Hsa51000

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Case Study 10 2020

A 59 year old man, presented to the emergency room complaining of fever and chills for 4 days, with dizziness over the last 24 hours.

Also complained of intermittent diarrhea and constipation over the last 6 months with occasional bloody stool.

Past history: Heavy smoker of 45 years and admitted drinking alcohol regularly.

Examination: Rapid breathing with lung sounds clear. Temperature 102.3 degrees F.

Hypotensive, tachycardic, and an appreciable heart mummer.

Blood was drawn for CBC and blood cultures. A stool specimen was collected for occult blood and a chest x-ray was performed.

Instructions:

Utilize the table below and description above to evaluate the status of your patient. When writing up your case study remember to enter the reference ranges and interpretations.

CBC Results
	Admission	Reference ranges	Interpretation
WBC	9.1 X109 /L	3.6 – 10.6 x 109 /L	Normal
RBC	4 X10 12/L	4.00 – 6.00 x 1012/L	Normal
Hemoglobin	12.2 g/dL	12.0 – 18.0 g/dL	Normal
Hematocrit	40 %	35% – 50%	Normal
MCV	100 fL	76 – 100 fL	Normal
MCH	32 pg	26 – 34 pg	Normal
MCHC	30 g/dL	32 – 36 g/dL	Low
RDW-CV	15.6 %	11.5 – 14.5%	High
Platelets	458 X 109 /L	150 – 450 x 109 /L	High
MPV	7.2 fL	7 – 9 fL	Normal
Differential
Neutrophils	52%	50 – 70%
Bands	10%
Lymphocytes	35%	18 – 42%
Monocytes	1%	2 – 11%
Eosinophils	0	1 – 3%
Basophils	0	0 – 2%
Metamyelocytes	2
Morphology
	1+ Macrocytes
	2+ Microcytes
	1+ Ovalocytes
	1+ basophilic stippling
	2+ hypochomia
	1+ polychromatophilia
	2+ toxic granulation
	Rare Dohle bodies
	Rare hypersegmentation
	2 nucleated RBC's

Bacterial Culture	Results
All blood cultures	Positive within 24 hours
Gram Stain	Gram positive cocci in chains
Culture on BAP	gamma hemolytic, small grey colonies
Biochemical Results
Catalase	Negative
Bile Esculin agar	growth with black precipitate
6.5% NaCl	Negative
L-pyrrolidinyl beta-naphthylamide PYR test	Negative

Instructions:

Use the questions below to guide you in writing up your case study. Remember to refer to the case study description and rubric when planning and writing your case study.

1. What criteria may be used to determine if a positive blood culture is due to contamination or bacteremia?

2. Does the patient have a bacteremia or a septicemia?

3. Given the colonial morphology, biochemical reactions and gram stain what is the most likely organism?

4. What other methods may be employed to get a definitive identification of this organism.

5. Relating back to the patient, what of the numerous underlying medical problems is associated with this organism?

6. How do the CBC results relate to the patient’s condition?

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