a determination Answer: A. This man presents with anemia and an elevated reticulocyte count which seems to suggest a hemolytic process. His reticulocyte count, however, has not been corrected for the degree of anemia he displays. This can be done by calculating his corrected reticulocyte count ([3% × (18%/45%)] = 1.2%), which is less than 2 and thus suggestive of a hypoproliferative process (decreased red cell production). Q.2. A 25-year-old man with pancytopenia undergoes bone marrow aspiration and biopsy, which reveals profound hypocellularity and virtual absence of hematopoietic cells. Cytogenetic analysis of the bone marrow does not reveal any abnormalities. Despite red blood cell and platelet transfusions, his pancytopenia worsens. Histocompatibility testing of his only sister fails to reveal a match. What would be the most appropriate course of therapy? A. Antithymocyte globulin, cyclosporine, and prednisone B. Prednisone alone C. Supportive therapy with chronic blood and platelet transfusions only D. Methotrexate and prednisone E. Bone marrow transplant Answer: A. Although supportive care with transfusions is necessary for treating this patient with aplastic anemia, most cases are not self-limited.
    [Show full text]
  • Evaluation of Anemia Survey (NHANES III) Data- 9 10-28% of Patients Over 65 Years Are Anemic Mark Wurster, M.D., F.A.C.P
    Anemia - Definition • National Health and Nutrition Examination Evaluation of Anemia Survey (NHANES III) data- 9 10-28% of patients over 65 years are anemic Mark Wurster, M.D., F.A.C.P. 9 One third of these are due to iron, folate, B12 The Ohio State University deficiency alone or in combination 9 One third are due to renal disease, or other chronic inflammatory response 9 One third are due to various primary marrow disorders, malignancies or other disorders Anemia Anemia - Definition Classification Schemes • A simplified approach to anemia, • Most common hematologic disorder emphasizing information already included • Decrease from normal levels of Hgb, Hct, RBC: in the CBC: 9 FlFemales – MHb14/dlMean Hgb = 14 g/dl; -2SD = 12 g /dl • Mean Cellular Volume (MCV) 9 Males – Mean Hgb = 15.5 g/dl; -2SD = 13.5 g/dl • Red Cell Distribution Width (RDW) • Caveat – Anemia is a syndrome, not a disease. • Retic count An abnormal Hgb or Hct should ALWAYS be investigated if confirmed on repeat testing. 1 Anemia Anemia Classification Schemes Classification Schemes • Mean Cellular Volume (MCV) • Red blood cell Distribution Width (RDW) • Decreased MCV (microcytic); < 80 fL 9 A numerical expression of • Normal MCV (normocytic); 80 – 99 fL anisocytosis, or variation in RBC size • Increased MCV (macrocytic); > 100 fL Anemia Anemia Classification Schemes Classification Schemes • Red blood cell Distribution Width (RDW) 9 Normal RDW - representing a uniform population • Red blood cell Distribution Width (RDW) of RBCs with respect to size (actually the standard deviation of red blood cell volume divided by the mean volume) 9 Normal; < or = to app.
    [Show full text]
  • Scurvy Due to Selective Diet in a Seemingly Healthy 4-Year-Old Boy Andrew Nastro, MD,A,G,H Natalie Rosenwasser, MD,A,B Steven P
    Scurvy Due to Selective Diet in a Seemingly Healthy 4-Year-Old Boy Andrew Nastro, MD,a,g,h Natalie Rosenwasser, MD,a,b Steven P. Daniels, MD,c Jessie Magnani, MD,a,d Yoshimi Endo, MD,e Elisa Hampton, MD,a Nancy Pan, MD,a,b Arzu Kovanlikaya, MDf Scurvy is a rare disease in developed nations. In the field of pediatrics, it abstract primarily is seen in children with developmental and behavioral issues, fDivision of Pediatric Radiology and aDepartments of malabsorptive processes, or diseases involving dysphagia. We present the Pediatrics and cRadiology, NewYork-Presbyterian/Weill Cornell Medical Center, New York, New York; bDivision of case of an otherwise developmentally appropriate 4-year-old boy who Pediatric Rheumatology and eDepartment of Radiology, developed scurvy after gradual self-restriction of his diet. He initially Hospital for Special Surgery, New York, New York; and d presented with a limp and a rash and was subsequently found to have anemia Division of Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, Michigan gDepartment of Pediatrics, and hematuria. A serum vitamin C level was undetectable, and after review of NYU School of Medicine, New York, New York hDepartment of the MRI of his lower extremities, the clinical findings supported a diagnosis of Pediatrics, Bellevue Hospital Center, New York, New York scurvy. Although scurvy is rare in developed nations, this diagnosis should be Dr Nastro helped conceptualize the case report, considered in a patient with the clinical constellation of lower-extremity pain contributed to writing the introduction, initial presentation, hospital course, and discussion, and or arthralgias, a nonblanching rash, easy bleeding or bruising, fatigue, and developed the laboratory tables while he was anemia.
