Question: A 28-year-old Man Presented To The Emergency Room With A Complaint Of Abdominal Pain. He Appeared Quite Ill, With Nausea, Cold Sweats, And Tachycardia. The Patient Appeared Slightly Jaundiced, And On Further Questioning Admitted That His Urine Had Been Dark And Discolored That Day. He Had Been Treated With A Sulfanomide Drug For An Undisclosed Illness. …

Question: A 28-year-old Man Presented To The Emergency Room With A Complaint Of Abdominal Pain. He Appeared Quite Ill, With Nausea, Cold Sweats, And Tachycardia. The Patient Appeared Slightly Jaundiced, And On Further Questioning Admitted That His Urine Had Been Dark And Discolored That Day. He Had Been Treated With A Sulfanomide Drug For An Undisclosed Illness. …

A 28-year-old man presented to the emergency room with acomplaint of abdominal pain. He appeared quite ill, with nausea,cold sweats, and tachycardia. The patient appeared slightlyjaundiced, and on further questioning admitted that his urine hadbeen dark and discolored that day. He had been treated with asulfanomide drug for an undisclosed illness. The preliminaryimpression was of acute appendicitis. The laboratory results are asfollows:

Amylase

Less than 31

30 – 110 U/L

WBC

6.3

4.5 – 10.5 x 103 / cumm

RBC

1.00

4.20 – 5.80 x 106 / cumm

HGB

4.4

13.5 – 16.5 g/dl

HCT

12.6

40 – 49%

MCV

126

80 – 100 fL

MCH

43.9

27.0 – 34.0 pg

MCHC

34.8

32.0 – 36.5%

Platelets

209

150 – 450 x 103/cumm

RDW

23.5

0 – 16.5%

Direct Bilirubin

0.7

0.0 – 0.4 mg/dl

Total Bilirubin

7.9

0.1 – 1.4 mg/dl

AST

567

0 – 100 IU/L

LDH

2844

0 – 100 IU/L

Haptoglobin

0.1 g/L

0.4 – 3.6 g/L

Segs

60

35 – 70%

Bands

5

2 – 7%

Lymphocytes

32

15 – 30%

Monocytes

1

0 – 10%

Eosinophils

1

0 – 8%

Basophils

1

0 – 3%

NRBC

8/100 WBC cells counted

RBC morphology

Mkd. Aniso, mod poik, occ basophilic stippling, sl-modpolychromasia, mod. Teardrop cells, occ. Schistocytes, bites, occ.ovalocytes

  1. Based on the serum chemistries, is the patient experiencing ahemolytic episode?

Please list the abnormal chemistryresults and associate them with potential cause.

  1. Please list the abnormal morphologies reported in theperipheral smear and associate them with the potential diagnosis inthis case.

           Why is the MCV macrocytic?

  1. What is the cause of this patients anemia? Be specific.
  1. What type of stain is a new methelyene blue stain?

If a new methelyene blue stain wasperformed on this patients RBC’s, what RBC inclusion may beseen?

  1. If the WBC reported was not corrected, should it havebeen?

Why or why not?

6. Please calculate the corrected WBCcount on this patient.