A 74 yo woman was admitted to the hospital because of low blood counts. She has felt weak and tired for 3 weeks, and more recently noticed palpitations and lightheadedness. She was hospitalized following a brief syncopal episode. Evaluation at a local hospital showed pancytopenia and so she was transferred here.

Past Medical History:

Medications:

Allergies

Family Hx

Social Hx: No tobacco, alcohol, illicit drugs. Widowed, lives with son and daughter-in-law.

ROS: Unintentional 20# wt loss in past 6 mo. Good appetite. No fever/chills/sweats. No focal neurologic symptoms. No bleeding. No change in urine color.

Physical Examination: Alert and oriented, in NAD. Temp 99.7 F, pulse 100, resp 20, BP 126/58, Sa02 94% on 2L. Mild scleral icterus. No lymphadenopathy. Lungs clear. 2/6 systolic murmur radiating to carotids. Abdomen normal. Skin normal. Neuro exam normal except for diffuse hyporeflexia.

TEST MENU

CBC and differential

Retic count

Blood smear

 

INR

aPTT

 

Bone marrow biopsy

Cytogenetics

 

Iron/TIBC

Ferritin

B-12

Folate

 

ESR

Coombs test

Hemoglobin electrophoresis

Hemoglobin A2

Haptoglobin

Osmotic fragility

G6PD

EPO

 

Thrombin time

Platelet function screen

Platelet aggregometry

Bleeding time

Fibrinogen

D-dimer

Fibrin monomer

Factor II, X, V, VII, IX, VIII, XI, XII, XIII

Protein C

Protein S

Antithrombin

Activated protein C resistance

Factor V Leiden

Prothrombin gene mutation

Homocysteine

Inhibitor screen

ADAMTS-13

 

SPEP

Serum immunofixation

UPEP

Urine immunofixation

Quantitative immunoglobulins

Serum viscosity

 

 

Lytes, glucose, creat, BUN

AST, ALT

Alk phos, GGT, bili

Calcium

LDH

CRP

Uric acid

Albumin, total protein

 

Urinalysis

Urine hemosiderin

 

Chest xray

Skeletal survey

BodyCT

V/Q scan

Helical chest CT

Other radiology

 

Other pathology (biopsy)

Culture results

Serologic tests