IV.

LABORATORY AND DIAGNOSTIC EXAMINATIONS

Laboratory Examinations

HEMATOLOGY
COMPO NOR Dec. 30,2015 Jan.13,2016 Jan. 19,2016 Jan. 26,2016 Jan. 27,2016 Jan. 31,2016 Feb. 23,2016 Feb. 28,2016
NENT MAL
Res Inter Res Inter Res Inter Res Inter Res Inter Res Inter Res Inter Res Inter
RAN
ults ults ults ults ults ults ults ults
GE pretati pretati pretatio pretatio pretati pretatio pretatio pretatio
on on n n on n n n
Red 4.0- 4.65 Norm 4.55 Norm 4.53 Normal 4.38 Normal - - 3.92 Decrea 4.12 Normal 3.72 Decrea
Blood 6.0x1 al al sed sed
Cell 0^12/
L
Hemoglo (Male) 128 Decre 127 Decre 121 Decrea 120 Decrea - - 108 Decrea 114 Decrea 102 Decrea
bin mass 140- ased ased sed sed sed sed sed
180
g/L
Hematoc 0.37- 0.38 Norm 0.38 Norm 0.37 Normal 0.35 Decrea - - 0.31 Decrea 0.34 Decrea 0.30 Decrea
rit 0.57 al al sed sed sed sed
Leucocyt 4.8- 8.20 Increa 7.60 Norm 6.00 Normal 6.70 Normal - - 5.40 Normal 4.80 Normal 5.50 Normal
e count 10.8x sed al
10^9g
/L
DIFFER
ENTIAL
COUNT
Segment 0.40- 0.77 Increa 0.66 Norm 0.62 Normal 0.67 Normal - - 0.64 Normal 0.56 Normal 0.64 Normal
ers 0.74 sed al
Lymphoc 0.19- 0.14 Decre 0.21 Norm 0.21 Normal 0.14 Decrea - - 0.18 Decrea 0.29 Normal 0.19 Normal
 ytes 0.48 ased al sed sed
Monocyt 0.03- 0.07 Norm 0.10 Increa 0.11 Increas 0.10 Increas - - 0.11 Increas 0.08 Normal 0.08 Normal
es 0.09 al sed ed ed ed
Eosinop 0.00- 0.01 Norm 0.03 Norm 0.06 Normal 0.09 Increas - - 0.07 Normal 0.07 Normal 0.09 Increas
hils 0.07 al al ed ed
Basophil 0.00- 0.01 Norm 0 Norm 0.00 Normal 0 Normal - - 0.00 Normal 0 Normal 0 Normal
s 0.02 al al
Reticuloc
ytes
Platelet 150- 431 Norm 377 Norm 470 Increas 450 Normal - - 370 Normal 440 Normal 326 Normal
count 450x1 al al ed
0^9g/
L
COAGU
LATION
STUDIE
S
Prothom 11-15 12.4 Norm 14.1 Norm - - - - 13.9 Norm - - - - - -
brin Time secon al al al
ds
PT % 100 83.3 - - 85.6 - - -
Activity
PT INR 0.96 1.13 - - 1.11 - - -
Activated 22-45 31.8 Norm 29.8 Norm - 28.6 Norm - - - - - -
PTT secon al al al
ds
CRP - Rea - - - - - - Rea
 ctive ctive
Semi- <6 12 Increa - - - - - - - - - - - - 6 Normal
Quantitat mg/L sed
ive CRP
INDICES
MCV 82-92 81 Decre 82 Norm 81 Decrea 80 Decrea - - 79 Decrea 82 Normal 80 Decrea
fl ased al sed sed sed sed
MCH 28-32 27 Decre 28 Norm 27 Decrea 27 Decrea - - 27 Decrea 28 Normal 27 Decrea
pg ased al sed sed sed sed
MCHC 32- 34 Norm 34 Norm 33 Normal 34 Normal - - 35 Normal 34 Normal 35 Normal
38% al al
ESR 0-10 30 Increa - - 54 Increas 23 Increas - - - - 45 Increas 40 Increas
(Westerg sed ed ed ed ed
ren)
Clotting 5-15 100 Norm 800 Norm 100 Normal - - 700 Norm - - - - - -
time(Lee mins 0 al al 0 al
and
White)

