chbare Posted July 22, 2006 Author Share Posted July 22, 2006 You get blood to the lab and they start cranking the results out. Unfortunately, the CT scanner and chemistry machines go down and the only thing you can get is a CBC. Hey, even the land of Oz has the occasional problem. EDIT: Cannot get a VQ scan in until the morning. WBC: 13/mm3 Hbg: 13.9g/dl HCT: 47% PLT: 159/mm3 Neut: 45% Lympho: 10% Mono: 2% Eosino: 42% Baso: 1% What are you thinking now? Take care, chbare. Link to comment Share on other sites More sharing options...
AZCEP Posted July 22, 2006 Share Posted July 22, 2006 The WBC is very low. Would lead you to think a viral cause. I'd still like to get a picture of the liver and gall bladder, for kicks. Link to comment Share on other sites More sharing options...
chbare Posted July 22, 2006 Author Share Posted July 22, 2006 AZCEP, try a WBC of 13,000/mm3. (I cut the zeros off, sorry if this was confusing) What do you think of the eosinophils? Edit: The flat and upright abd is negative. (nothing major such as, air fluid levels, free air, or evidence of ileus) The gallbladder US is negative. Take care, chbare. Link to comment Share on other sites More sharing options...
hammerpcp Posted July 22, 2006 Share Posted July 22, 2006 You get blood to the lab and they start cranking the results out. Unfortunately, the CT scanner and chemistry machines go down and the only thing you can get is a CBC. Hey, even the land of Oz has the occasional problem. EDIT: Cannot get a VQ scan in until the morning. WBC: 13/mm3 Hbg: 13.9g/dl HCT: 47% PLT: 159/mm3 Neut: 45% Lympho: 10% Mono: 2% Eosino: 42% Baso: 1% What are you thinking now? Take care, chbare. I am thinking I don't have a freakin clue what you are taking about. I better give this pt a blanket and take them to the hospital. Link to comment Share on other sites More sharing options...
AZCEP Posted July 22, 2006 Share Posted July 22, 2006 AZCEP, try a WBC of 13,000/mm3. (I cut the zeros off, sorry if this was confusing) What do you think of the eosinophils? Edit: The flat and upright abd is negative. (nothing major such as, air fluid levels, free air, or evidence of ileus) The gallbladder US is negative. Take care, chbare. The increase could be related to the pulmonary infiltrate that was discussed, but somehow I'm thinking you didn't make it that easy Link to comment Share on other sites More sharing options...
medic429 Posted July 22, 2006 Share Posted July 22, 2006 I noticed "people walking thier dogs" and thought about some kind of worm or parasite from the dogs maybe? Then I did some research and came up with idiopathic hypereosinophilic syndrome ?? just my guess...... Link to comment Share on other sites More sharing options...
JackMaga Posted July 22, 2006 Share Posted July 22, 2006 Eosinophilia leads me to two possible aetiologies: either an allergic one or a parassitosis... given the recent history of outdoor activities and no known allergies I would lean toward a parasite infection. Toxocara canis I think would be a suitable candidate for this presentation (eosinophilia, pulmonary simptoms, abdominal pain, hepatomegalia, not to mention having dogs all around the place); a stool analisis should confirm this hypotesis... Link to comment Share on other sites More sharing options...
Ace844 Posted July 22, 2006 Share Posted July 22, 2006 Eosinophilia leads me to two possible aetiologies: either an allergic one or a parassitosis... given the recent history of outdoor activities and no known allergies I would lean toward a parasite infection. Toxocara canis I think would be a suitable candidate for this presentation (eosinophilia, pulmonary simptoms, abdominal pain, hepatomegalia, not to mention having dogs all around the place); a stool analisis should confirm this hypotesis... Yeah, what he said... I'll be in the corner now.. I was thinking maybe AML at first... Link to comment Share on other sites More sharing options...
chbare Posted July 22, 2006 Author Share Posted July 22, 2006 Medic 429, you nearly go it, good thinking. JackMaga, you nailed it. This guy has Toxocariasis, a type of round worm infection. Here is a link for some more information on Toxocariasis. http://www.emedicine.com/med/topic2293.htm EDIT: I will explain the very basics of the CBC findings just so people who are not exposed to labs can see what we were talking about. WBC= White blood cell count. This number is usually between 5,000-10,000/cubic mm of blood in the adult. So, 13,000/mm3 is on the high side. An elevated WBC indicates something is activating the immune system. (stress, trauma, infection, allergy, etc.) Now, we look at the different types of WBC's. There are 5 basic types of WBC's. I gave the relative value of the 5 types. That means I broke it down into percentages. Normally Neutrophils take up 50-70% of the total WBC -Lymphocytes- 25-45% -Monocytes- 2-6% -Eosinophils- 1-4 % -Basophils- 0.5-1% Neutrophils- their mechanism of action includes phagocytosis and activation of fever. An elevation in these cells may indicate a bacterial infection. Lymphocytes- their mechanism of action is based around antibody production. An elevation may indicate a viral infection. Monocytes- These cells are the second line of defense against bacterial and viral illness in addition to phagocytosis of large protozoa such as fungi. These are thought of as the scavengers that clean up the field after the battle. Eosinophils- the roll of these cells are not well understood. May be involved in the activation of histamine. These are elevated during an allergic reaction or parasitic infection. Some cancers can cause elevations as well. Basophils- the roll of these cells are not well understood as well. They may play a role in allergic reactions. This is the very basic info, so I will not talk about granulocytes vs agranulocytes, bands, or segs. Hopefully this was helpful. Good job on this scenario everybody, it was a rough one. Take care, chbare. Link to comment Share on other sites More sharing options...
medic429 Posted July 22, 2006 Share Posted July 22, 2006 Great scenario chbare!! Thank you! Link to comment Share on other sites More sharing options...
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