Peers Capstone Review Using The Revised Rubic

Peers Capstone Review Using The Revised Rubic

Capstone assignment on

Clostridium Perfringens

Associates degree in Medical Technology

Univ

Case History:

96-year-old female was admitted to the hospital with complaint of generalized weakness and diarrhea. She described persistent diarrhea without blood for two weeks as well as fever, body ache and chills. Patients’ past history revealed she was relatively healthy with a previous history of cholesterol management with medication and medications for back pain. Blood Pressure on arrival was within normal limits. Initial lab work was ordered at 17:37 and the CBC revealed an elevated white blood cell count of 13.4 (4.8-10.8%) with a differential that showed an elevated neutrophil count of 82.4% (45.0- 75.0%), 16.0 % lymphocytes (15.0-45.0%), 0.8% monocytes (1.0-10.0%), 0.4% eosinophils (0.0-5.0%), and 0.4% basophils (0.0-3.0%). Her CBC also showed a slightly decreased red blood cell count of 4.09 mill/cmm (4.20-5.40 mill/cmm) with a hemoglobin and hematocrit within normal limits. Red blood cell indices were also normal. CMP revealed elevated total bilirubin 1.5 mg/dl (0.10-1.20 mg/dl), alkaline phosphatase 145 IU/L (39-136 IU/L), AST 182 IU/L (8-46 IU/L), and elevated ALT 262 (12-78 IU/L). The patient had an elevated heart rate and temperature of 101.5 degrees Fahrenheit indicating a positive sepsis screen although her Lactic acid was within normal limits at 1.3 mmol/L (0.4-2.0 mmol/L). Patient was started on the broad-spectrum antibiotics Fortaz. Blood cultures were collected.

The following morning labs were collected and received into the laboratory at 03:00. After centrifugation the tech noticed the tubes did not appear as though they had been spun. With further investigation the tech realized the patient’s specimens were grossly hemolyzed. The patients CBC now indicated a variety of suspect flags and system flags. There was a rapid change from the previous evenings CBC results. The following are comparison tables showing the initial CBC results with the first morning results: