IMMUNOLOGY-SEROLOGY AND BLOOD BANKING

August 20 to September 16, 2018

“Thrombocytopenic Autoimmune and Anemic Disease of A 20-Year Old Female”

A Case study presented to the faculty of

Medical Laboratory Science
In partial fulfilment of the Internship Training for the
Degree of Bachelor in Medical Laboratory Science

Ryan Spencer P. Alocelja

Julienne Kyt G. Castillo
Jhenniely Dorotan
Presented by: Annie Claire N. Ogatis
Romie Bren G. Solacito
Quennie L. Villegas
Clinical Instructor: Abdulhatta G. Abas, RMT
Lou Martin Quintana, RMT
 INTRODUCTION

Systemic Lupus Erythematosus (SLE) represents the prototype of human

autoimmune diseases. It is a chronic systemic inflammatory disease marked by
alternating exacerbations and remissions, affecting between 15 and 50 individuals out of
100,000 in the United States. Incidence of the disease has tripled over the last four
decades. The peak age of onset is usually between 20 and 40 years. Women are much
more likely than men to be stricken, by a margin of approximately 10 to 1. It is also more
common in African Americans and Hispanics than in whites. With earlier diagnosis and
improved treatments, the 5-year survival rate has increased to greater than 90 percent.
Disseminated intravascular coagulation (DIC) is characterized by the widespread
activation of the hemostatic system, resulting in fibrin thrombi formation throughout the
microvasculature. DIC is estimated to be present in as many as 1% of hospitalized
patients. [4] DIC is not itself a specific illness; rather, it is a complication or an effect of
the progression of other illnesses. It is always secondary to an underlying disorder and is
associated with a number of clinical conditions, generally involving activation of systemic
inflammation.
CASE REPORT

A 20-year old female consulted her physician because of the presence of pigment-
sized reddish-purple spots on her lower legs and on her face these physical symptoms
was accompanied with weight loss, joint pain, stomach pain, severe fatigue and her
fingers turning white and tingling when cold.

Physical Examination
Temperature 37 degrees Celsius Normal
Pulse Rate 115 beats per minute Increased
Blood Pressure 140/90 Increased

The physician requested for Complete Blood Count with Platelet Count,
Reticulocyte Count, RBC Indices, Chemistry Test – Albumin, BUN, Creatinine, SGPT,
Electrolytes, and Bilirubin, Coagulation Test – PT and APTT and Immunology – ANA, and
DsDNA.
Laboratory Report – Day 1

HEMATOLOGY REPORT
Hemoglobin 82 (120 – 140) Low
Hematocrit 0.22 (0.37 – 0.43) Low
White Blood Cells 6.9 (5 - 10) Normal
- Neutrophil 0.78 (0.55 – 0.65) High
 - Lymphocyte 0.13 (0.25 – 0.35) Low
- Eosinophil 0.01 (0.02 – 0.05) Low
- Monocyte 0.07 (0.02 – 0.05) High
- Basophil 0.01 (0.0 – 0.06) Normal
Platelet Count 14 (150 - 500) Low
Reticulocyte Count 0.7 (1.1 – 2.7) Low
MCV 96.2 (81 - 99) Normal
MCH 35.5 (28 - 33) High
MCHC 36.9 (32 - 36) High
CHEMISTRY REPORT
Albumin 35.5 (35 - 52) Normal
BUN 6.2 (2.8 – 7.2) Normal
Creatinine 82.7 (44 - 96) Normal
SGPT/ALT 25.8 (0 - 34) Normal
Electrolytes:
- Sodium 133.9 (135 - 148) Normal
- Potassium 3.7 (3.5 – 5.5) Normal
- Chloride 101.9 (97 - 119) Normal
- Calcium 2.2 (2.1 – 2.7) Normal
Bilirubin
- Total Bilirubin 201.6 (2 - 21) High
- Direct Bilirubin 14.3 (0.1 – 3.4) High
- Indirect Bilirubin 187.7 (1.9 – 18.6) High
COAGULATION REPORT
Prothrombin Time Control 13.9
Prothrombin Time Test 14.9
INR 1.087
% Activity 80.5
APTT Control 31.8
APTT Test 50.2
IMMUNOLOGY REPORT
ANA 1.11
DsDNA 0.37

