September 13th (Monday) - A Case Study

MOUSE,MICKEY                                            B+       Queue
DOB  10/04/1932 Sex M Pat No 654321       Source    HOSPITAL  Received  11:58
Address   DISNEYLAND            Clinician KILDARE                    10/09/2010

  Date 10/09/2010 14/07/2010 30/06/2010 23/06/2010 09/06/2010 09/10/2007      
  Time 11:28      09:30      10:05      10:00      10:00      u/k             
  Spec AW117471J  AW215069M  AW170145Q  AW146255Q  AW380100H  AW188183G               

HB    7.6        10.5       12.2       11.2       12.9       14.0            
WBC   9.3        3.9        7.2        4.1        7.1        6.0             
PLT   264        124        135        145        129        165             
RBC   2.76       3.50       4.18       3.94       4.50       4.78            
HCT   0.260      0.320      0.360      0.350      0.380      0.423           
MCV   94.2       90.3       85.4       89.1       85.3       88.5            
MCH   27.5       30.0       29.2       28.4       28.7       29.3            
MCHC  29.2       33.2       34.2       31.9       33.6       33.1            
NEUH  5.9        1.6        4.6        1.7        4.8        3.71            
LYMPH 2.6        1.8        2.2        2.1        1.9        1.49            
MONO  0.7        0.4        0.3        0.4        0.3        0.50            
EOS   0.0        0.0        0.0        0.0        0.0        0.24            


                            Cursor Down for more                       
 Disc: CLIN    Sect: HAEW          THE DIARIST       SRE/APEX    

An interesting case. Consider the historical record. The patient has been haemodynamically stable, with haemoglobin and platelet levels toward the lower end of the reference ranges for at least three years.

He’s developed a gastrointestinal bleed which is evidenced by the drop in haemoglobin level. However the interesting parameter is the platelet count. It has effectively doubled (which is expected in such cases), but such doubling isn’t immediately noticeable because the number is now in the middle of the reference range.

Moral of the story – look at changes in values, not the values in isolation.

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