Help PLEASE!!!!

[DN08]

So I had this patient this past week... In for wheezing, 3 months old, no infection, and No other Dx was made. But abnormal labs are as follows:

Hgb: 8.6 (L) Hct: 26.0 (L) MCV: 72.1 (L) MCH: 23.9 (L)

RDW: 17.6 (L) Plt: 469 (H)

So obviously there is some microcytic anemia going on... My question is, Is there any way these labs could be related to the respiratory issues? and how? I have some thoughts on it, but not sure if my rashionals are valid. ALso, you should know the newborn only consumes Gentlease (which is iron fortified), so the anamia shouldn't be diet related.

Also, My pt had RSV a month ago. Now the creatinine is low and potassium is high... RSV related?

FYI, This is not part of my homework, Im just trying to peice it all together in my head.

THANKS!!!!!!

[PICNICRN, BSN, RN]

The answer is probably not the "respiratory issue" exactly- most likely it is the viral infection itself. Especially in the neonatal population you will see a decrease in H/H and increase in Plts with the viral process- due to inflamatory response- hemolysis of the red cells and increased utilization of iron within the cells.

[DN08]

Thanks! So how long after an RSV infection would it take for the lab values to return to normal? That is, If he ever fully recovered???

Any thoughts on the potassium and creatinine?

[PICNICRN, BSN, RN]

How high is the K?? Just slightly elevated or like 7? Depends!

A really high K could mean renal failure(acute or chronic) but sounds like that is not the case- especially if the Creatinine is low. Then you have to start looking at meds that could cause a rise in K- like spirlactalone/Ace inhibitors/cyclosporin- most likely the kiddo you describe is not on any of those. Then there is massive breaking down of red cells like in DIC- again, doesn't sound like your kiddo.

If the K is just slightly elevated then it is most likely due to a hemolized sample- heel stick or turniquet for example.

As for the creatinine being low.... I'd look at the kids protien. I'd bet the kids albumin is low especially if the H/H is low. Thats an easy fix!