A 33 year old male with pyrexia and slight jaundice

A 33 year old male with pyrexia and slight jaundice

Case Study 2013

A 33 year old male who is a sailor visits his GP complaining of headache, feverish (~38.5°C), nausea and vomiting and slight pain in the upper right quadrant and looked slightly jaundiced.   On physical examination, doctor noticed several tattoos on his body some of which patient described to have got done on his recent four months travel to South East Asia. His blood pressure was 60/90 and pulse rate 90 beats/minute.

His blood samples were sent for biochemical and haematological analysis.

Serum Biochemistry results

Albumin              38g/l

Total protein     72 g/l

Urea                      5.2 mmol/l

Creatinine           92 μmol/l

Blood pH             7.5

Bicarbonate       35 mmol/l

Sodium                                134 mmol/l

Potassium          3.3 mmol/l

Cholesterol        7.2 mmol/l

Triglycerides    3.1mmol/l

CRP                       12 0mg/l

Liver function test

AST                        300 IU/l

ALT                       380 IU/l

GGT                       80 IU/l

ALP                       219 IU/l

Bilirubin              55 µmol/l

Urine test

Urine colour      Bright yellow

Urine pH             8.5

Urinary sodium               low

 

Haematology:

Haemoglobin     110 g/l

MCV                      97 fL

MCHC                   331 g/l

WBC                      5.0 x 10⁹/l

Neutrophils       1.3 x 10⁹/l

Lymphocytes   4.1 x 10⁹/l

Monocytes         0.2 x 10⁹/l

Eosinophils        0.1 x 10⁹/l

Basophils            0.0 x 10⁹/l

Platelets              104 x 10⁹/l

ESR                        50 mm/h

Haematocrit      0.41  l/l)

RDW                     17.2

Blood film results

Occasional target cells and stomatocytes.  Anisocytosis and rouleaux.  Neutropenia. Small  pleomorphic lymphocytes noted, typically reactive. Thrombocytopenia.

 

At the age of 46 years, he was brought to the casualty department with complains of vomiting blood. His feet were swollen and showed jaundice. On examination, his blood pressure was low, he had enlarged spleen. His wife informed that he had difficulty in sleeping  since past  few months and had been complaining of feeling tired and had abdominal distension on and off and also complained of upper abdominal pain.  She also mentioned that he had a history of high consumption of alcohol and has been consuming 1-2 bottles of alcohol/d since past 15years.

Biochemistry results

Albumin              23g/l

Total protein     50 g/l

Urea                      6.8 mmol/l

Creatinine           87 μmol/L

Blood pH             7.38

Bicarbonate       26 mmol/l

Sodium                                129 mmol/l

Potassium          4.0 mmol/l

Cholesterol        9.1 mmol/l

Triglycerides    4.0 mmol/l

CRP                       5mg/l

 

Liver function test

AST                        25 IU/l

ALT                       14 IU/l

GGT                       42 IU/l

ALP                       90 IU/l

Bilirubin              38 µmol/l

 

Urine tests

Urine colour      Clear

Urine pH             7.2

Urinary sodium               slightly raised

 

Haematology related to Liver inflammation/cirrhosis

MCV      87 fL

MCHC   328 g/l

ESR        120 mm/h

PT          18 seconds

APTT    38 seconds

Fibrinogen                         1.83 g/l

D-Dimer                              576 ug/l

Liver biopsy samples showed fibrosis with nodular appearance as well as evidence of Mallory bodies in hepatocytes.

Case Study interpretation and discussion should include reasoning for values that are outside the reference range and contextualised with patient symptoms and suspected pathology.