Case Study No.3
A 30-year-old man with a long history of intravenous drug abuse and chronic hepatitis B presents with jaundice. Physical examination reveals a malnourished man with ascites (edema in the abdomen). The patient has poor concentration.
The doctor has ordered the following tests to him
Total protein, albumin, globulins, calcium, BUN, creatinine, total bilirubin, AST , ALT, CBC Coagulation profile (PT)
Q One If you were the phlebotomist who is obtaining the samples, what kind of tubes you may use
Q Two what is the function of our liver
The doctor has ordered the following tests to him
Total protein, albumin, globulins, calcium, BUN, creatinine, total bilirubin, AST , ALT, CBC Coagulation profile (PT)
Q One If you were the phlebotomist who is obtaining the samples, what kind of tubes you may use
Q Two what is the function of our liver
Q Three what is liver function profile
Q Four what are the patient precaution points you may tell the nurse in order to prepare patient
Q Five If you were the lab technician or specialist who runs the samples for this patient, what are the causes make you reject the patient's specimens
After running these tests, these are the results of the patient
Total protein 8.3 g,d/L (normal, 6.O-7.8 g/dL)
albumin 2.5 g/dL (normal, 3.5.-5.5 g/dL)
globulins 5.8 g/dL(normal, 2.3-3.5 g/dL)
calcium 6.5 mg/dL (normal, 8.4-10.2 mg/dL)
BUN 5 mg/dL (normal, 7-18 mg/dL)
Creatinine 0.9 mg/dL (normal, 0.6-1.2 mg/dL)
Total bilirubin 6.0 mg/dL (normal, 0.1-1.0 mg/dL)
AST 7 U/L, (normal, 8-20 U/L)
ALT 5 U/L (normal, 8-20 U/L)
CBC: macrocytic anemia with hypersegmented neutrophils, mild neutropenia, and mild thrombocytopenla
Coagulation: prothrombin time (PT) is prolonged and does not correct with intramuscul vitamin K
Total protein 8.3 g,d/L (normal, 6.O-7.8 g/dL)
albumin 2.5 g/dL (normal, 3.5.-5.5 g/dL)
globulins 5.8 g/dL(normal, 2.3-3.5 g/dL)
calcium 6.5 mg/dL (normal, 8.4-10.2 mg/dL)
BUN 5 mg/dL (normal, 7-18 mg/dL)
Creatinine 0.9 mg/dL (normal, 0.6-1.2 mg/dL)
Total bilirubin 6.0 mg/dL (normal, 0.1-1.0 mg/dL)
AST 7 U/L, (normal, 8-20 U/L)
ALT 5 U/L (normal, 8-20 U/L)
CBC: macrocytic anemia with hypersegmented neutrophils, mild neutropenia, and mild thrombocytopenla
Coagulation: prothrombin time (PT) is prolonged and does not correct with intramuscul vitamin K
Q Six If you were responsible for reviewing the patients results before releasing, to ensure the results are accurate an no errors happened
AA What are the pathological causes that lead to abnormal liver function profile
BB How do you explain the result of low transaminase enzymes although the patient has hepatitis and drug abuse
CC How do you explain abnormal tests, hypoalbuminemia, and prolonged prothrombin time that does not correct with intramuscular vitamin K
DD Why TP is high while Albumin is decreased
EE Does the patient kidney affected? Why BUN is low
FF Why Ca is abnormally low in this patient
Q Seven What is the relation between the patient diagnosis and the poor concentration symptoms
Q Eight What is the most likely cause of the macrocytic anemia in this patient
Q Nine the physican is already graduated,
Aa He forgot to write the diagnosis, what do you think the diagnosis is
Bb what do you suggest an additional test to investigate liver function
Cc what do you suggest an additional test to investigate CNS problem
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