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Patient A: In May 2001, a 21-year old woman, Patient A, was rushed to a local emergency room in Virginia after coming home from college with severely jaundiced sclera. According to the patient, her eyes had been yellow for a few days, which she attributed to allergies. She reported feeling healthy except for slight pruritus (i.e. intense itching) on the backs of her hands. Test results for Patient A are listed in Table 1 below.

Patient A: In May 2001, a 21-year old woman, Patient A, was rushed to a local emergency room in Virginia after coming home from college with severely jaundiced sclera. According to the patient, her eyes had been yellow for a few days, which she attributed to allergies. She reported feeling healthy except for slight pruritus (i.e. intense itching) on the backs of her hands. Test results for Patient A are listed in Table 1 below.

Phlebotomy Essentials
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
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Hi, so I have attached a screenshots of what I need help with. But basically they are a case of 2 patients. I tried to solve them but I was not sure. I diagnosed Patient A with Hepatitis E and Patient B with Hepatitis C.

Patient A: In May 2001, a 21-year old woman, Patient A, was rushed to a local emergency room in Virginia after coming home from college with severely jaundiced sclera. According to the patient, her eyes had been yellow for a few days, which she attributed to allergies. She reported feeling healthy except for slight pruritus (i.e. intense itching) on the backs of her hands. Test results for Patient A are listed in Table 1 below. Results of ultrasound imaging of her abdomen were unremarkable. Patient A was questioned extensively about her lifestyle and her sexual history. She indicated that she was not sexually active, did not have a history of drug abuse, and consumed very little alcohol. She had not recently been out of the country and denied any deviations from her normal diet. Her medical history revealed that she was a young adult woman who had been extremely healthy and active before this admission to the hospital. The patient insisted that other than the pruritus on her hands, she felt well. Patient A was discharged; in a few days, the jaundice disappeared. Patient B: At the same time, a 31-year old Asian-American woman, Patient B, who has had a fever, nausea and fatigue for the past 24 hours was brought to the emergency room. She reports dark urine and has had 3 light colored stools since the day before. She has previously been healthy and has no previous history of jaundice. Her physical examination shows a low-grade fever of 100.6°F/38.1°C, faint scleral icterus, and hepatomegaly. Her blood pressure and neurologic exam are normal and there is no rash. Initial laboratory results for Patient B are also included in Table 1. Patient B has no children and her boyfriend was not ill. She has been in a monogamous relationship with her boyfriend for 2 years and has been taking oral contraceptives. She was born in the United States; her parents immigrated to the United States from Taiwan in the 1950s. She works as a food preparer for a catering business. She returned 4 weeks ago from a 1-week vacation in Mexico where she stayed with her boyfriend in several hotels. She drank only bottled water but ate both cooked and uncooked food at numerous restaurants and she visited a family friend and her three young children in a Mexico City suburb. Her hepatitis vaccinations are unknown. She has not gone camping or hiking and is unaware of any tick exposures. She has never used illicit drugs, drinks alcohol occasionally, and has never received a blood transfusion. Patient B has a pet cat but no other animal exposures. She had chickenpox and mononucleosis during childhood. Table 1. Patient A and Patient B's Emergency Room test results. Patient A Test (Reference Range) PTT (21.5-34.0 s) AST (5.0-40.0 U/L) ALT (7.0-56.0 U/L) Total Bilirubin (0.2-1.3 mg/dL) ALKP (30 – 90 U/L) GGT (3.0-60.0 U/L) Patient B 36.7 s Not done 714.0 U/L 960.0 U/L 8.4 mg/dL 650 U/L 877 U/L 3.4 mg/dL 58 U/L Not done 201.0 U/L Negative Not done Pregnancy Test Negative 4600 cells/ul Not done CBC Not done Differential Normal
Transcribed Image Text:Patient A: In May 2001, a 21-year old woman, Patient A, was rushed to a local emergency room in Virginia after coming home from college with severely jaundiced sclera. According to the patient, her eyes had been yellow for a few days, which she attributed to allergies. She reported feeling healthy except for slight pruritus (i.e. intense itching) on the backs of her hands. Test results for Patient A are listed in Table 1 below. Results of ultrasound imaging of her abdomen were unremarkable. Patient A was questioned extensively about her lifestyle and her sexual history. She indicated that she was not sexually active, did not have a history of drug abuse, and consumed very little alcohol. She had not recently been out of the country and denied any deviations from her normal diet. Her medical history revealed that she was a young adult woman who had been extremely healthy and active before this admission to the hospital. The patient insisted that other than the pruritus on her hands, she felt well. Patient A was discharged; in a few days, the jaundice disappeared. Patient B: At the same time, a 31-year old Asian-American woman, Patient B, who has had a fever, nausea and fatigue for the past 24 hours was brought to the emergency room. She reports dark urine and has had 3 light colored stools since the day before. She has previously been healthy and has no previous history of jaundice. Her physical examination shows a low-grade fever of 100.6°F/38.1°C, faint scleral icterus, and hepatomegaly. Her blood pressure and neurologic exam are normal and there is no rash. Initial laboratory results for Patient B are also included in Table 1. Patient B has no children and her boyfriend was not ill. She has been in a monogamous relationship with her boyfriend for 2 years and has been taking oral contraceptives. She was born in the United States; her parents immigrated to the United States from Taiwan in the 1950s. She works as a food preparer for a catering business. She returned 4 weeks ago from a 1-week vacation in Mexico where she stayed with her boyfriend in several hotels. She drank only bottled water but ate both cooked and uncooked food at numerous restaurants and she visited a family friend and her three young children in a Mexico City suburb. Her hepatitis vaccinations are unknown. She has not gone camping or hiking and is unaware of any tick exposures. She has never used illicit drugs, drinks alcohol occasionally, and has never received a blood transfusion. Patient B has a pet cat but no other animal exposures. She had chickenpox and mononucleosis during childhood. Table 1. Patient A and Patient B's Emergency Room test results. Patient A Test (Reference Range) PTT (21.5-34.0 s) AST (5.0-40.0 U/L) ALT (7.0-56.0 U/L) Total Bilirubin (0.2-1.3 mg/dL) ALKP (30 – 90 U/L) GGT (3.0-60.0 U/L) Patient B 36.7 s Not done 714.0 U/L 960.0 U/L 8.4 mg/dL 650 U/L 877 U/L 3.4 mg/dL 58 U/L Not done 201.0 U/L Negative Not done Pregnancy Test Negative 4600 cells/ul Not done CBC Not done Differential Normal
1. What is the differential diagnosis for Patient A and B 2. What additional information would assist you with the diagnosis of both Patients A and B 3. What diagnostic tests are needed and why Table 2. Patients serologic test results Test (reference range) Patient A result Patient B result Total anti-HAV negative positive positive positive negative IgM anti-HAV negative negative negative Total anti-HBc IgM anti-hepatitis B core antigen negative positive negative negative positive HBSAG anti-HBs anti-HCV negative 4. What do the above tests indicate 5. What is the recommended treatment for both the patients
Transcribed Image Text:1. What is the differential diagnosis for Patient A and B 2. What additional information would assist you with the diagnosis of both Patients A and B 3. What diagnostic tests are needed and why Table 2. Patients serologic test results Test (reference range) Patient A result Patient B result Total anti-HAV negative positive positive positive negative IgM anti-HAV negative negative negative Total anti-HBc IgM anti-hepatitis B core antigen negative positive negative negative positive HBSAG anti-HBs anti-HCV negative 4. What do the above tests indicate 5. What is the recommended treatment for both the patients
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