Clinical Chemistry Case Study

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A 55-year old man presents to his primary care physicians office with new symptoms of exertional fatigue. On direct questioning, he did admit to vague malaise for over 6 months. On examination, he was in considerable pain but otherwise seemed fairly fit. He was mildly anemic but had no lymphadenopathy and no fever. The doctor order various laboratory tests. Samples are collected and submitted to the laboratory for analysis.
Chemistry Lab Results
Assay Patient Results Normal Range
Glucose 108 mg/dl 70-110
BUN 25 mg/dl 7-18
Creatinine 1.10 mg/dl 0.40-1.40
Sodium 142 mmol/L 136-145
Potassium 4.1 mmol/L 3.5-5.1
Choloride 102 mmol/L 98-107
Co2 25 mmol/L 23-29
Total Protein 10.5 g/dl 6.2-8.5
Albumin 4.3 g/dl 3.5-5.3
Calcium 11.3 mg/dL 8.5-10.5
ALT 28 U/L Up to 38 U/L
ALP 180 U/L 35-123 U/L
AST 25 U/L Up to 40 U/l

Other Lab resuts:
Hematology :
ESR : Increased
Smear Review: Moderate Rouleaux
Protein : + 2

1- Draw the SPE pattern that correlates with the patients suspected diagnosis.
2- Please answer the following with : normal , increased , decreased
Albumin :
3- Why is the BUN slightly increased? Explain
4- Why is the ALP and Calcium elevated? Explain
5- What is causing the Rouleaux in the blood smear? What abnormal cells might also be present in the blood smear?
6- Which immunoglobulin is most likely being produced in excess?
7- Based off the patient’s clinical history, lab results, including SPE, what is the most likely the disease/condition?
Case study 2
Matthew, an 8 year-old boy presents to the emergency room with swelling of his face and hands. Usually an active kid, Matthew complains of feelong tired and wanting to eat. His mother mentioned to the E.R doctor that Matthew has also had a marked decreased in his urine output. Blood is drawn and a urine sample is collected.
Chemistry Lab Results :
Assay Patient Results
Glucose 150 mg/dl
BUN 28 mg/dl
Creatinine 2.40 mg/dl
Sodium 132 mmol/L
Potassium 4.5 mmol/L
Chloride 100 mmol/L
CO2 25 mmol/L
Total Protein 4.8 g/dl
Albumin 1.3 g/dl
Calcium 9.0 mg/dl
Cholesterol 280 mg/dl
Triglycerides 264 /dl

Other lab results:
Protein: +4

1- The results of the following will be? (Please answer with : normal , increased , decreased
Albumin :
2- Based off the patients lab results, why is he experiencing swelling of his face and hands?
3- Based off his clinical condition, why is a possible cause of this patient’s Hyperlipidemia?
4- What is causing the large amounts of protein in the urine, but low levels of protein and albumin in the serum? Explain
5- Upon examination of the urinary sediment , what abnormal urinary constituent could be seen and why?
6- Based off the patients clinical history, lab results, including SPE, what is the most likely disease?
A 53-year old runner experienced chest pain near the end of a marathon. He completed the race and when the pain persisted. Went to the ER for evaluation. At 8 hours after the onset of pain, total CK was elevated with CKMB 1% of total CK.
1- Did this patient have a myocardial infraction? Explain your answer.
2- What additional lab tests should be performed to rule out a myocardial infraction?
3- What is causing the patient to have an elevated total CK?

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