CASE STUDY 6 A 28-year-old man presents to the emergency department with a complaint of abdominal pain. He appears quite ill with nausea, cold sweats, and tachycardia. He had taken aspirin when he started feeling sick. The patient appears slightly jaundiced and on further questioning admits that his urine had been dark and discolored that day. The preliminary impression was of acute appendicitis. Pertinent Hematology Results (refer to normal values in your text) WBC 6.3 x 10°/L RBC 1.00 x 1012/L Hgb 4.4 g/dL Hct 12.6% MCV 126 fL MCH 43.9 pg MCHC 34.8% The white blood cell differential was essentially normal: however, the red blood cell morphology was abnormal, showing basophilic stippling slight polychromasia, moderate teardrop cells, and occasional schistocytes and ovalocytes. Pertinent Chemistry Results Direct bilirubin 0.7 mg/dL (0.0 to 0.4 mg/dL) Total bilirubin 7.9 mg/dL (0.1 to 1.4 mg/dL) Indirect bilirubin 7.2 mg/dL (0.1 to 0.8 mg/dL) SGOT 567 IU/L (0 to 100 IU/L) LDH 2844 IU/L (0 to 100 IU/L What was the likely cause of the patient’s low hemoglobin? What is the significance of the patient’s chemistry results? What is the likely clinical course for this patient? What is the patient diagnosis?
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