Question

CASE STUDY A 22-year-old woman was admitted froes the emergency department for tests. She had fever, dysuria, and lower back pain. Immediate laboratory results revealed the fol lowing: CBC Urinalysis 4+ urine protein 1+ Hgb Many bacteria Moderate blood Moderate WBC Casts: few hyaline, few granular Chemistry: WBC:11.8 X 10P/L RBC, 29 x 1012/1 Hgh: 8.3 g/dL Het: 255 MCV: 88 L MCH: 29 PB BUN: 113 mg/dL Creatinine: 7.7 mg/dL MCHC: 300 L or 305 RDW: 14.79 1+ aniso 1+ poik 1 + crenated RBCS Blood cultures were drawn and eventually produced coagulase negative Staphylococcus. Blood was still present in the patient's urine after 2 days, and bleeding was noted from intravenous infusion sites. Coagulation tests were ordered before the patient was to go to surgery for kidney biopsy. Platelet count: 296 X 10P/L PT: 11.7 seconds (control: 10.0-12.9 seconds) APTT: 32 seconds (control: 23-35 seconds) Bleeding time: > 20 seconds FDP: > 40 ug/mL (APTT is activated partial thromboplastin time: FDP means fibrin/fibrinogen degradation products.) This patient was suffering from bacterial sepsis and renal failure. The admitting CBC demonstrated a mild anemia with some created red cell morphology typical of renal disease. The patient had received several units of packed red cells with no noticeable difference in her hematocrit (Hct). The anemia could be the product of several mechanisms. First, there was blood loss from her abnormal platelets (see Chap. 23) and from the DIC that she later developed. Her presenting anemia was most likely a result of the anemia of inflammation. Chronie and acute infections can produce this form of anemia The anemia of renal disease was also present in this pa- tient and was seen in conjunction with other causes of anemia Questions 1. Classify the anemia with regard to RBC indices. 2. Explain the significance of the RDW value in this case 3. List the laboratory parameters in this case that coincide with anemia associated with renal disease. 4. What is the major cause of renal failure associated with anemia? 5. Why would chronic iron loss be a concer in this patient?

Answer 1

1. As patient has low mchc value so the anemia is iron deficiency anemia as mean corpuscular hemoglobin concentration (MCHC), is the amount of hemoglobin relative to the size of the cell or hemoglobin concentration per red blood cell. This type of anemia is also called as microcytic hypochromic anemia.

2. A red cell distribution width (RDW) test is a measurement of the range in the volume and size of your red blood cells (erythrocytes).

The RDW test may also be used to diagnose:

• Other blood disorders such as thalassemia, an inherited disease that can cause severe anemia
• Medical conditions such as heart disease, diabetes, liver disease, and cancer, especially colorectal cancer.

3. lab parameters in coincidence with anemia associated with renal disease are high value of BUN and creatinine

4. cause of renal failure associated with anemia is decreased secretion of erythropoietin by kidneys. As a result  less erythropoisis occurs and causes anemia.

5. chronic blood loss would be a concern because patient may undergo shock that may lead to multiorgan dysfunction syndrome that may result in patient death.

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