Diagnostic. Laboratory studies are used for two purposes: 1.to confirm the diagnosis 2.to determine...
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Transcript of Diagnostic. Laboratory studies are used for two purposes: 1.to confirm the diagnosis 2.to determine...
Diagnostic
• Laboratory studies are used for two purposes:
1. to confirm the diagnosis 2. to determine the extent of organ
involvement and severity of complications.
Patient Laboratory Worksheet
• Blood Chemistry-Na, K, BUN, Creatinine, Alkaline phosphatase, iPO4, iCa, SGOT, SGPT
• CBC (complete blood count)• MAT• Ultrasound (whole abdomen)• Chest X-ray• Anti-HAV IgM, HBsAg, AntiHBs, AntiHBc IgG
Laboratory Findings In Leptospirosis
• ESR – Increased• Leukocyte Count – ranges from 3,000-26,000/microliter• Mild Thrombocytopenia• Elevated levels of Bilirubin & ALP• Mild increase in serum levels of aminotransferases• PT may be prolonged• Elevated Creatine Phosphokinase
• Harrison’s, Internal Medicine, 17th Ed.
Radiologic Findings
• Patchy alveolar pattern, corresponds to scattered alveolar hemorrhage, affect lower lobes in the periphery of the lung fields.
• Harrison’s, Internal Medicine, 17th Ed.
BLOOD CHEMISTRY 09/16 09/18 09/19 09/21 Normal Values
BUN 41.6 29.4 21.3 7–20 mg/dL
Creatinine 3.3 1.8 1.6 1.3 0.6–1.2 ng/mL
Alkaline phosphatase 166 33–96 U/L
Total bilirubin 5.3 0.3–1.3 mg/dL
Direct bilirubin 4.2 0.1–0.4 mg/dL
Indirect bilirubin 1.1 0.2–0.9 mg/dL
Na 130 134 142 136–146 meq/L
K 3.7 3.3 4.7 3.5–5.0 meq/L
iPO4 2.8 2.5–4.3 mg/dL
iCa 1.06 4.5–5.3 mg/dL
URINALYSIS 09/16/09 09/17/09 Normal Values
Color Yellow Yellow
Transparency Slightly turbid Slightly turbid
pH 5.0 5.0 5.0–9.0
Specific Gravity 1.010 1.015 1.001–1.035
Albumin - -
Sugar - -
RBCs 5-7/hpf 0-1/hpf 0–2/high powerfield
Pus cells 3-6/hpf 3-6/hpf 0–2/high powerfield
Squamous cells Few Few None
Bacteria + + None
Amorphous urate + +
CBC 09/16/09 Normal Values
Hgb 118 133–162 g/L
RBC 5.63 4.30–5.60 x 1012/L
Hct 0.35 0.388–0.464
MCV 61.60 79–93.3 fL
MCH 20.40 26.7–31.9 pg/cell
MCHC 33.40 32.3–35.9 g/dL
RDW 15.20 < 14.5%
MPV 7.0 9.00–12.95 fL
Plt 234 165–415 x 109/L
WBC 11.40 5-10 x 109/L
Neutro 0.89
Bands 0.02 0.0-0.05
Seg 0.87 0.40–0.70
Lympho 0.10 0.20–0.50
Eosino 0.01 0.0–0.6
09/18
Prothrombin time 12.7
Normal control 12.5
PT ratio 1.0
INR 1.0
aPTT 45.6
Normal control 36.3
CHEMILUMINESCENT IMMUNOASSAY
09/16
Anti HAV IgM 0.254nonreactive
• Ultrasound of the LGBPS (09/15/09): Normal sized liver with fatty changes, slightly contracted gallbladder, ultrasonologically normal pancreas, spleen, kidneys and urinary bladder, prostatic hypertrophy with concretions
• MAT (done last 09/18/09 in UP-PGH): Positive (indicative of Leptospirosis)
• Chest Xray (09/18/09): Subsegmental atelectasis, left lobe
• ECG (09/18/09): Sinus rhythm, left axis deviation, nonspecific ST-T wave changes
Microscopic Agglutination Test (MAT)
• Principle: Antibodies in the test serum react with antigens on the surface of the bacteria and agglutinate them.
• A single MAT titer of or 1:400 on any sera or identification of spirochetes on dark-field microscopy, when accompanied by the appropriate clinical scenario, is strongly suggestive.
o A positive MAT was defined as a single titer of >1:400 or a 4-fold rise in titer between acute and convalescent sera samples, confirms the diagnosis of leptospirosis.
» CDC (Centers for Disease Control)