Morgan Wong, DO
Nicholas Villalobos, MD
Department of Internal Medicine
University of New Mexico
Albuquerque, NM USA
History of Present Illness
A 68-year-old man presented to the emergency department with a one-day history of lower back pain, arthralgias, and malaise. The patient had a previous splenectomy and was concerned about influenza.
Past Medical History, Social History, and Family History
He has a history of osteoarthritis, seasonal allergies, and splenectomy. He is a nonsmoker. Family history is noncontributory.
Physical Examination
Upon admission, the patient’s vital signs were notable for a temperature of 35.3 degrees Celsius, blood pressure of 74/44 mmHg, oxygen saturation of 85% on room air with a respiratory rate of 24 breaths per minute. Physical exam was prominent for non-pitting edema of the distal upper and lower extremities, as well as diffuse macular rash of the palms and soles.
Laboratory
CBC
Chemistry
Coagulation
Arterial blood gases
Procalcitonin >200 ng/ml.
His blood peripheral smear was examined.
Figure 1: Peripheral blood smear on admission.
Given the results of the preliminary laboratory results and peripheral smear what hematologic abnormality are you most concerned with at this time? (Click on the correct answer to proceed to the second of five pages)
Cite as: Wong M, Villalobos N. February 2017 critical care case of the month. Southwest J Pulm Crit Care. 2017;14(2):54-9. doi: https://doi.org/10.13175/swjpcc144-16 PDF