    [Show full text]
  • Hematopoiesis/RBC Disorders
    Neonatal Hematopoiesis and RBC Disorders Vandy Black, MD, MSc Pediatric Hematology June 2, 2016 Objectives • Review normal erytHropoiesis in tHe fetus and neonate and regulation of fetal hemoglobin • Outline tHe differential diagnosis of neonatal RBC disorders witH a focus on tHe clinical and laboratory findings • Discuss common presentations of intrinsic red cell disorders in neonates WhicH of tHe following infants is most likely to be diagnosed with a primary hematologic disorder (i.e. need ongoing follow-up in my office)? A. A full-term male with a Hb of 7.5 gm/dL at birth (MCV 108) B. A one week old witH a newborn screen tHat shows Hb FAS C. A full-term Caucasian male with a peak bilirubin of 21 mg/dL whose mom is AB+ D. A 26 week AA female wHose fatHer Has a history of G6PD deficiency RBC Disorders in tHe NICU • Anemia is a common finding in tHe NICU • Differential is broad • Hospitalized preterm infants receive more PRBC transfusions tHan any otHer patient group • >80% of ELBW infants receive at least one PRBC transfusion How RBC Disorders Present? • Anemia on a CBC – May be an expected or incidental finding • Abnormal RBC indices • Abnormal newborn screens • Hyperbilirubinemia • Screening because of family History What is Normal? CHristensen et al, Semin Perinatol 2009 What is Normal? CHristensen et al, Semin Perinatol 2009 Hemoglobin SwitcHing How to ApproacH Anemia • Are otHer cell lines involved? • What is tHe MCV? • What is tHe reticulocyte count? • What does tHe peripHeral blood smear sHow? Microcytic Anemia • Iron Deficiency – Iron supplementation for preterm infants • Thalassemia – Beta-thalassemia less likely in the neonatal period • Chronic Inflammation – Disorders of iron transport (e.g.
    [Show full text]
  • WSC 10-11 Conf 7 Layout Master
    The Armed Forces Institute of Pathology Department of Veterinary Pathology Conference Coordinator Matthew Wegner, DVM WEDNESDAY SLIDE CONFERENCE 2010-2011 Conference 7 29 September 2010 Conference Moderator: Thomas Lipscomb, DVM, Diplomate ACVP CASE I: 598-10 (AFIP 3165072). sometimes contain many PAS-positive granules which are thought to be phagocytic debris and possibly Signalment: 14-month-old , female, intact, Boxer dog phagocytized organisms that perhaps Boxers and (Canis familiaris). French bulldogs are not able to process due to a genetic lysosomal defect.1 In recent years, the condition has History: Intestine and colon biopsies were submitted been successfully treated with enrofloxacin2 and a new from a patient with chronic diarrhea. report indicates that this treatment correlates with eradication of intramucosal Escherichia coli, and the Gross Pathology: Not reported. few cases that don’t respond have an enrofloxacin- resistant strain of E. coli.3 Histopathologic Description: Colon: The small intestine is normal but the colonic submucosa is greatly The histiocytic influx is reportedly centered in the expanded by swollen, foamy/granular histiocytes that submucosa and into the deep mucosa and may expand occasionally contain a large clear vacuole. A few of through the muscular wall to the serosa and adjacent these histiocytes are in the deep mucosal lamina lymph nodes.1 Mucosal biopsies only may miss the propria as well, between the muscularis mucosa and lesions. Mucosal ulceration progresses with chronicity the crypts. Many scattered small lymphocytes with from superficial erosions to patchy ulcers that stop at plasma cells and neutrophils are also in the submucosa, the submucosa to only patchy intact islands of mucosa.
