I have a patient in clinical whose labs are confusing to me....

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    My patient has low WBC, Hgb, and Hct but all other labs are normal as of today. The pt was admitted for a seizure or possible TIA (they are still trying to figure this out)....and this is pretty much all I have on the patient. I just don't see how her diagnosis and her labs add up. Any help would be appreciated!

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  2. 8 Comments...

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    Tell us more about the patient.

    You must have some PMHx....
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    How "low" are these labs? Please provide more information.
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    That's really about all that I have. Today was "patient pick up" so we don't do a lot. The only history is epilepsy. The patient was admitted to the ICU previously where intubation was required and the CT has show brain calcification sense then. Memory loss is also a factor but the patient is mid 40's. Hx was negative for respiratory, cardiac, and GI/GU problems. Patient has also verbalized hallucinations in the past. WBC 3.8 Hgb 11.5 Hct 35.8.
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    Quote from KJohnson31892
    That's really about all that I have. Today was "patient pick up" so we don't do a lot. The only history is epilepsy. The patient was admitted to the ICU previously where intubation was required and the CT has show brain calcification sense then. Memory loss is also a factor but the patient is mid 40's. Hx was negative for respiratory, cardiac, and GI/GU problems. Patient has also verbalized hallucinations in the past. WBC 3.8 Hgb 11.5 Hct 35.8.
    Is pt on anti epileptic meds? Dilantin?
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    BostonFNP thanks for pointing out that I left that off! Yes. Depakote Extended Release 1000 mg BID, Lamictal 50 mg qday, and Dilantin 1000mg BId
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    Quote from KJohnson31892
    BostonFNP thanks for pointing out that I left that off! Yes. Depakote Extended Release 1000 mg BID, Lamictal 50 mg qday, and Dilantin 1000mg BId
    What are some adverse effects of those meds?
    Always a good place to start a differential.
    GrnTea likes this.
  9. 1
    Quote from KJohnson31892
    That's really about all that I have. Today was "patient pick up" so we don't do a lot. The only history is epilepsy. The patient was admitted to the ICU previously where intubation was required and the CT has show brain calcification sense then. Memory loss is also a factor but the patient is mid 40's. Hx was negative for respiratory, cardiac, and GI/GU problems. Patient has also verbalized hallucinations in the past. WBC 3.8 Hgb 11.5 Hct 35.8.
    Ok if this patient is a pre-menopausal woman I don't really see anything too alarming about these results. Normal hemoglobin is broadly considered to be 12-18 g/dL and normal hematocrit for women 35-45. Remember that every lab sets their own normals based on where the majority of their patients fall so "normal" lab values vary within labs. Something being flagged doesn't necessarily mean it's a problem. The last lab I had a CBC at considered 4 to be the low normal for WBC and 34.9 to be the low normal for hematocrit. Maybe it's because I'm an oncology nurse, but a hemoglobin of 8 or greater and a hematocrit of 25 is good in my book.

    A seizure or TIA wouldn't necessarily be reflected in any labs. The patient has a history of epilepsy so could have totally normal labs and still have seizures.
    GrnTea likes this.
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    Quote from BostonFNP
    What are some adverse effects of those meds?
    Always a good place to start a differential.
    A would have to agree! While the CBC values don't actually look all that bad (actually pretty good, if not quite "normal") there are medications that can suppress the bone marrow... On a more "general" note, you might see medications that the patient is taking that simply doesn't quite make sense for their "current" problem. The meds can be a VERY good hint as to the patient's medical problems that aren't being currently addressed.
    GrnTea likes this.


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