Bleeding 1-7 300 Norm 300 Norm 230 Normal - - 200 Norm - - - - - -
Time(Ivy mins al al al
s
Method)
Blood B - - - - - - -
Type
RH Posi - - - - - - -
Typing tive
Analysis:
The levels of hemoglobin, hematocrit and platelet count of the TB patients were significantly lowered after completion of the intensive
phase of TB treatment. Significant variation of the RDW and PDW were also observed among treatment nave and treatment
completed patients. Hematological abnormalities resulted from TB treatment should be assessed continuously throughout the course
of tuberculosis therapy.
http://bmchematol.biomedcentral.com/articles/10.1186/s12878-015-0037-1
Eosinophils are associated with antigen-antibody reactions. The most common reasons for an increase in the eosinophil count are
allergic reactions such as hay fever, asthma, or drug hypersensitivity.

http://www.rnceus.com/cbc/cbcdiff.html

Basophils

The purpose of basophils is not completely understood. Basophils are phagocytes and contain heparin, histamines, and serotonin.
Tissue basophils are also called"mast cells." Similar to blood basophils, they produce and store heparin, histamine, and serotonin.
Basophil counts are used to analyze allergic reactions. An alteration in bone marrow function such as leukemia or Hodgkin's disease
may cause an increase in basophils. Corticosteroid drugs, allergic reactions, and acute infections may cause the body's small
basophil numbers to decrease.

http://www.rnceus.com/cbc/cbcdiff.html

Lymphocytopenia is an abnormally low number of lymphocytes (a type of white blood cell) in the blood. Many disorders can decrease
the number of lymphocytes in the blood, but viral infections (including AIDS) and undernutrition are the most common.

https://www.msdmanuals.com/home/blood-disorders/white-blood-cell-disorders/lymphocytopenia

Decreased in: Iron deficiency, thalassemia; decreased or normal in anemia of chronic

disease. http://www.sh.lsuhsc.edu/fammed/outpatientmanual/content.html
The ESR is increased in inflammation, pregnancy, anemia, autoimmune disorders (such as rheumatoid arthritis and lupus),
infections, some kidney diseases and some cancers (such as lymphoma and multiple myeloma).

https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate

CLINICAL CHEMISTRY
TES NO Jan. Jan. Jan. Jan. Jan. Feb. Feb. Feb. Feb. Feb.
T RM 4,2016 19,2016 22,2016 25,2016 26,2016 1,2016 2,2016 8,2016 13,2016 23,2016
AL
Re Inter Re Inter Re Inter Re Inter Re Inter Re Inter Re Inte Re Inter Re Int Re Inter
RA
sul sul sul sul sul sul sul r sul sul er sul
NG pret pret pret pret pret pret pret pret
ts ts ts ts ts ts ts ts ts ts
E atio atio atio atio atio atio pret atio pre atio
n n n n n n atio n tati n
n on
Bloo 2.7- 1.3 Dec - - - - - - 2.8 Nor - - - - - - - - - -
d 7.1 3 reas 9 mal
Ure ed
a
Nitro
gen
Cre 71- 35. Dec - - - - - - 42 Dec - - - - - - - - - -
atini 115 2 reas reas
ne ed ed
SLD < 16 Nor - - 14 Nor - - - - - - - - - - - - - -
H 248 2 mal 9.3 mal
2
SG < 16. Nor - - - - - - - - - - - - - - - - - -
OT/ 40 16 mal
AST
SGP < 18. Nor - - - - - - - - - - - - - - - - 10. Nor
T/AL 46 2 mal 89 mal
T
Total 60- 67. Nor - - 60. Nor - - - - - - - - - - - - 68. Nor
Prot 83 31 mal 1 mal 44 mal
ein
Albu 35- 34. Dec - - 34. Dec - - - - - - - - - - - - 38. Nor
min 55 28 reas 41 reas 07 mal
ed ed
Glob 22- 33. Nor - - 25. Nor - - - - - - - - - - - - 30. Nor
ulin 32 03 mal 69 mal 37 mal
A/G 1.5 1.0 Dec - - 1.3 Dec - - - - - - - - - - - - 1.2 Dec
Rati 0- 4 reas 4 reas 5 reas
o 3.1 ed ed ed
Total 2.0 1.9 Dec - - - - - - - - - - 2.6 Incr - - - - 2.6 Incr
Calc 2- 2 reas 3 eas 3 eas
ium 2.6 ed ed ed
Sodi 135 - - 13 Dec - - 13 Nor 13 Nor - - 13 Nor 13 Nor 13 Nor - -
um - 2.9 reas 6 mal 6.6 mal 9.3 mal 8.7 mal 7.3 mal
148 ed
Pota 3.5- - - 3.1 Dec - - 3.1 Dec 3.3 Dec 3.1 Dec - - 2.9 Dec 3.7 Nor 3.0 Dec
ssiu 5.3 9 reas 9 reas 5 reas 8 reas 5 reas 8 mal 2 reas
m ed ed ed ed ed ed
Chlo 98- - - 94. Dec - - 97 Dec 98. Nor - - 99. Nor 10 Nor 10 Nor - -
ride 107 3 reas reas 3 mal 9 mal 1.4 mal 1.9 mal
ed ed
Gluc - - - - - 5.4 blan - - - - - - - - - - - - - -
ose 2 k
RBS
Bloo 208 - - - - - - - - - - - - - - - - - - 70 Incr
d - 9.0 eas
Uric 428 0 ed
Acid

