My pt died, lab results question?

[BinkieRN, BSN, RN]

I had an 85 year old pt who I admitted for profound anemia. Blood had been ordered. All of the labs had been draw. I was doing the admission assessment when suddenly she coded and did not make it. Later I looked at her labs. WBC was 230,000. Troponin was 68. Myoglobin was 1141. The doctor said she died of an MI. I have never seen or heard of a WBC that high? Does that go along with an MI? or could she have been septic also? She did not have a temp. When she came in her 02 sat was 76%. She wanted to lie flat with the rebreather on at 100%. I encouraged her to raise the head of her bed and she refused. Can lying flat cause additional respiratory distress? Thank You.

[TazziRN, RN]

Lying flat can make it harder to breathe.

Yes, she sounds like she was septic.

Yes, sepsis can cause an MI.

[BinkieRN, BSN, RN]

Lying flat can make it harder to breathe.

Yes, she sounds like she was septic.

Yes, sepsis can cause an MI.

Can lying flat cause enough respiratory distress to cause a patient to quit breathing?

Have you ever heard of a WBC of 230,000?

I didn't know sepsis could cause an MI. Wouldn't she have had a temp?

[TazziRN, RN]

Elderly people who are septic often have subnormal temps, rather than high.

I've seen whites over 100,000 before, rarely but I have seen it.

Did she quit breathing because she was lying flat, or because she coded?

[adria37]

It sounds like to me she had CLL. That would explain her high white count, anemia, and even sepsis, because the immune system functions poorly with this. I am sorry you lost a patient.

[BinkieRN, BSN, RN]

Elderly people who are septic often have subnormal temps, rather than high.

I've seen whites over 100,000 before, rarely but I have seen it.

Did she quit breathing because she was lying flat, or because she coded?

I really don't know? She was talking and orientated and then very suddenly she was unresponsive, I shook her and called her by name, no reply, I hit the code button.

[BinkieRN, BSN, RN]

It sounds like to me she had CLL. That would explain her high white count, anemia, and even sepsis, because the immune system functions poorly with this. I am sorry you lost a patient.

What is CLL? Leukemia in the elderly?

[adria37]

How bad was her anemia? That could have been more stress than her heart could take. O2 sats are not accurate with anemic patients either. Look at her CBC again, I bet her differential is all out the whazoo and almost all lymphs and no bands (indicative of sepsis)

[adria37]

Chronic lymphocytic leukemia

[adria37]

it is commonly found in elderly patients.

http://www.emedicine.com/med/topic370.htm

Here is an eMed article.

[BinkieRN, BSN, RN]

How bad was her anemia? That could have been more stress than her heart could take. O2 sats are not accurate with anemic patients either. Look at her CBC again, I bet her differential is all out the whazoo and almost all lymphs and no bands (indicative of sepsis)

I believe the hct was 6.2. I didn't look at the diff.

[adria37]

Best guess from what you posted if I were having to do a differential diagnosis on a quiz

85 y/o MI probably secondary to severe anemia probably secondary to CLL