Hematology report shows that the patient is experiencing anemia and

thrombocytopenia due to its low hemoglobin-hematocrit result and platelet count. In
connection to its low platelet count the Coagulation Report suggested that the patient was
experiencing bleeding disorder or excessive clotting disorder by this, to compensate the
low platelet count the physician requested for Platelet Concentrate Transfusion. The
Immunology report concludes that the patient is diagnose with Systemic Lupus
Erythematosus because of the presence of the ANA and DsDNA which are specific to
individual with Systemic Lupus Erythematosus. Bilirubin Panel was in abnormal state, and
suspecting that the patient also having Hemolytic Anemia but to trace the cause of its
abnormality the physician requested for another laboratory tests: Hematology – Retic
Count, RBC Indices, Chemistry – Liver Enzyme Panel, Microscopy – Urinalysis,
Immunology – Direct Coomb’s Test and HBsAg.
Laboratory Report – Day 2

HEMATOLOGY REPORT
Reticulocyte Count 1.6 (1.1 – 2.7) Normal
MCV 97.9 (81 - 99) Normal
MCH 35.7 (28 - 33) High
MCHC 36.5 (32 - 36) High
CHEMISTRY REPORT
SGOT/AST 26.5 (0 - 34) Normal
ALP 46.3 (38 – 126) Normal
SGPT/ALT 25.8 (0 - 34) Normal
CLINICAL MICROSCOPY REPORT: Urinalysis
Macroscopy
- Color Light Amber
- Transparency Clear
Chemistry
- Leukocyte Negative
- Blood 3+
- Nitrite Negative
- Specific Gravity 1.010
- Urobilinogen Normal
- Ketone Negative
- Protein Trace
- Bilirubin Negative
- Ph 7.00
- Sugar Negative
Microscopy
- Pus Cells 0-2/HPF
- Epithelial Cell Rare
IMMUNOLOGY REPORT
Direct Coomb’s Test Negative
HBsAg Non-Reactive
 Based on the Laboratory Report – Day 2 the Direct Coomb’s Test shows that the
Platelet Concentration Transfusion was successful and the cause of its high level of
Bilirubin Panel is not caused by Hepatitis B Virus but in support to that, the Liver Enzyme
test result was in range. To check if her platelet count was in range the physician
requested for another Hematology Report – Complete Blood Count with Platelet Count.
Laboratory Report – Day 3

HEMATOLOGY REPORT
Hemoglobin 92 (120 – 140) Low
Hematocrit 0.27 (0.37 – 0.43) Low
White Blood Cells 13.2 (5 - 10) High
- Neutrophil 0.74 (0.55 – 0.65) High
- Lymphocyte 0.17 (0.25 – 0.35) Low
- Eosinophil 0.00 (0.02 – 0.05) Low
- Monocyte 0.08 (0.02 – 0.05) High
- Basophil 0.01 (0.0 – 0.06) Normal
Platelet Count 8 (150 - 500) Low

Laboratory Report – Day 3 shows that the patient is still have thrombocytopenia
this can be caused by her Systemic Lupus Erythematosus and/or Hemolytic Anemia –
Disseminated Intravascular Coagulation.
DISCUSSION

Thrombocytopenia, characterized by abnormally low levels of thrombocytes, also

known as platelets, in the blood. The cause can be broad, and this is only secondary to
certain disease. In our patient where she is diagnosed with Systemic Lupus
Erythematosus, the primary cause of the disease, this is an autoimmune disease than
can cause thrombocytopenic blood film. Another is that our patient is also having
Hemolytic Anemia – Disseminated Intravascular Coagulation which is classified as
secondary to certain disease such as systemic destruction. Which also known having a
thrombocytopenic blood film due to activation of platelets.
CONCLUSION

In conclusion the patient is having an Autoimmune Disease of Systemic Lupus

Erythematosus that can lead into activation of platelet and formation of thrombi leading
Disseminated Intravascular Coagulation that results to thrombocytopenia and destruction
of Red Blood Cells resulting high levels of Bilirubin Panel. By this to prevent lowering of
platelet, the patient should undergo platelet concentrate transfusion.
 REFERENCES

Harmening, D. M. (2012). Modern Blood Banking & Transfusion Practices (6th ed.).

Philadelphia, PA: F.A. Davis.

Keohane, E. M., Smith, L. J., & Walenga, J. M. (2015). Rodak's Hematology Clinical

Principles and Applications (5th ed.). St. Louis, MI: Elsevier Saunders.

Stevens, C. D., & Miller, L. E. (2017). Clinical immunology & Serology: A Laboratory

Perspective (4th ed.). Philadelphia, PA: E.A. Davis Company.