Case study – Chemistry 2 Julia Dugger 09/08/2015 A 54 year old female was presented with complaints of lethargy, excessive thirst and diminished appetite. Given the fact that these symptoms are very broad and could be the underlying cause of various diseases, the physician decided to order a urinalysis by cystoscope; a comprehensive diagnostic chemistry panel; and a CBC with differential, to acquire a better understanding on his patient health status. The following abnormal results caught the physician’s attention: a) Urinalysis with significantly increased amounts of blood (via dipstick and sediment), protein, and leukocytes as well as slightly increased bilirubin and slightly decreased pH; b) Comprehensive diagnostic chemistry panel with significantly increased amylase (1626 with normal being 300-1100 U/L), total …show more content…
bilirubin (1.7 with normal being 0.1-0.8 mg/dL), BUN (54 with normal being 10-30 mg/dL), total protein (10.9 with normal being 5.4-8.2 g/dL), globulins (via calculation: total protein – albumin = globulins→ 10.9 g/dL-1.0 g/dL = 9.9 g/dL with normal being 1.5-5.7 g/dL) plus slightly increased creatinine levels (2.2 with normal being 0.3-2.1 mg/dL) as well as decreased albumin (2 mg/dL, calcium >11 mg/dL, and hemoglobin <10 g/dL. And even though, the calcium levels obtained from this patient (8.3 with normal being 8.0-11.8 mg/dL) do not correlate with the common characteristics of multiple myeloma - while all other values do, the physician should order a protein electrophoresis (SPE) to identify/quantify the serum and urine proteins; as well as immunofixation electrophoresis (IFE) to evaluate the monoclonal/polyclonal abnormal immunoglobulin(s) present. According to Dispenzieri, Lacy, and Greipp (2004), one of the main characteristics of multiple myeloma is the presence of the M protein.
Since most patients will either have an intact immunoglobulin or a free light chain, quantifying the amount of the M protein will aid in calculating the myeloma tumor burden; staging the myeloma patients; and documenting their response to treatment (Dispenzieri, Lacy, & Greipp, 2004). Moreover, since in 93% of patients a monoclonal protein can be detected in serum and in roughly 70% a monoclonal protein or fragment will be present in urine, according to Nau and Lewis (2008), the diagnosis of an asymptomatic (smoldering) multiple myeloma disease depends on the presence of serum M protein levels of ≥ 3 g/dL; ≥ 10% of bone marrow plasma cells; no related organ or tissue destruction like bone lesions; and no symptoms. On the other hand, the diagnosis of a symptomatic multiple myeloma disease can be accomplished by the presence of M protein in serum and/or urine together with clonal bone marrow plasma cells or plasmacytoma; myeloma-related organ or tissue impairment; and obvious symptoms (Nau, & Lewis,
2008). After evaluating all the results obtained and strengthening the diagnosis of multiple myeloma, the physician should consider proper treatment. According to Barrick and Mitchell (2001), treatment should aid in reducing the overall tumor burden through reducing or eliminating the M protein from the plasma and urine as well as to provide symptom management. However, whereas stage I diseases are only monitored without initial chemotherapy - there is no evidence, according to Rosen (1999), that initial treatment of early stages will results in greater long-term disease response or survival, - patients with stage II or III diseases should receive chemotherapy; high-dose chemotherapy (HDC) with autologous or allogeneic stem cell transplantation; therapy with alpha interferon or thalidomide; radiation therapy; and supportive care (Barrick, & Mitchell, 2001). Supportive care is especially important, since, according to Barrick and Mitchell (2001), most patients develop skeletal manifestations (treated with intravenous bisphosphonate); have underlying immunologic issues; may have hypercalcemia (treated with hydration, furosemide, steroids, and a bisphosphonate); may show renal failure (treated via hydration, sodium bicarbonate as well as hemodialysis in severe cases); and definitely will experience pain (percutaneous vertebroplasty and kyphoplasty are promising new procedures for pain relief).
P3 – Describe the investigations that are carried out to enable the diagnosis of these physiological disorders
Breast cancer has always been a common thread among the women of my family; especially on my mother’s side, including my Grandmother whom passed away due to this disease before I could ever meet her. More so, my mother was gravely affected by this disease early in my life. Thankfully, she was able to stop the cancer from spreading; the doctors were able to find the cancerous cells and remove them. Due to this grave, but powerful impact on my life, I have been determined to becoming a biomedical scientist to assist on the research and treatment of this deadly disease. Although this acts as my principal driver, to study in this field, I have also been intrigued and driven by the idea that I could aid lower setting regions to receive health benefits using studies in translational medicine and
SPECIFIC PURPOSE: To inform my audience on what osteosarcoma is, how it is treated, and Zach Sobiech’s story.
