Case 14 The presenting symptoms of a 5-year-old boy include coughing, wheezing,

Question

Case 14

The presenting symptoms of a 5-year-old boy include coughing, wheezing, and shortness of breath.

Manual differential counts:

WBC: 8.3                                        Band neutrophils:

RBC: 3.95                                       Segmented neutrophils: 20

Hgb: 11.0                                        Lymphocytes: 60

Hct: 31.1                                         Monocytes: 2

MCV: 78.7                                     Eosinophils: 18

MCH: 27.8                                     Basophils:

MCHC: 35.3                                   Metamyelocytes:

RDW: 12.9                                     Myelocytes:

PLT: 241.9                                      Promyelocytes:

1. Describe the peripheral blood findings.

The following values are normal for 5-year-old children:

RBC count: 4-5.2

Hgb: 10.2-15.2

Hct: 34-48

Segmented neutrophils: 30-60

Lymphocytes: 29-65

Neutropenia and eosinophilia

2. What additional tests should be performed?

Evaluate the results of the following additional studies:

ABGs: decreased partial pressure of oxygen (Po2)

3. Based on all the data provided, what condition is most likely?

4. What information is most diagnostic?

5. Comment on the hemoglobin, MCV, and lymphocyte percent for this patient.

Explanation / Answer

Answer 1. The peripheral blood finding includes MCV, MCH, MCHC and RDW. Peripheral blood finding shows increase in the level of platelet count, neutropenia and eosinophilia. Segmented neutrophils are also present.

Answer 2. Additional test can be done like acid base balance, lung function test for lung volumes and capacity. The ABG test shows the decrease in the partial pressure of oxygen.

Answer 3. Most likely diagnosis of the given condition is of asthma.

Answer 4. The most diagnostic information is increased eosinophil count and decreased partial pressure of oxygen. In case of asthma the respiratory tubes become narrowed and air and oxygen is reduced during the inspiration.

Answer 5. Hemoglobin of the patient is within normal limits but MCV and lymphocytes are increased in order to accommodate more oxygen. This is because of decrease in partial pressure of oxygen. Hemoglobin is also towards the high level of normal limit. Hemoglobin is the carrier of the oxygen.

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