My pt died, lab results question?

[BinkieRN]

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.

[GilaRRT]

Do not beat your self up on this one. Looks like she was having the big one. It is not uncommon to have myocardial ischemia and additional stress on the heart when you are septic. Your heart is actually working overtime attempting to compensate for global tissue ischemia and the typical changes associated with septic shock. It is much like the high output cardiac failure seen in severe heat injury patients. The additional cardiac stress (increased myocardial O2 demand with reduced supply), decreased ability to load, carry, and off load O2 from the anemia, possible septic shock, and the MI set your patient up to buy the farm. She did not have a chance.

[FireStarterRN, 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.

That's what I was thinking.

[sammyrnlv]

Troponin is usually higher in MI; sounds like sepsis did her in! She was 85, kiddo, don't stress! HOB is always up in most cases. You granted her last request!:nuke:

[BinkieRN, BSN, RN]

Thank you everyone

[psalm, RN]

My baby had a WBC of 320,000...turned out he had osteomyelitis of the R ankle joint. Has a nasty scar on his almost 31 year-old R ankle and is the picture of health (spent 3 weeks in the hosp. for IV antibiotics at the age of 9.5 months).

[Virgo_RN, BSN, RN]

Troponin is usually higher in MI

Not so. Had an MI pt. tonight whose trops peaked at 16.

[ThatGuyTom]

can the high WBC count have something directly related to the MI? such as infiltration into the necrotic tissue perhaps?

[aeauooo]

I believe the hct was 6.2.

The 'crit was 6.2 - not the hemoglobin? That's extremely anemic.

With a troponin of 68 your patient definitely had an MI - a big one - but that may not have been the immediate cause of death.

Remember that there are three components to oxygen delievery: hemoglobin, saturation, and cardiac output. If the patient's Hct was 6.2 (are you sure that wasn't the Hb?), her oxygen delivery was in the toilet, so her myocardium was dying from lack of oxygen, but with WBCs that high, she also had some serious comorbidities. Was a blood gas drawn? I'll bet her pH was 7.0 +/- 0.2.

MI? Yes, definitely.

Sepsis? Probably.

Cause of death? Too sick to live.

[Sabby_NC]

Lying flat can make it harder to breathe.

Yes, she sounds like she was septic.

Yes, sepsis can cause an MI.

Yup I agree with Tazzi on this.

Hope you are ok after your patient died... *hugs*

[Virgo_RN, BSN, RN]

can the high WBC count have something directly related to the MI? such as infiltration into the necrotic tissue perhaps?

WBCs are often elevated with MI, but not THAT high. There had to have been something else going on.

[rnewmanjunkie]

Sounds like she had leukemia of some sort. Had her WBC been high before this admission? CLL patients usually have a WBC that gradually increases. If this was a sudden increase, then she had acute leukemia, either an ALL (not unheard of in the elderly) or AML. That can cause the low H&H and could cause the MI.

[GilaRRT]

Or, she had ALL, MI, anemia, and sepsis.