Case 4 A 35-year-old woman is in the intensive care unit with sepsis after a ces
ID: 3517597 • Letter: C
Question
Case 4
A 35-year-old woman is in the intensive care unit with sepsis after a cesarean section.
Manual differential counts:
WBC: 4.3 Band neutrophils: 25
RBC: 3.20 Segmented neutrophils: 45
Hgb: 10.0 Lymphocytes: 10
Hct: 29.8 Monocytes:
MCV: 93.2 Eosinophils:
MCH: 31.5 Basophils:
MCHC: 34.5 Metamyelocytes: 15
RDW: 17.9 Myelocytes: 5
PLT: 10.0 Promyelocyte:
NRBCs: 9/100 Marked toxic granulation:
WBCs:
1. Describe the peripheral blood findings.
2. Interpret the coagulation screening tests.
3. What additional tests should be performed?
The results of the proposed additional studies were as follows:
Fibrinogen: 193 mg/dL
d-dimer: 1.5 ?g/mL
4. Based on all the data provided, what condition is most likely?
5. What information is most diagnostic?
6. Why is the fibrinogen not decreased in this case?
Explanation / Answer
Answer-1-this patient is mildy anaemic with elevated platelet count.
Answer-2-bleeding count and clotting time should be done to monitor the platelet function.
Answer-3-fibrinogen and d-dimers levels should be measured to monitor the coagulation process.
Answer-4-patient is anemic and immature cells are seen in the peripheral blood film.body response to the sepsis is not adequate.there is some defect in the coagulation pathway, that's why fibrinogen is not decreased.
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