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