“Coughing Up Blood” part 2

Patient is intubated for airway protection. She is also resuscitated with 2 liters of IV crystalloid fluids. Initial workup elicits the following: Lab WBC 10.2 (normal differential), Hgb 11.4, Plt 190K Na+ 136, K+ 4.0, Cl– 110, HCO3– 24, BUN 52, Cr 2.6, Glucose 112 AST: 27, ALT 25, Total Bilirubin 0.2, Albumin 3.2 ABG:Continue reading ““Coughing Up Blood” part 2″

“Coughing Up Blood” part 3

This patient has two separate problems: Hemoptysis (with likely Diffuse Alveolar Hemorrhage) and Acute Kidney Injury (with likely glomerulonephritis as evidenced by urinalysis findings) in the setting of elevated inflammatory markers. Diffuse Alveolar Hemorrhage Diagnosed by bronchoscopic alveolar lavage (BAL) obtaining sequential 5mL aliquots that show increasing RBCs Differential Diagnosis: Pulmonary capillaritis Vasculitis Anti-GBM diseaseContinue reading ““Coughing Up Blood” part 3″

Microangiopathic Hemolytic Anemia (MAHA)

Laboratory Evaluation Anemia in the setting of increased reticulocyte count, elevated LDH, decreased haptoglobin, elevated plasma free hemoglobin, elevated indirect bilirubin, and a negative Coomb’s test (see Anemia) raises suspicion for a microangiopathic hemolytic anemia (MAHA). A peripheral smear may elicit schistocytes (see above picture). Initial workup in the suspicion for a microangiopathic hemolytic anemiaContinue reading “Microangiopathic Hemolytic Anemia (MAHA)”

Viral Hepatitis

Hepatitis A Virus (HAV) Transmission: Fecal-oral Presentation: Febrile illness, nausea/vomiting, diarrhea, anorexia, abdominal distension, rarely causes fulminant liver disease Diagnosis: Hepatitis A Virus IgM Management: Conservative management Hepatitis B Virus (HBV) Transmission: Blood, sex, vertical (mother-to-baby) Presentation Acute: Similarly to Hepatitis A: Febrile illness, nausea/vomiting, diarrhea, abdominal pain. Rarely, jaundice and fulminant liver disease. Chronic:Continue reading “Viral Hepatitis”

“My blood pressure is high” continued

This young male with difficult-to-control hypertension on maximum-dose therapy of two antihypertensives requires a workup for secondary hypertension. Labs WBC 6,400, Hgb 13.6, Plt 245,000 Na+ 146, K+ 2.8, Cl– 110, HCO3– 30, BUN 27, Creatinine 0.8, Calcium 8.5 TSH: 2.4 8 AM Plasma Aldosterone Concentration (PAC): 22 ng/dL; Plasma Renin Activity (PRA): 0.6 ng/mLContinue reading ““My blood pressure is high” continued”

Coagulation

Coagulation Cascade Coagulation Labs PT (Prothrombin Time): Thromboplastin (which contains Tissue Factor) is added to blood and the time needed to clot is recorded. Specifically analyzes the extrinsic pathway (factors II, V, VII, and X, and fibrinogen) (1) INR (International Normalized Ratio): Because of variability in thromboplastin reagent mixtures around the world, the INR wasContinue reading “Coagulation”

Lumbar Puncture Interpretation

Meningitis Routine Laboratory Results Specific Markers PCR May vary from center to center, but generally will detect E. coli, H. influenzae, N. meningitidis, Listeria monocytogenes, Streptococcus agalactiae, Streptococcus pneumoniae, CMV, Enterovirus, HSV 1/2, HHV-6, Human parechovirus, VZV, and Cryptococcus neoformans/gattii ADA (Adenosine Deaminase) Sensitivity and specificity for tuberculous meningitis varies depending cutoff level, however, approachesContinue reading “Lumbar Puncture Interpretation”

Lactic Acidosis

Lactic acid is a commonly obtained laboratory marker. The differential diagnosis for a patient with a lactic acidosis is broad. Differentiating these etiologies requires an understanding of the underlying biochemical pathways. Type A (Hypoxic) Tissue Hypoxia This is the most common cause of lactic acidosis, especially in patients with shock When tissue is not receivingContinue reading “Lactic Acidosis”