PHLEBOTOMY CASE

JANUARY 16, 2020

Joe M., a 52-year-old man, came to the ER with an extremely inflamed big toe, chills, and fever. He had
recently attended a niece’s wedding, where he had eaten a lot of rich food and imbided a larger amount of
alcohol than normal. His physician ordered the laboratory tests shown in Tables 2-19 to 2-21.

Table 2-19 Chemistry Panel

Joe M. Reference Range
Sodium 139 136-145 mEq/L
Potassium 4.2 3.6-5.0 mEq/L
Chloride 104 101-111 mEq/L
CO2 27.0 24.0-34.0 mEq/LS
Glucose 100
Bilirubin, total 0.3
AST 25
ALP 42
Total protein 6.5
BUN 20
Creatinine 0.9
Calcium 8.8
Uric acid 11.5
Albumin 3.6

Table 2-20 Hematology Results

Joe M. Reference Range
CBC
WBC 15.0 5-10 x 109/L
RBC 5.04 5-6 x 10912/L
Hb 153 135-175 g/L
Hct .46 .41-53 L/L
MCV 92 80-100 fL
MCH 29 26-34 pg
MCHC 33 31-37%
Platelets 240 150-400 x 109/L
Segs 64 25-60%
Band 0 0-10%
Lymphocytes 21 20-50%
Monocytes 14 2-11%
Eosinophils 0 0-8%
Basophils 1 0-2%
Atypical lymphocytes 0 0-5%
RBC morphology Normal Normal
ESR 30 mm/h (0-15 mm/h)

Table 2-21 Urinalysis

Joe M. Reference Range
Macroscopic
Color Yellow Colorless to amber
Appearance Clear Clear
Specific gravity 1.022 1.001-1.035
pH 6.0 5-7
Protein Neg Neg
Glucose Neg Neg
Ketones Neg Neg
Bilirubin Neg Neg
Blood Neg Neg
Urobilinogen Normal Normal
Nitrite Neg Neg
Leukocyte esterase Neg Neg
Microscopic
 WBCs 0-2/HPF 0-5/HPF
RBCs 0-1/HPF 0-2/HPF
Epithelial cells Rare squamous/HPF Few to moderate
Casts 0-1 hyaline/LPF Few to hyaline
Crystals Many uric acid

Questions
1. List or highlight the abnormal laboratory results.
2. Based on the laboratory results and medical history, what is the most probable diagnosis?
3. A. What are the two main types of hyperuricemia (increased uric acid)?
B. List five conditions under category.
4. List at least four risk factors for the development of this condition.
5. What is the epidemiology of this condition? (What demographic groups are associated with this
condition?)
6. What is the pathophysiology of this condition; in other words, what happens in the body?
7. If Joe’s physician performed an arthrocentesis (puncture of a joint space with a needle to aspirate
accumulated fluid), what would you expect to find in the joint fluid?
8. What types of food should Joe avoid? List six foods that should not be part of his daily diet.
9. What three renal complications are associated with this condition?
10. Briefly two medications used to treat this condition and how they work (medications used to treat the
disease, not symptoms, but the underlying – to prevent recurrent attacks).