    [Show full text]
  • Simultaneous Pure Red Cell Aplasia and Auto-Immune Hemolytic Anemia in a Previously Healthy Infant
    Simultaneous Pure Red Cell Aplasia and Auto-immune Hemolytic Anemia in a Previously Healthy Infant Robert P. Sanders, MD July 16, 2002 Case Presentation Patient Z.H. • Previously Healthy 7 month old WM • Presented to local ER 6/30 with 1 wk of decreased activity and appetite, low grade temp, 2 day h/o pallor. • Noted to have severe anemia, transferred to LeBonheur • Review of Systems – ? Single episode of dark urine – 4 yo sister diagnosed with Fifth disease 1 wk prior to onset of symptoms, cousin later also diagnosed with Fifth disease – Otherwise negative ROS •PMH – Term, no complications – Normal Newborn Screen – Hospitalized 12/01 with RSV • Medications - None • Allergies - NKDA • FH - Both parents have Hepatitis C (pt negative) • SH - Lives with Mom, 4 yo sister • Development Normal Physical Exam • 37.2 167 33 84/19 9.3kg • Gen - Alert, pale, sl yellow skin tone, NAD •HEENT -No scleral icterus • CHEST - Clear • CV - RRR, II/VI SEM at LLSB • ABD - Soft, BS+, no HSM • SKIN - No Rash • NEURO - No Focal Deficits Labs •CBC – WBC 20,400 • 58% PMN 37% Lymph 4% Mono 1 % Eo – Hgb 3.4 • MCV 75 MCHC 38.0 MCH 28.4 – Platelets 409,000 • Retic 0.5% • Smear - Sl anisocytosis, Sl hypochromia, Mod microcytes, Sl toxic granulation • G6PD Assay 16.6 U/g Hb (nl 4.6-13.5) • DAT, Broad Spectrum Positive – IgG negative – C3b, C3d weakly positive • Chemistries – Total Bili 2.0 – Uric Acid 4.8 –LDH 949 • Urinalysis Negative, Urobilinogen 0.2 • Blood and Urine cultures negative What is your differential diagnosis? Differential Diagnosis • Transient Erythroblastopenia of Childhood • Diamond-Blackfan syndrome • Underlying red cell disorder with Parvovirus induced Transient Aplastic Crisis • Immunohemolytic anemia with reticulocytopenia Hospital Course • Admitted to ICU for observation, transferred to floor 7/1.
    [Show full text]
  • Effects of Heterologous Antineutrophil Serum in Guinea Pigs Hematologic and Ultrastructural Observations
    Effects of Heterologous Antineutrophil Serum in Guinea Pigs Hematologic and Ultrastructural Observations David M. Simpson and Russell Ross Two pools of rabbit anti-guinea pig neutrophil serum (ANS) were prepared using an intravenous (ANS I) or subcutaneous (ANS II) route of immunization with proteose peptone-stimulated peritoneal exudate neutrophils (PMNs) from albino guinea pigs. In vitro, both pools of ANS contained high titers of agglutinating antibodies to neutrophils and lower titers against lymphocytes and red cells. Ag- glutinins against all three cell types could be selectively removed by absorption. The in vivo hematologic effects of both the absorbed and unabsorbed antisera were examined after intraperitoneal administration, and the effects of ANS on neu- trophils in blood, bone marrow, and peritoneal cavity were examined by light and electr microscopy of spleen, liver, lung, lymph node, buffy coat, bone mar- row and pellets of peritoneal cells removed at various time intervals within 24 hours. Injection of either antisera caused a rapid decrase in circulating neu- trophils and lymphocytes, whi reached thefr lowest levels within 12 hours. Neutrophils that disappeared from the circulation were sequestered primarily in liver and spleen where they were phagocytized, as morphologically intact cells, by macrophages and then rapidly digested. Immature bone marow neutrophils as young as early myelocytes were ingested by macrophages in the marrow at 6 hours or later after ANS. Neutrophils that were phagocytized were apparently opsonized by ANS since there was no ultrastructurl evidence of neutrophil lysis in blood or bone manrow after ANS treatment. However, both lysed and ingested neubrophils were observed in the peritoneal cavity.
    [Show full text]
  • Left Shift Cbc Example Foto
    Left Shift Cbc Example Remittent Crawford roughen, his cliffs palms divaricating irreproachably. Timorous and catchweight unheedingly.Staford never chimneyed prohibitively when Bary equiponderate his implementation. Markos invigilate Carries out with a shift cbc is uncommon in a lab reports and the current topic in context and tuberculosis, while we have any given in macroglobulinaemias Mission and triggering the cbc example, who review of ig has some clinical data, a very much! Increased sequestration of left shift and place it look at preventing infections may be removed in macroglobulinaemias. Cells to an anemic animal that is a good example of this. Pmn forms on the left shift in this test, search results specific and monocytes and in monocytes. Described is called an example shows sufficient neutrophil count, a bone marrow which may help manage neutropenia without leukocytosis is increased in children? Categorized into the left shift example of the cells are the possible. Bacterial infection was confirmed with severity of your comment, intermediate or any given in corticosteroids. Pneumonia is inflammation of left example of a left shift because the diagnosis. Connected by means of white blood test and assesses the condition of. Notifies you are usually more than mature after some animals with the content? Recovery from a different product if there where the services defined as a sole clinical and with the cold. Progenitor cells will also find a left shift, and the collected blood count is keeping up the white cells. Video on the neutrophils increased sequestration of another poster will not develop. Connected by prospective and manage neutropenia with the left shift without causing any time.
    [Show full text]