Blood Count Syndrome

A complete blood count was done for this patient upon admission in order to give a baseline to help guide the patient’s care. The blood count also can show how the hematological system was affected by the trauma that the patient suffered in the motor vehicle accident he was in. If the patient was hemodynamically unstable, he may have needed blood transfusions to bring the blood counts up. In later tests, the patient had an increase in white blood cell counts could indicate infection, possibly of the injuries he had sustained. The patient also underwent surgery to correct the injury to his spine, causing more blood to be lost in the process. The platelet, hemoglobin, and hematocrit counts could help to show if the patient was suffering from

internal bleeding after the surgery had been performed, with the white blood cell count again reflecting the possibility of an infection at the site.
Other factors monitored by the complete blood count include the mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and red cell distribution width with standard deviation. The mean corpuscular volume measures the average volume of the red blood cells in the sample taken (Curry, 2015). The mean corpuscular hemoglobin reflects the amount of hemoglobin in terms of weight found in the red blood cells, while the mean corpuscular hemoglobin concentration looks at the amount of hemoglobin in a certain volume of red blood cells (Merritt & Curry, 2014). Red cell distribution width measures the variability in red blood cell size and volume, and the standard deviation of this uses a histogram to measure the width of the distribution of red blood cell sizes (Curry, 2015). All these can be used to look for anemia, sickle cell diseases, liver diseases, and other hematological diseases (Curry, 2015).
The first sample taken from the patient was low in the amounts of red blood cells, white blood cells, hemoglobin, hematocrit and platelets. This was taken after the patient’s injuries were sustained, which could have caused bleeding that resulted in anemia or a decrease in the amount of the main components in the patient’s blood. The next blood count was taken the next day. The patient had surgery the night before which caused more blood to be lost. The red blood cell count, hemoglobin and hematocrit levels decreased more due to this, however the platelet and white blood cell counts increased. The platelets possibly increased in order to cause clotting at the surgical site to stop bleeding. The white blood cell count also increased in order to stop invading microorganisms at the surgical site and prevent infection. All other values for both the first and second samples remained within normal range.
The blood chemistry test is also taken upon admission to the hospital as a baseline to use to guide patient care and can also show factors that can be affected by the trauma that the patient suffered. The chemistry test shows the levels of electrolytes found in the blood: sodium, potassium, chloride, phosphorus, magnesium and calcium. Imbalances in these electrolytes can cause complications, which especially in the case of potassium, can be deadly. Also shown by the chemistry test, blood urea nitrogen and creatinine levels show how well the kidneys are functioning in filtering waste from the blood. Trauma and blood loss can affect how the kidney’s function in filtering waste, acid-base balance, and electrolyte balance. Another marker of kidney function is glomerular filtration rate, which measures the rate filtrate is created by the glomerulus of the kidney (Winkelman, 2016). This is controlled by the kidneys themselves, meaning changes in the function of the kidneys can lead to altered filtration rate (Winkelman, 2016). Lactic acid is measured by the chemistry test, and an increase in this can signify acidosis caused by the lactic acid being formed by cells that do not have adequate oxygen to process glucose (Workman, 2016). This decrease in available oxygen could be caused by damage or impairment of the lungs. Carbon-dioxide, which is also measured by the chemistry test, can also show impairment of the lungs themselves or the gas-exchange which takes place in the lungs. Amylase is an enzyme found in saliva that helps to digest carbohydrates. This is also released into the blood by the pancreas when it is damaged, which is why it is measured by the chemistry test (Lal, 2015).
Both blood chemistry tests done on the patient at the time of admission and the next day, showed high glucose and chloride levels. Glucose levels in the blood can be increased by stress (Chard, 2016). Stress on the body could have been caused by the injuries the patient sustained, and by the surgery that was performed to correct these injuries. The increases in chloride could be contributed to other imbalances in the body, since chloride is exchanged with cells in the body (Workman, 2016).
The gem arterial blood gas test used a sample of blood from one of the patient’s arteries to test metabolic and gas components. These components work together to keep the blood’s pH in balance to prevent complications. Imbalances can be caused by respiratory or kidney impairment, since the lungs and kidneys work together in balancing pH, or by changes in the amount of buffers in the body due to fluid and electrolyte changes, stress on the body, or complication of other body systems (Workman, 2016). These can be created by surgery which causes fluid loss, infection, and stress on the body systems.
The arterial blood gas tests look at the respiratory components of partial pressure of carbon dioxide, partial pressure of oxygen, carbon dioxide, oxygen saturation and fraction of inspired oxygen.