Dec. Creatinine = urinary insufficiency

if the creatinine and BUN tests are found to be abnormal or if someone has an underlying disease that is known to affect the
kidneys, such as diabetes or high blood pressure, then creatinine and BUN tests may be used to monitor for kidney dysfunction
and the effectiveness of treatment.
https://labtestsonline.org/understanding/analytes/creatinine/tab/test/
Low albumin levels can also be seen in inflammation, shock, and malnutrition. They may be seen with conditions in which the
body does not properly absorb and digest protein, such as Crohn's disease or celiac disease, or in which large volumes of
protein are lost from the intestines.
https://labtestsonline.org/understanding/analytes/albumin/tab/test/s

A/G ratio decrease because of reflect overproduction of globulins, such as seen in multiple myeloma or autoimmune diseases, or
underproduction of albumin, such as may occur with cirrhosis, or selective loss of albumin from the circulation, as may occur with
kidney disease (nephrotic syndrome).

https://labtestsonline.org/understanding/analytes/tp/tab/test/

Total calcium may result from a problem with the parathyroid glands, as well as from diet, kidney disorders, or certain drugs.
http://www.msdmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/hypocalcemia-(low-level-of-calcium-in-the-
blood)
Low sodium may be caused by drinking too much water, for example during strenuous exercise, without adequate replacement
of sodium.
http://www.webmd.boots.com/a-to-z-guides/hyponatraemia

Hypokalemia is not commonly caused by poor dietary intake. The most common reason that potassium levels fall is due to the
loss from the gastrointestinal (GI) tract and the kidney.

http://www.medicinenet.com/low_potassium_hypokalemia/article.htm

A decreased level of blood chloride (called hypochloremia) occurs with any disorder that causes low blood sodium.
Hypochloremia also occurs with congestive heart failure, prolonged vomiting or gastric suction, Addison disease,emphysema or
other chronic lung diseases (causing respiratory acidosis), and with loss of acid from the body (called metabolic alkalosis).

https://labtestsonline.org/understanding/analytes/chloride/tab/test/
 CLINICAL MICROSCOPY
(PLEURAL FLUID)
PHYSICAL NORMAL VALUES Jan. 24,2016 Jan. 31,2016
CHARACTERISTICS
Results Interpretation Results Interpretation
Color Yellow Pleural Bloody Red Hemothorax
effusion
Volume Approx. 10 mL 1 mL
Transparency Slightly Cloudy Turbid
 URINALYSIS

PHYSICAL NORMA Dec. 30,2015 Jan. 11,2016 Jan. 19,2016 Jan. 24,2016 Jan. 31,2016
CHARACTERISTI L
Results Interpretati Results Interpretati Results Interpretati Results Interpretati Results Interpretatio
CS VALUE
on on on on n
S
Color Light Light Light Light Dark
Yellow Yellow Yellow Yellow Yellow
Reaction 6.5 6.5 7.5 6.5 7.5
Transparency Turbid Hazy Slightly Hazy Hazy
Turbid
Specific Gravity 1.020 1.020 1.010 1.010 1.010
CHEMICAL TEST
Sugar Negativ Negativ Negativ Negativ Negativ
e e e e e
Protein Negativ Trace Trace Trace Trace
e
MICROSCOPIC
FINDINGS
WBC Cast 0-1/lpf - - - -
RBC None 35- 3-5 /hpf 4-7 /hpf 2-4 /hpf
Seen 40 /hpf
/hpf
PUS Cells 0-2 /hpf 3-5 /hpf 8-10 8-10 12-
/hpf /hpf 14 /hpf
Epithelial Cells Few - Few Rare Few
Bacteria - - - - -

RBC = intermittent catheterization

Turbid = probably because of urinary retention, because theres no uti.
ARTERIAL BLOOD GAS RESULT
NORMAL RANGE Dec. 30,2015 Jan. 22,2016
Results Interpretation Results Interpretation
pH 7.35-7.45 7.499 Increased 7.504 Increased
pCO2 35-45 mmHg 36.4 Normal 30.1 Decreased
pO2 80-100 mmHg 180 Increased 95.6 Normal
HCO3 22-26 mEq/L 27.7 Increased 23.2 Normal
O2 Saturation 97% 98.1% Normal 97.9 Normal
Oxygenation Adequate Oxygenation Adequate Normal Adequate Normal
Oxygenation Oxygenation
Interpretation Uncompensated Uncompensated
Metabolic Respiratory
Alkalosis
Alkalosis

