Case Five A 53 year old man was admitted with complaints of easy fatigability an

Question

Case Five

A 53 year old man was admitted with complaints of easy fatigability and swelling of his legs. He noticed that he was always thirsty and had an urge to urinate 8-10 times per day. He also noticed progressive dark pigmentation of his skin. His father and uncles had died of "yellow jaundice". Upon physical exam, he was found to be SOB, with tachycardia. He had pitting edema of the lower extremities with ascites. Hepatomegaly was noted. The physician ordered a liver function profile:

Patient

Reference Range

Total Protein

7.4

6.4-8.3 g/dL

Albumin

3.1

3.5-5.2 g/dL

Total bilirubin

2.5

0-2.0 mg/dL

Direct bilirubin

1.2

0.0-0.2 mg/dL

ALP

202

56-119 U/L

AST

70

<35 U/L

ALT

100

<45 U/L

Additional results revealed:

Patient

Reference Range

Glucose

180

74-100 mg/dL

Serum iron

198

65-177 ug/dL

TIBC

236

250-400 ug/dL

Ferritin

1280

20-250 ng/mL

A liver biopsy was performed and revealed cirrhosis with massive amounts of hemosiderin in the hepatocytes.

1. Which lab results are consistent with edema and ascites?

2. How do the serum Fe, TIBC, and ferritin results relate to the results of the liver function tests?

3. Given the TIBC and Fe results, can you calculate the %saturation?

4. What is hemosiderin?

Patient

Reference Range

Total Protein

7.4

6.4-8.3 g/dL

Albumin

3.1

3.5-5.2 g/dL

Total bilirubin

2.5

0-2.0 mg/dL

Direct bilirubin

1.2

0.0-0.2 mg/dL

ALP

202

56-119 U/L

AST

70

<35 U/L

ALT

100

<45 U/L

Explanation / Answer

Which lab results are consistent with edema and ascites?

Blood tests and urine test are consistent with edema and ascites

How do the serum Fe, TIBC, and ferritin results relate to the results of the liver function tests?

Increased serum Fe can occur due to liver damage

Low TIBC levels may be the result of liver damage

Increased ferritin levels are usually is the result of damaged liver. Hence serum Fe, TIBC, and ferritin results relate to the results of the liver function tests

3. Given the TIBC and Fe results, can you calculate the %saturation?

Yes.

Formula is

Saturation = (Serum Iron / Total Iron Binding Capacity) x 100%

%saturation is 83.898

What is hemosiderin?

Hemosiderin is an insoluble protein or a pigment that contains iron and it is a product of Haemolysis. Hemosiderin found as granules in most tissues, especially in the liver.

Related Questions

Navigate

• Browse (All)
• Browse C
• Subjects

---

---

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.