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NB5484 Chemical Pathology Data Interpretation Case Study

A 32-year-old male patient presented to the clinic with loss of appetite, fatigue, weight loss and weakness. Patient also complained of some upper abdominal discomfort. A young clinical physician attending the patient reported there was no abnormality in the patients physical examination except for slight redness on the palm. Patients blood was taken for examination. Biochemical parameters examination results were as follows: Fasting blood glucose Urea Creatinine ALT AST ALP Total bilirubin TSH fT3 fT4 98 mg/dL 17 mg/dL 0.8 mg/dL 61 IU/mL 33 IU/mL 85 IU/mL 0.8 mg/dL 1.4 IU/mL 1.90 pg/mL 0.96 ng/mL

With existing biochemical results, additional serology test was done on the blood. Serological markers of the patient were as follows: AntiHCV HBsAg AntiHBs HBeAg AntiHBe HBV-DNA PCR AntiHIV ANA AMA ASMA negative positive negative negative positive 25,000 copies/mL negative negative negative negative

Masters in Biomedical Science

NB5484 Chemical Pathology Data Interpretation


Anti-GPC negative

Patient also showed a Knodell hepatic activity index (HAI) of 3+1+1+3=8. The patient was started on 10 million units of interferon alpha 2b treatment three times per week. However, within 4 months of the treatment the patient presented with dry mouth, urinary frequency 8 to 10 times per day, higher intake of water, nocturia and asthenia and he was admitted to the clinic. His physical examination was unremarkable except for dry lips. He had family history of type I diabetes mellitus. Blood analysis results were: Fasting blood glucose ALT AST Urea Na K TSH fT3 fT4 Anti-Tg Anti-TPO Serum iron Complete blood count HBV DNA PCR HbA1c Anti-GAD AIA ANA titer AMA ASMA 224 mg/dL 26 IU/mL 18 IU/dL 15 mg/dL 144 mmol/L 3.5 mmol/L 0.002 IU/mL 4.36 pg/mL 2.28 pg/mL positive positive normal normal 2000 copies/mL 9.6% 69 IU/mL 30.6% 1/160 negative negative (Normal: 6%) (Normal: 0 1 IU/mL) (Normal: 0 8.2%)

Masters in Biomedical Science

NB5484 Chemical Pathology Data Interpretation


Anti-GPC Anti-dsDNA negative negative

Complete urine analysis results were: Density Glucose Ketone Bilirubin Protein 1010 ++++ ++ negative negative

Questions: 1. 2. How would you interpret the patients initial laboratory test ? (please include the reference range for each value). Analyze and relate the patients laboratory tests results with the disease. What is your differential diagnosis or diagnosis referring to the initial laboratory test prior to treatment? Interpret the laboratory results and explain about the patients conditions following treatment. What do you think is a suitable treatment to manage the patient following the secondary presentation? Predict the laboratory analysis results with your choices of treatment. (Include the duration of the given treatment).

3. 4.

Masters in Biomedical Science