Lab Case 44

A 70 year old female presents generally unwell with malaise and fatigue for the past two days.

Her blood results are as follows:

Hb          95   g/l  (110-155)

PCV        0.280

MCV       78

MCH       26

Plt           589   (150 -400)   X10^9

WCC      15.1   (4-11)   X10^9

Na           138   mmol/l  (137-145)

K             6.0    mmol/l  (3.5-5)

Cl            102   mmol/l  (99-111)

HCO3      18    mmol/l  (24 +-2)

Urea        16.7 mmol/l   (3-8)

Creat       356  umol/l    (30-100)

1. Describe and interpret the abnormalities

2. What ECG changes would you expect?

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2 thoughts on “Lab Case 44

  1. Mildly hypochromic, mildly microcytic anaemia:
    ?secondary to chronic renal impairment, iron deficiency, chronic disease

    ?Acute on chronic renal failure – moderate hyperkalaemia, uraemia, high creatinine
    ?secondary to sepsis/intercurrent illness although wcc and platelets not hugely deranged
    HAGMA based on HCO3 with anion gap of 22
    Delta (22-12 =10)/(24-18 =6). = 1.6, pure HAGMA
    Would like to see lactate /glucose/pH on formal gas and capillary ketones.
    I think the uraemia is too low to account for this on its own, however if this is in conjunction with metformin in an acute renal deterioration?

    ECG changes in moderate hyperkalaemia include repolarisation abnormalities (tall peaked t waves) and early flattening of p waves
    If there is cardiac hypoperfusion from the same renal insult there may also be some mild widespread ischaemic changes.

    Or I could be way off the mark since its 3am!

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    • Very good Rachel. One more thought, could there be some acute blood loss on top of all the chronic changes, Possibly GI. The low HB with low Hct and high platelets may suggest this.
      3 am, wow that’s dedication or you could be bored at work

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