Dr. Samson is seeing a patient suspected of having a streptococcal infection. Th

Question

Dr. Samson is seeing a patient suspected of having a streptococcal infection. The physician has ordered an ASO test. What is this test? Identify the diseases this test is able to detect.

Mary Murphy, a 79-year-old woman, is suspected of having an intracranial hemorrhage. The physician has ordered a CT scan of the brain. Explain what a CT scan consists of and the types of information it can provide to the physician.

Reba Alexander, a 45-year-old female, has recently been hospitalized because she has a blood clot in her left iliac artery. Dr. Jason, a vascular surgeon, has written a progress note indicating he suspects that Mrs. Alexander has a clotting disorder. Based on this conclusion, the physician has placed her on the medication warfarin for anticoagulation therapy. This therapy requires frequent blood tests to measure the INR. What blood tests are performed in order to measure the INR? If Mrs. Alexander has an INR value of 1.0, is she within the therapeutic range of anticoagulation therapy? How could anticoagulant therapy, such as warfarin, affect other tests, such as the PTT?

Lester Lancour is a 2-year-old male patient who has had a high fever for more than 72 hours. Dr. Adams is certain that the child has meningitis. He has ordered a lumbar puncture in order to determine if the problem is viral or bacterial. Dr. Adam's order indicates that he wants an identification of the white blood cells that may be present in the CSF. What is a lumbar puncture and how is it performed? Discuss the diagnostic significance of elevated white blood cells in CSF. List the diseases that can be identified by an elevated white blood cell count.

Explanation / Answer

ASO TEST :

Streptococcal infections are present in many individuals without exhibiting any symptoms and they are considered as carrier. Primary infections invade the throat and healthy tissues whereas seconday infections invade weak or unhealthy tissues which are affected by illness or injury. They affects the bones, ears, eyes, joints, or intestines frequently. These type of infections can invade the affected areas and travel to the bloodstream and spreads throughout the body and make the person infectious. There are numerous strains identified which are types A, B,C, D and G whic are most likely to make the people sick.

Antistreptolysin O (ASO) titer is a blood test which measures the presence of antibodies against streptolysin O, which a substance produced by group A streptococcus bacteria. The main function of streptolysin O is to cause hemolysis which means breaking open of red blood cells in particular, beta-hemolysis. High levels of ASO levels in blood could damage the heart and joints. In most cases, penicillin is used to treat patients with increased levels of aso titre.

The test is recommended to understand the post streptococcal complications like

COMPUTED TOMOGRAPHY(CT SCAN) :

A CT scan is an equipment which helps to take computer processed images at different angles of the object placed for scanning and it is non invasive for plain scanning. This scan can also be used for taking biopsy with CT guided techniques. Since its introduction in the 1970s, CT has become a very important tool in the field imaging which works effectively than X-rays and medical ultrasonography. It has more recently been used for preventive medicine or screening for disease.

CT scans produce 2-dimensional images of a "slice" or section of the body, but the data can also be used to to construct 3-dimensional images for better understanding of the illness. A CT scanner emits a series of narrow beams through the human body as it moves through an arc. It is different from taking X-ray because it emits only one beam at a time.

CT is faster in detecting the condition of the underlying tissues and helps to analyse the degree of involvement and complexity of an illness. It is useful for obtaining images of:

- it helps to determine the presence of tumor which include size, location, degree of the tumor and its surrounding tissues

- it helps to understand the abnormalities in the tissue, vessels like inflammation, bleeding etc.

- different CT scans can predict the abnormalities of that specific location focussed for scanning.

- it can help the doctor to understand the structure of bone and their associated abnormalities

INR TEST :

Warfarin is a medication that comes under the category of Anticoagulant which means it is used as a blood thinner. It is commonly used to treat blood clots such as deep vein thrombosis and pulmonary embolism and talso helps to prevent stroke in people who have atrial fibrillation, valvular heart disease or artificial heart valves.

When taking an anticoagulant, it is very important to check the blood tested for bleeding times to ensure that the medications are taken safely and not at increased risk for bleeding.

- Prothrombin Time (PT) : PT is a test to determine how fast it takes for your blood to clot.When the patient on anticoagulant, this helps the doctor to understand if the patient is taking the medicine properly or is there any risk factors like bleeding exist. This help the doctor to decide upon the dosage management of the patient. Normal range for an adult is 9.9-13 seconds. The desired PT is about one and a half times the normal PT.

- International Normalized Ratio (INR) : INR is tested for those on anticoagulant medications to prevent stroke, embolism and heart attack. Normal level for an adult: 0.9 – 1.2. For most indications, the therapeutic INR range is considered to be 2.0 to 3.0. It is considered to be 2.5 to 3.5 when the medicine is used as a secondary prevention after a myocardial infarction or for patients with high-risk mechanical prosthetic heart valves. Hence Mrs.Alexander is not iwthin the therapeutic range of anticoagulation therapy.

The PTT is used primarily to investigate unexplained bleeding or clotting. It may be ordered along with a prothrombin time (PT) test to evaluate hemostasis. Using Warfarin as anticoagulation therapy—the PTT is not used to monitor warfarin therapy, but it may be affected by it. Typically, the PT is used to monitor warfarin therapy. However, ther can be some variance in the Partail Thromboplastin Time.

Cerebrospinal Fluid Analysis :

Lumbar puncture (LP), also known as a spinal tap, a medical procedure in which a needle is inserted into the spinal canal, to collect the cerebrospinal fluid (CSF) for diagnostic testing of central nervous system, including the brain and spine. Lumbar puncture was first introduced in 1891 by the German physician Heinrich Quincke

The procedure is done under local anesthesia and maintaining strict aseptic techniques. The patient is placed in C Shaped position like a bow at the bedside and or sittingposition by bending forward . Followed by A hypodermic needle is inserted into the subarachnoid space and CSF fluid is collected. Fluid may be sent for biochemical, microbiological, and cytological analysis.

The most common purpose is in suspected meningitis.In any age group, subarachnoid hemorrhage, hydrocephalus, benign intracranial hypertension, and many other diagnoses may be supported or excluded with this test. It may also be used to detect the presence of malignant cells in the CSF, as in carcinomatous meningitis or medulloblastoma.

- Small numbers of lymphocytes, monocytes and netrophills in neonates are normal in nature

- There may be a increased levels of;

- neutrophills with bacterial infection

- lymphocytes with a viral or fungal infection

- increased numbers of WBC can indicate leukemia present in central nervous system

- slight increase in lymphocytes can be related to immune disorders

- There may be increase in different types of WBCs in brain abscess, following seizures, bleeding within the brain or skull, metastatic tumor and inflammatory disorders like sarcoidosis.

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