PH increase- It means the solution is becoming less acidic and more alkaline. You probably already know that the pH scale runs
from 0 to 14 with a pH of <7 for acidic solutions, 7 for a neutral solution and >7 for an alkaline solution. The further you are away
from 7 the more acidic or alkaline the solution is ( so I like to think of it as two scales running outwards from 7 ).

https://ph.answers.yahoo.com/question/index?qid=20081104112414AAOm5xt
PO2 increase- reflects the amount of oxygen gas dissolved in the blood. It primarily measures the effectiveness of the lungs in pulling
oxygen into the blood stream from the atmosphere.

http://www.glowm.com/lab_text/item/3


Diagnostic tests

CT-Guided Biopsy

Date Submitted: January 28, 2016

Date Reported: February 3, 2016
Specimen: Paravertebral area, C5-C6 vertebra, right
Pathologic Diagnosis: Paravertebral area, C5-C6 Vertebra, right; CT-guided biopsy: bloody aspirate with scant
necrotic debris
Comments: Interpretation limited by absence of viable parenchymal elements.
Gross examination: received are four smeared slides and a small container with approximately 40 cc of thin,
bloody fluid. Four (4) different quick slides and 1 cell block are prepared. (Feb. 1, 2016)
Microscopic examination: The smears and cell block disclose rare necrotic tissue fragments with scattered mixed
inflammatory cells. These are all set in a bloody background. (February 3, 2016)

Ultrasound

Date: February 3, 2016

Chest Sonography: Presence of 32 ml of fluid in the left hemithorax and consolidation in the left lower lobe. Right
hemithorax is unremarkable. Right LF is with effusion.
Impression: Pleural effusion, left. Pneumonic consolidation, left lower lobe.
 X-ray (Cervical APL)

Date of Examination: December 30, 2016

Date of Realease: January 15, 2016
Results:
o Negative for spondylolisthesis
o There are compression deformity of C4 down to C7
o Vertebral bodies with narrowing of the disc spaces
o Retropharyngeal fullness is noted. Consider infectious spondylitis (Potts Disease) MRI correlation is
recommended.
o Atlas dens interval is intact
o Prevertebral space is not thickened.
o The lateral masses of C1 are equidistal to the odontoid process.

X-ray (Chest)

Date of Examination: December 30, 2015

Date of release: January 6, 2016
Date Submitted: January 24, 2016
Results:
Date Reported: January 27, 2016
o Infiltrates are seen in the right lower lobe.
o Perihilar
Specimen: streaky
Pleural fluid,densities
right are seen with enlarged transbronchial lymphnodes
o Heart is not enlarged
Pathologic diagnosis:
o Diaphragm Pleural fluid,sulci
& costophrenic right, E
are CTT insertion:
intact
o Negative for malignant cells
Impression:
o Cytomorphologic findings consistent with a chronic inflammatory process
o Pneumonitis, right lower lobe
oComments:
E Please
CTT insertion
Consider correlate
concomitant with
PPTB the TB-PCR results
(Healing)
Suggest follow-up
o Examination:
Gross
Specimen consists of white turbid fluid. Four smears and two cell blocks are prepared for cytologic study.
(January 24, 2016)
Microscopic examination:
Smears and cell block sections show numerous lymphocytes, plasma cells, and neutrophils set against a
fibrinous background. There are no malignant cells and no epithelioid histiocytes/granuloma formation identified.
Date: February 3, 2016
Findings:
o There is a reversal of the usual cervical lordosis, with collapse of C5 vertebra
o C5 appears posteriorly displaced in relation to C6
o Cortical irregularities of the end plates of the adjacent C4 and C6 vertebral bodies are seen. There are
abnormal marrow signals of C3 to C6 vertebrae.
o A large paravertebral soft tissue mass extending from the level of C2 to T1 measuring approximately 10 x
MRI
5 xCervical
3 cm (1xtxap
Spine is appreciated, causing moderate cord compression. There is increased cord signal from
C2 to C7 reflective of edema.
o The craniocervical junction is grossly unremarkable
o C2-C3, C3-C4, C6-C7, and C7-T11 disc space heights are maintained.
o Incidental note of small and slightly prominent lymph nodes in the bilateral internal jugular chains, right
upper lobe pleural thickening and infiltrates
Impression:
o Large paravertebral soft tissue mass from C2 to T1 causing cord compression with associated collapse of
C5 vertebral body consistent with Potts disease
o Cervical kyphosis with posterior displacement of C5 over C6.