เอกสารประกอบการสอนรายวิชา MT3123

กรณีศึกษา (case study)

อ.เพ็ญนภา

A 28-year-old man requested cholesterol testing because his father had died of a myocardial
infarction in his thirties, his paternal grandfather had developed angina in his early forties and died
suddenly in his late forties, presumably of an infarction, and there was a further history of ischemic heart
disease at a young age in his more extended family. The GP noted that he had tendon xanthomas on his
knuckles and on his Achilles tendons. He took plenty of exercise, followed a healthy diet and was not
overweight, did not smoke and was normotensive. The results of blood chemistry are as the following

Serum Results Reference range

Total cholesterol 409 < 200 mg/dL
Triglyceride 124 < 150 mg/dL
HDL-C 73 > 40 mg/dL
Total cholesterol:HDL-C 5.6
LDL-C 313 < 100 mg/dL

1. What is the results interpretation?

2. Classify the hyperlipidemia for this man.
3. Does he have the CHD risk factors? If does, please identify.

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เอกสารประกอบการสอนรายวิชา MT3123

กรณีศึกษา (case study)

อ.ดร.ชมพูนุท
A 64-year-old man was admitted on a Sunday for an elective operation on his nasal sinuses; his
previous hospital notes were not available. He appeared to be fit for operation on clinical examination, and
his pre-operative ECG was normal, but the following results were obtained on a blood specimen analysed
as part of the routine pre-operative assessment:

Serum Results Reference range

BUN 20 6-20 mg/dL
Na+ 135 135-145 mmol/L
K+ 8.8 3.6-5.0 mmol/L
Cl- 100 98-107 mmol/L
Total CO2 30 22-30 mmol/L
The serum was pale-yellow, non-lipemic, no fibrin clot.

1. How would you interpret the hyperkalemia in relation to the findings on clinical examination and
the normal ECG recording?
2. Would your comments be influenced by the information that became available later that day,
when the patient’s medical records were received, that he had chronic lymphocytic leukemia?

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เอกสารประกอบการสอนรายวิชา MT3123

กรณีศึกษา (case study)

อ.ดร.ปานทิพย์

A 79-year-old female has just been admitted to the general surgical ward to have a large bowel
tumor surgically removed.
The tumor was discovered at colonoscopy after she presented to her doctor with a six month
history of rectal bleeding.
On admission she appears to be severely short of breath and extremely tried. Further questioning
reveals that her rectal blood loss has been no greater than usual.
Physical examination
Pulse 100 beats/min
Blood pressure 100/80 mmHg
Respiratory rate 24 breaths/min
SaO2% (on air) 100%
Arterial blood gas (on air)
H+ 32.3 nmol/L (35-45)
pH 7.49 (7.35-7.45)
PCO2 25 mmHg (35-45)
PO2 89 mmHg (>80)
Bicarbonate 22 mmol/L (22-28)
BE -2 mmol/L (-2-+2)
SPO2 99.8% (>98%)
+
K 3.8 mmol/L (3.5-5)
Na+ 138 mmol/L (135-145)
Cl- 96 mmol/L (95-105)
iCa 1.17 mmol/L (1-1.25)
Hb 6.8 g/dL (13-18)
Glucose 3.9 mmol/L (3.5-5.5)

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เอกสารประกอบการสอนรายวิชา MT3123

กรณีศึกษา (case study)

อ.ดร.เพ็ญพักตร์

An 18-year-old female was taken to the emergency room in coma. Her parents noticed that she
had polydipsia, polyuria, and rapid weight loss which started approximately 1 month ago and had
worsened in the last week. She had not been taking any medications and the clinical history was otherwise
unremarkable. On examination, breathing was deep and rapid (Kussmaul respiration), pulse rate was 100
beats per minute, and blood pressure 110/70 mmHg; she also had signs of dehydration. She was drowsy
and confused. The biochemical tests showed:

Glucose 520 mg/dL

Urea 50 mg/dL Creatinine 0.8 mg/dL
Na+ 148 mEq/L K+ 4.6 mEq/L
PO4 3- 2.0 mEq/L Cl- 112 mmol/L
Arterial pH 7.0 PO2 98 mmHg
PCO2 25 mmHg HCO3- 12 mEq/L
O2 sat 98%

