I love a good mystery.

 Who doesn’t love a good whodunnit? I’m this case, whatdunnit?That’s part of why I love my job in the healthcare field and as an analyst, trying to piece things together to find a big picture or get a short glimpse into what might happen. Bag of chocolate covered cherries or bbq chips disappear? Probably my fiancé. Birds chirping when I wake up? Getting close to spring. Buildup of Ruskies on the Ukrainian border? Probs and invasion. But a WBC count of 1 I’m a healthy young adult? Hmmmm, as the kids say “idk bro”. Do they say that? Idk. 

A 23 year old patient was admitted with pancytopenia after spontaneous bleeding from the gums. Not uncommon if you brush with the fury of a belt sander. Spontaneously? That’s weird. So the labs show severe pancytopenia as mentioned, WBC of 1, RBC of 2, platelets of 6, and ANC of one. Side note, what else do I need to see here? For anyone with experience let me know what else you’d look at. Спасибо большое. 

My favorite person in the hospital (ID doc, really fun, crusty old guy) comes and does all the tests for infectious causes. HIV, EBV, CMV, all the hepatitises (hepatiti?), and of course COVID-19 and influenza. Nothing. Oncology does a bone marrow biopsy. Very low density of cells. But no dysplasia, no sign of any malignancy. What the hell?

The patient is no longer at the hospital, out to a much bigger institution so I don’t know what happened. But I want to. So instead I’m going to cover today, and in the future, some causes of blood dyscrasia. Starting with influenza virus. As a new nurse, not sure if I think this is likely, rationale is an article in the Western Journal of Medicine stating it is more likely from an immune reaction or hypoplasia. We probably have all heard of IRIS (from below the baseline) or the over-activating of the immune system in regards to an infection or malignancy. Could this be it? Actually, maybe it was the flu? The patient didn’t report sickness in the last month but who knows? Delayed response from the immune reaction to a sub-clinical infection? 

Either way. I’m just throwing spaghetti at the wall. As mentioned before, I’m learning by putting this out there to hopefully get you thinking and maybe teaching me. Later on I’m going to look at the other viruses and malignancies once I get enough understanding to sound somewhat coherent. So stay tuned for that. In the mean time, let me know what you think? Seen this kinda thing before? What was it? Recommendations for reading on the topic? Send them my way. До свидания. 

References

Image of reactivated 1918 influenza virus under an electron microscope by Cynthia Goldsmith at the CDC. 

Pancytopenia from StatPearls at the NIH National Library of Medicine by Chirvauri & De Jesus updated November 2022. 

Severe Neutropenia from the Western Journal of Medicine by Munshi & Montgomery in April 2000. 

Autoimmune neutropenia associated with influenza virus infection in childhood: a case report from BMC Infectious Diseases by Caballero et al. August 2021. 

Comments

Post a Comment

Popular posts from this blog

What the H?

Image
As far as I can remember, I was never a medically minded person up until Christmas 2019. I knew what food poisoning was, blastomycosis, blood clots,  and cracked ribs were, but that was it. I'm sure I knew of others, but I never gave them a second thought as I was spared much in the way of illness. It's funny how such things shaped my life, and I never gave them any hold in my mind until much later. Not that these diagnoses were as profound as say, a cancer diagnosis, but they impacted me in many ways. All this to say, that was my breadth of awareness of the medical field, the corpsmen (God love them, seriously) were no help to teach me. I do remember vividly for some reason I can't explain, the time I found out about H. pylori, the "H" in the title. I had a buddy at the time with some gnarly, debilitating stomach pain. Boy did I not known what the hell to do about that. Ibuprofen? Acetaminophen? Nah, I know better now. And that. bug, and subsequent complications,...
Read more

Well S*#t

Image
We are just going to keep talking about GI subjects until I get tired of them. Probably after this but who knows? I get to take care of a lot of GI/GU patients at work with some of the "Greatest Hits" of the gut. Diverticulitis, intestinal perforations, colorectal cancer, pancreatitis, bowel obstructions, abscesses, bleeds, and the like. I won't ever be a GI specialist but I do love infections and the big dog at the moment is everyone's favorite, Clostridioides difficile  AKA Clostridium difficile maybe C. diff  or in this mess of words, CD.  CD is a Gram -positive, spore forming, obligate anaerobic, motile, "drumstick-shaped" bacillus. To expand on that, they need low-no oxygen environments (like the gut), create spores that are hardy and able to survive conditions that would kill the live bacteria, and CD creates toxins that cause many of the effects of a CD infection. Though we generally associate CD with the diseases it causes, sometimes called CDAD or C...
Read more

Bacitracin: Bacteria from Tracey

Image
Not even joking. No cap. The solemn truth. On the record. The truth, the whole truth, and nothing but da truth. Bacitracin was named after bacteria from a lady named Margaret Tracey. How is that for useless knowledge taking up space in your brain? Before we get into that story, me thinks the three of you reading this have probably used, or had been the target of use for, bacitracin as a kid. The little packets are ubiquitous in first aid kits across the world. Got a cut? Bacitracin. Burn or scrape? Bacitracin. Ran out of toothpaste? Bacitracin. I really hope that sarcasm was evident, the lack of humor nowadays is stunning. Please don't eat bacitracin.  In 1943, a young girl named Margaret Tracy was seen at a hospital in New York, the precursor to Columbia-Presbyterian Medical Center. She had been hit by a car earlier that day and suffered a compound fracture of her tibia, which collected dirt from the road. The doctors cultures the wound which grew Bacillus subtilis and Staph aureu...
Read more