Man with Colitis and Pancytopenia

Alison Woodworth

A 32-year-old Caucasian male presented to the emergency department with complaints of bloody diarrhea 20 times per day and dehydration. A CBC was notable for anemia with normal white blood cell and platelet counts. Past medical history was significant for Crohn's disease diagnosed at age 20 involving the small and large intestines. He underwent ileocecal resection, and had been asymptomatic and required no therapy for the past 5 years. During his 2-day hospital course, anemia and dehydration were corrected, the diarrhea resolved, and immunosuppression with prednisone and azathioprine was started to treat a flare of inflammatory bowel disease.

Three weeks later, he returned to the gastroenterology clinic for a follow-up appointment during which he complained of fevers, chills, and rectal pain for the past 3 days. On physical examination he was diaphoretic, febrile (39.8°C), and tachycardic, and experienced pain with movement. No lymphadenopathy was appreciated, and lung and heart exams were normal. His abdomen was mildly tender with hypoactive bowel sounds. No ascites or peripheral edema was noted.

Laboratory data included the following:

Reference

Value,

Interval,

Reference

Conventional

Conventional

Value,

Interval,

Analyte

Units

Units

SI Units

SI Units

WBC

0.6 x 103/mL

3.8-9.8

0.6 x 109/L

3.8-9.8

Neutrophil count

0.0 x io3/mL

1.7-6.7

0.0 x 109/L

1.7-6.7

Lymphocyte count

0.6 x 103/mL

0.9-3.2

0.6 x 109/L

0.9-3.2

Monocyte count

0.0 x i03/mL

0.2-0.9

0.0 x 109/L

0.2-0.9

Hemoglobin

8.2 g/dL

13.8-17.2

82 g/L

138-172

Hematocrit

23%

41-50

0.23 volume

0.41-0.50

Platelets

42 x 103/mL

140-440

42 x 109/L

140-440

Sodium

145 mmol/L

135-145

Same

Potassium

3.5 mmol/L

3.3-4.9

Same

Value, Conventional Units

Reference Interval, Conventional

Value, SI Units

Same Same

Reference Interval, SI Units

Analyte

Chloride

CO2, total

Glucose

Urea nitrogen

Creatinine

Protein, total

Albumin

Bilirubin

106 mmol/L 29 mmol/L 98 mg/dL 19 mg/dL 1.3 mg/dL 7.0 g/dL 3.6 g/dL 37 IU/L 50 IU/L 0.4 mg/dL

Units

62-133

68-85

Chest x-ray showed no active disease. Blood cultures were positive for Esherichia coli and Streptococci viridans. Urine cultures were negative. A bone marrow biopsy and aspirate were markedly hypocellular (<10% cellularity, normal for 30-year-old adult ^70%) without features of myelodysplasia or a myeloid or lymphoid malignancy.

Was this article helpful?

0 0
Supplements For Diabetics

Supplements For Diabetics

All you need is a proper diet of fresh fruits and vegetables and get plenty of exercise and you'll be fine. Ever heard those words from your doctor? If that's all heshe recommends then you're missing out an important ingredient for health that he's not telling you. Fact is that you can adhere to the strictest diet, watch everything you eat and get the exercise of amarathon runner and still come down with diabetic complications. Diet, exercise and standard drug treatments simply aren't enough to help keep your diabetes under control.

Get My Free Ebook


Post a comment