Kayla is a 24yo, G3 P1011, who was seen for a follow-up ultrasound assessment. The patient has chronic HTN but has not been on any medication. She has had some borderline elevated BP’s over the past couple of weeks. Her BP today when she arrived was 143/81 and 5 minutes later was 137/86. Her urine evaluation is negative for protein. She did have labwork performed revealing a creatinine of .58, uric acid of 6.2, with normal liver enzymes and a platelet count of 232,000. Her 24-hr urine was also normal at 200.
The patient will commonly present with multiple symptoms, the most common are the 3 P’s – polyuria, polydipsia, and polyphagia. However, subjective symptoms may include reports of fatigue, abdominal pain, nocturnal enuresis, weight loss, changes in mood, and blurred vision. Objectively the signs will be hyperglycemia, confirmation of weight loss, abnormal lab values such as an elevated hemoglobin A1c (HbA1c) level, and abnormal urine results.
Related to Mr.X’s history of stage 5 CKD, abnormal calcium and phosphate levels will be contrary to each other. Patients with a history of renal failure with a high phosphate level may exhibit signs of hypocalcemia, such as the Trousseau or Chvostek’s sign.
Ordered reviewed and interpreted laboratory data and other diagnostic studies to assess the patient's clinical problems and health care needs.
The study of structure, function and pathological disorders in blood is called “Haematology”. Blood consists of 55% plasma and 45% blood cells. Plasma is a mixture of 7% protein, 91% water and 2% other solutes. The types of proteins present in blood are albumin, globulin, and fibrinogen. Other remaining solutes consist of ions, nutrients, gases and respiratory substances and waste products. On th...
The patient is a 75-year-old female who is brought to the ER because of some dizziness. She has a very complicated medical history of mitral valve prolapse, uterine fibromas having hysterectomy, a question of Ménière's disease, anxiety, hypertension, asthma, CVA in 1994 with mild right-sided residual weakness, urethral stenosis, recurrent UTIs, pulmonary embolism, and idiopathic afib she did presyncopal developed Equinox, a history of diverticulosis, and diverticulitis. The patient is admitted inpatient. It is to be noted initially there is a question of a syncopal episode. Troponins are negative. She is dehydrated with urinary specific gravity of 10:30, and she has positive nitrates and leukocytes. She was initially placed in the emergency
As mentioned above; Hypoalbuminaemia is a predominantly events that occur due to losses of protein urinary. In response to this, hepatic albumin synthesis increased but they are still insufficient to prevent the fall in the serum albumin concentration. Proteinuria, Nephrotic range proteinuria is almost invariably due to glomerular disease.
If the patient has a urinary catheter, and most ICU patients do, he or she may not have any reportable symptoms. Therefore, good assessment of urinary elimination, done in relation to a patient’s signs, symptoms, urine amount, intake and output, and lab values, is important. The lab values are discussed in Chapter 5. Acute and chronic renal failure can cause numerous systemic symptoms and altered homeostasis ( Collins, 2011). See Table 3-10 for abnormal urinary elimination.
Rationale: These laboratory test results have been shown to be fair indicators of malnutrition. Ackley and Ladwig p. 576
The Phase I trial will be discussed here as it pertains to the topic at hand. The typical treatment for cervical cancer if surgery is not a viable option – like if the cancer has spread, then called locally advanced cervical cancer – is chemotherapy and radiation treatment at the same time. This phase I clinical trial is simply looking to add ipilimumab to this regimen, but once the chemo/radiation has been completed (LACC article). Chemo and radiation destroy tumor cells, which causes tumor-associated antigens to be released. Once released, these antigens are exogenous (outside the cell) and will be presented to helper T cells to initiate an immune response.
In 1984, Caeser Milstein of England and George Kohler of Switzerland were awarded Nobel Prize for engineering ‘monoclonal antibodies’. These are made outside the body by the fusion of B-cell and myeloma cells (cancerous cells). These hybrid cells are known as hybridomas.
weight gain, and a decrease in urination. A tentative diagnosis of acute renal failure is