Question

An elderly woman presents with shortness of breath, cough, and fever. Her initial lab results are as follows:

                       Manual differential:
WBC       19.3               Band neutrophils            25
RBC       3.90               Polymorphonuclear neutrophils   50
Hgb       11.5               Lymphs               10
Hct       35.1               Monos                  5
MCV        90.0               Eos                  2
MCH       29.5               Basos      
MCHC       32.8               Metamyelocytes          5
RDW       12.9               Myelocytes              3
PLT   580.3

  

The results of the proposed additional tests were as follows:
Sputum Gram stain:   Gram-positive diplococci
Culture:        Streptococcus pneumoniae
Blood cultures:   S. pneumoniae (in all three samplings)
ESR:           39 mm/hr
Chest radiograph:   Diffuse fluid in alveolar spaces

1.   Describe the peripheral blood findings. (5 pts)

2.    Based on all the data provided, what condition is most likely? (5 pts)
     

3.   How would the bone marrow respond? (5 pts)

4.   What information is most diagnostic? (5 pts)

Answer 1

1. Leukopenia, a low WBC count to less than 50,000cells/microlitre is a clinical sign of impending sepsis. Secondly, blood culture shows the presence of streptococcus pneumoniae causing the disease pneumonia. Chest radiography also reveals the presence of fluid in the alveolar space.

2. PNEUMONIA is the most likely cause of the disease in this patient. Patient have the symptoms of cough, shortness of breath and fever which clearly confirms the diagnosis. Along with this, blood cultures shows the presence of streptococcus gram negative bacteria in the blood.

3. It has a greater effect on the bone marrow transplantation. The pneumonia is caused by cytomegalo virus, a common microbe leading cause of many health problems. But when a patient's immune system has been suppressed, as it is in a bone marrow transplantation, the half of the virus die due to transplantation. So, this treatment has an increasing effect on people diagnosing with pneumonia.

4. All reports are useful in confirming a diseases. They are interrelated each other in diagnosing a patient. In this case, blood culture after 24 hours of incubation clearly shows the presence of streptococcus pneumonia in the blood which explains the diagnosis of the diseases. Along with this chest X-ray also helps to find out the diseases. Fluid accumulation in the alveolar space is a common sign in patients with pneumonia.