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เอกสารประกอบการสอนรายวิชา MT3123

กรณีศึกษา (case study)

อ.ดร.กรวิภา

Unusual Electrolyte and Glucose Results

The paper printout from the chemistry instrument was marked with a flag next to the plasma
glucose level. The glucose concentration was 48 mg/dL, critically lower than the reference range for
fasting plasma glucose levels of about the critically low value when she noticed that the concentrations of
other tests for this specimen were only slightly higher than the critical range lower limit and some results,
such as chloride and sodium, were very elevated. The technologist considered the reasons why so many
results were abnormal, with many abnormally low. To solve the problem, the technologist considered
what the tests have in common. The technologist contacted the patient’s nurse to determine whether the
patient was receiving IV fluids. She also asked if it was possible that the specimen was contaminated with
IV solution. The nurse confirmed that the patient was receiving a saline (salt water solution) IV infusion
and that the blood could have been collected improperly from a vein above the IV line. A new employee
had collected the specimen, and the proper procedure may not have been followed. The nurse drew a new
sample, which gave improved results. A comparison of the results from both specimens is provided below

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เอกสารประกอบการสอนรายวิชา MT3123

From all the data above

1. What is the problem in this case?
2. Which phase did the error occur in this case? Pre-analytical, Analytical or Post-analytical phase?
3. What’s type of error? Systematic error or Random error?
4. Please explain the effect of serum specimens contaminated with saline IV solution on common
laboratory results, including electrolytes and protein levels.

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เอกสารประกอบการสอนรายวิชา MT3123

กรณีศึกษา (case study)

อ.จิรวัส

A 35-year-old man who had been unwell for six weeks presented with bilateral pitting edema of
the lower limbs. Urinalysis revealed severe proteinuria (4+). He was considered to have the nephrotic
syndrome and was admitted to hospital for further investigation. Over the following three days his plasma
and urinary biochemistry values were as follows.

Plasma 9/5 10/5 11/5 Normal range

Sodium 138 144 144 mmol/L 136-145
Potassium 4.0 4.2 3.9 mmol/L 3.5-4.5
Chloride 105 107 111 mmol/L 98-107
Bicarbonate 29 30 31 mmol/L 22-29
Urea 7.5 6.0 7.0 mmol/L 3.3-6.7
Creatinine 0.12 0.12 0.09 mmol/L 0.06-0.12
Calcium 2.00 2.10 1.94 mmol/L 2.2-2.6
Total protein 53 51 46 g/L 60-80
Albumin 26 25 22 g/L 35-50
Cholesterol 11.1 - - mmol/L 3.5-7.3
Triglyceride 2.61 - - mmol/L 0.4-1.8
Urine
Albumin 13.4 9.3 8.6 g/24h <0.15

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เอกสารประกอบการสอนรายวิชา MT3123

กรณีศึกษา (case study)

อ.ภาวดี

ผูป้ ่ วยชายอายุ 15 ปี อาการบวมที่ ขา 2 ข้า ง มีอ าการมือ สั่ น เป็ นๆ หายๆ มาตลอด 1 ปี และพบวง
แหวนสี น้ าตาลที่กระจกตา อาการอื่นๆ เข้าได้กบั liver cirrhosis

ผลตรวจทางห้องปฏิบตั ิ การ
Glucose 85 mg/dL (70 – 100 mg/dL)
BUN 14 mg/dL (6 – 23 mg/dL)
Creatinine 0.9 mg/dL (0.6 – 1.1 mg/dL)
Total protein 7.5 g/dL (6.0 – 8.0 g/dL)
Albumin 1.9 g/dL (3.5 – 5.0 g/dL)
Globulin 5.6 g/dL (2.3 – 3.5 g/dL)
Ceruloplasmin 12 mg/dL (20 – 60 mg/dL)
Cholesterol 150 mg/dL (<200 mg/dL)
AST 70 U/L (<40 U/L)
ALT 31 U/L (<40 U/L)
Urine
24-h urine copper 90 mg/dL (20 – 80 mg/dL)