A 73-year-old, previously healthy man had spent the previous summer on Martha’s Vineyard. On returning to his home in Boston after Labor Day, he began to feel unusually tired and had difficulty breathing. He also reported that his urine had become dark brown several days after returning home. On physical examination, the patient was found to be jaundiced, and he had an enlarged spleen. A complete blood count, urinalysis, and blood chemistries were ordered. His total white blood cell count was normal, but he had an increased percentage of segmented neutrophils. His hemoglobin and hematocrit values and platelet count were all below the normal reference range. He had hematuria and proteinuria. His liver function test results were greatly elevated. His renal function assays were also elevated. A follow-up Wright-stained peripheral blood smear revealed numerous B. microti organisms. The patient was treated with quinine and the antibiotics clindamycin and doxycycline. He also received 2 units of packed red blood cells (RBCs). Six days later, the patient was discharged from the hospital. Would the patient’s travel history be suggestive of malaria or another bloodborne infectious disease? What is the definitive diagnosis for babesiosis? What additional laboratory tests are of diagnostic value?

Phlebotomy Essentials

6th Edition

ISBN:9781451194524

Author:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Publisher:Ruth McCall, Cathee M. Tankersley MT(ASCP)

Chapter1: Phlebotomy: Past And Present And The Healthcare Setting

Section: Chapter Questions

Problem 1SRQ

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A 73-year-old, previously healthy man had spent the previous summer on Martha’s Vineyard. On returning to his home in Boston after Labor Day, he began to feel unusually tired and had difficulty breathing. He also reported that his urine had become dark brown several days after returning home.

On physical examination, the patient was found to be jaundiced, and he had an enlarged spleen. A complete blood count, urinalysis, and blood chemistries were ordered. His total white blood cell count was normal, but he had an increased percentage of segmented neutrophils. His hemoglobin and hematocrit values and platelet count were all below the normal reference range. He had hematuria and proteinuria. His liver function test results were greatly elevated. His renal function assays were also elevated. A follow-up Wright-stained peripheral blood smear revealed numerous B. microti organisms.

The patient was treated with quinine and the antibiotics clindamycin and doxycycline. He also received 2 units of packed red blood cells (RBCs). Six days later, the patient was discharged from the hospital.

Would the patient’s travel history be suggestive of malaria or another bloodborne infectious disease?
What is the definitive diagnosis for babesiosis?
What additional laboratory tests are of diagnostic value?

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