Increases in carbon dioxide and decreases in oxygen result in respiratory acidosis, or a decrease in pH of the blood, while decreases in carbon dioxide and increases in oxygen result in respiratory alkalosis, or an increase in blood pH (Workman, 2016). The metabolic component looked at by the arterial blood gas test is the amount of bicarbonate in the blood. Bicarbonate works with the hydrogen ions to balance pH, and decreases in bicarbonate can create metabolic acidosis while an increase in bicarbonate can result in metabolic

alkalosis.
This test was done on the patient on the date of admission and the next day, due to the patient being placed on a ventilator. The first test showed a decrease in blood pH and a major increase in the partial pressure of oxygen. The patient was placed on a ventilator during surgery on the date of admission, which could be the reason as to why the partial pressure of oxygen was increased. The patient’s blood pH was low on the first tests, and while it was barely in the normal range, the patient’s bicarb was close to being low. The patient was injured resulting in fluid shifts which could have affected the amount of bicarbonate in the patient’s blood resulting in a decrease in the blood’s pH. This means the patient is at risk for metabolic acidosis. The next day the pH had increased to a normal level and the bicarbonate had also increased. The partial pressure of oxygen had also decreased, due to a decrease in fraction of inspired oxygen possibly from changes to the setting of the ventilator.
The coagulation test was done on the patient because he had to have surgery done to repair the injuries he sustained in a motor vehicle accident.

The coagulation studies show the clotting abilities of the blood and the amount of time it takes for the blood to clot. It is important for the blood to clot in order to prevent blood loss. However, if the factors tested by the coagulation test are not within the normal ranges, the patient is at risk for excessive bleeding or even unwanted blood clots in the body. The coagulation test is also done with patients who are on anticoagulant therapies. The results are used to adjust the doses, and the normal ranges are adjusted to reflect the fact that an anticoagulant is in use to prevent unnecessary blood clots, such as those that cause deep vein thrombosis and pulmonary embolism. The patient however was not on any anticoagulant medication therapies. The test was repeated after surgery in order to make sure no therapy was needed to prevent future clots from

