Case 6 (9/01/2013): Patient Presentation

Click this link to download the case file from box.net:https://app.box.com/s/63zhu6qqnhk9xjndud4d

…Case 6 is a 22 year-old male who presents with sudden onset of intense jaundice. Fever, chills, myalgia, poor appetite and intermittent diarrhea developed one week prior to ER. He was treated by primary physician 2 days prior to ER for nasal stuffiness and post-nasal drip with oral Cefdinir and Zofran. A battery of tests with negative findings were performed: acetaminophen, stool culture, ova/parasites, fecal leukocytes, stool occult blood, C. difficile, Cryptosporidium stain, Giardia antigen, and Entamoeba histolytica antigen. Urine copper (random): 300 ug (N: 3-50 ug/day). You may assume that information not listed in the patient case sheet was either not recorded or not significant.

Questions: The hemoglobin was 13.9 gm/dL 6:25 hours prior to admission and is 7.8 gm/dL 102 hours post-admission, down 6.1 gm/dL over 4.5 days. At what hemoglobin level or other decision point should this patient receive PRBC transfusion? Do you have any other striking comments about this case?

You must download the file after opening the link in box.net, or you will not be able to easily see all of the information in the file. The patient’s subsequent case management will be posted Wednesday and a commentary about the case management will be posted Friday.

This material is Copyright © 2013 by Columbia Healthcare Analytics, Inc. and may not be used for other purpose without permission.

Leave a Reply

Your email address will not be published. Required fields are marked *