Your patient is a married 47 year old white female homemaker with 2 children and an 18 year history of systemic lupus erythematosus (SLE). She has no known allergies. The pt takes an occasional naproxen for joint pain and antacid for heartburn but no other prescription or OTC (over the counter) medication. She neither smokes nor drinks alcohol (ETOH). Except for lupus, the patient's medical history is unremarkable. She is 5 feet 5 inches in height and weighs 102 pounds which is a decrease in weight of 23 pounds since her last physical examination nearly a year ago. She has had several small patches of hair loss on her head and her joints often hurt. Her ESR (erythrocyte sedimentation rate) is elevated at 70. She has a red rash on the sun exposed parts of her skin that looks like a vasculitis. She has 4 brothers and 3 sisters. An older sister has rheumatoid arthritis (RA) and an aunt with pernicious anemia and her deceased mother had Graves disease.

She had been aware of these problems for approximately four months. A physical examination was conducted during which her PCP noted multiple rash-like lesions on sun-exposed areas of the body, primarily on the arms and legs. A tissue biopsy of one of the lesions was taken and microscopic examination of the tissue revealed vasculitis (white blood cells within the walls of the blood vessels). An ANA test was positive. The lungs were clear to auscultation, heart sounds were normal with a prominent S1 and S2, and there was no evidence of enlarged lymph nodes. Blood tests revealed an Hct of 23% and an RBC count of 3.5 million/mm3. She was also jaundiced with some yellowing within the sclera. Microscopic examination of a peripheral blood smear revealed that red blood cells were normal in shape, size, and color, ruling out iron, folate, and vitamin B12 deficiencies. The total WBC count was 5,500/mm3 and her Plt count was 350, 000/mm3. Urinalysis was normal. She was placed on predisone for two months, during which time all signs and symptoms of disease resolved.

What can be said about the patient’s Hct, RBC count, WBC count, and Plt count?

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Elin Hessel
Elin HesselLv2
28 Sep 2019

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