happening.
Both times the test was done on the patient, the results were within normal range. The prothrombin time decreased between the first and second days, possibly due to blood loss from surgery. The international normalized ratio only decreased by 0.1 while the partial thromboplastin time increased by 1.8 therefore increasing the chances of an unwanted blood clot (Chard, 2016). This could be due to the stress placed on the body by the surgery done on the patient.
The automated differential test is done to show the amounts of different types of white blood cells or leukocytes found in the immune system (Workman, 2016). Increases in these can indicate infection or inflammation, while decreases could be due to age, medication side effects, or disease. Neutrophils destroy the invading microorganisms by phagocytosis, lymphocytes can become sensitized to foreign cells and proteins to destroy them, monocytes mature into macrophages that then stimulate immune responses and immediate inflammatory responses, eosinophils break down chemicals released by other leukocytes that increase vasodilation, and basophils stimulate inflammatory responses (Workman, 2016). Immature granulocytes are immature cells that tend to follow neutrophils (Curry, 2015). The absolute count of each type of these cells includes both mature and immature cells (Workman, 2016). The patient had this test done because he needed surgery. Surgery increases the risk for infection and the patient’s immune system needs to be ready to fight foreign microorganisms to prevent this. The test was taken only once, and all results were in the normal range.
The patient’s blood type was tested just in case a blood transfusion was needed dur to blood loss from surgery. While there is no reference range for a blood type test, there are three types of antigens that can be found on blood cells: A, B, and AB. If blood cells have neither A or B antigens, then it is considered type O blood (Byar, 2016). Another category of antigen that could be found on the blood is the Rh antigen. Blood cells without this antigen are said to be Rh negative, while cells that do are Rh positive (Byar, 2016). These factors are tested before a blood transfusion is done because only certain blood types are accepted by each. The patient who is type O and is RH positive can only accept type O blood, but can accept that type with either positive or negative RH factors (Byar, 2016). Any other type of blood given to the patient will cause a life-threatening antibody reaction, due to the patient’s body making antibodies against the antigens it does not have on its own cells (Byar, 2016). The antibody screen is done to reflect this, and the patient’s screen against type O, Rh positive blood, shows no antibodies against this type of blood.
The final lab study done on this patient is a POC glucose test. This test was done after surgery and was taken about every six hours afterwards, possibly due to the patient being NPO. All levels taken were higher than the normal range, possibly due to stress placed on the body during surgery. High glucose levels were found in the blood chemistry tests. Glucose is the energy cells used to function in the body. Intake of glucose is affected by insulin which is released by the pancreas. Too much or too little insulin can cause complications, and possibly lead to a diagnosis of diabetes if it becomes chronic.
The three types of imaging tests performed on the patient were x-rays, computed tomography scans, and magnetic resonance images. Most of these performed in order to further assess the patient’s claim that he could not feel any sensation below the nipple line, however x-rays were performed after surgery to assess the placements of screw and rods at the surgical site, and other x-rays where taken after the patient was intubated in order to check tube placement. Upon arrival to the emergency department, the patient’s injuries were unknown and the cause of his inability to feel sensation was also unknown. A portable chest x-rays were ordered first since it could be taken right in the emergency department, and could show any injury to the chest or possibly the spine. No acute findings or abnormalities were found.
Computed tomography scans were then ordered of the head, chest, cervical spine, abdomen and pelvis. While no acute findings were found in any of those images, moderate degenerative change of the discs between C3 and C7 was found in the cervical spine images. This was not acute, meaning it could have been contributed to by age or stress created by wear and tear on the discs between the vertebrae, resulting in change of the quality of or damage to the discs. No abnormalities were found in the scans of the head, chest, abdomen or pelvis. Computed tomography reformatted scans were ordered of the thoracic and lumbar spines. Reformatted scans can result in multiple views of the scanned areas and even three-dimension virtual images of the structure of bones (“Computed Tomography”, 2016). The images of the thoracic spine showed disc protrusion in the lower thoracic spine with no bone fractures found, and a magnetic resonance image of the thoracic spine was advised as a follow up. The scan of the lumbar spine found severe spinal stenosis, or narrowing of the spinal column at L3 and L4 due to disc protrusion, and moderate stenosis at L2, L3, T11 and T12 with more disc protrusion. A magnetic resonance image of the lumbar spine was also ordered for follow up.
The magnetic resonance imaging done of the thoracic spine was negative for abnormalities and acute findings. The imaging of the lumbar spine showed more degrative disc disease and narrowing as well as mild stenosis between L4 and L5, which again could be caused by age or wear and tear over time. The imaging of the cervical spine showed acute cord contusion, compression fractures of the vertebrae, bone bruising, soft tissue injury and cord compression. The compression and contusion of the spinal cord was causing the patient to be unable to feel sensation below the nipple line, and damage to the spinal cord is life threatening. This is what warranted the need for surgery to be performed.
After surgery was performed, two x-rays were taken to confirm the placement and alignment of the vertebrae operated on, and to confirm the placement of screws and rods used to stabilize the injured area. The next morning, an abdominal x-ray was taken to note the placement of the orogastric tube into the patient’s stomach, which was in normal place and did not affect the bowels. A chest x-ray was then taken to note the placement of the patient’s endotracheal tube. The tube was 9.2 cm above the carina, which was too high and the tube needed to be advanced further. Another chest x-ray was taken later in the morning after the tube had been advanced, and the tube was then 7.1 cm above the carina but still needed to be advanced another two centimeters.