Hematocrit Reading Research Articles

Acute and Rapidly Progressive Forms of Glomerulonephritis in the Elderly

This article presents a comparison of acute glomerular nephritis (AGN) with rapidly progressive glomerular nephritis (RPGN) in patients aged 60 or older. In 7 elderly patients with AGN, the renal disease was preceded by skin infection (4 cases), sore throat (2 cases), or pneumonia (1 case). The 7 patients with RPGN had no history of prior infection. Both AGN and RPGN were manifested clinically as acute renal failure, but the RPGN patients had significantly higher serum creatinine levels and lower hematocrit readings. Hypocomplementemia was a feature only of AGN. The biopsy specimens from patients with RPGN showed crescents in 50--100 percent of the glomeruli, whereas specimens from patients with AGN showed no significant extracapillary proliferation. Six AGN patients recovered and 1 died. Despite dialysis, 4 RPGN patients died and the remaining 3 require maintenance dialysis. It is concluded that AGN in the elderly is more common than previously believed, frequently follows skin infections, and has a reasonably good prognosis. In contrast, RPGN, also not rare in the elderly, has a much worse prognosis.

Barium Enema Examination in a Patient With Right Lower Quadrant Pain

<h3>History</h3> A 34-year-old man complained of poorly localized periumbilical pain, on the night before admission, which moved to the right lower quadrant. The patient was nauseated but denied vomiting, diarrhea, or constipation. The morning of admission, on physical examination, the patient's abdomen was tender in the right lower quadrant. There was no guarding or rigidity, and bowel sounds were normal. The evening after admission, the patient stated that the pain had ceased; on physical examination, the abdomen was no longer tender. A complete blood cell count done the morning of admission showed a hemoglobin level of 14.7 g/dL, hematocrit reading of 43.1%, and 14,300 WBCs per cubic millimeter, with a slight shift to the left. On subsequent blood cell counts obtained that evening and the following morning, the WBC counts dropped to 12,200/cu mm and 10,100/cu mm, respectively. A plain film of the abdomen was normal. Figures 1 and 2

T4-Thyroid Storm in Pernicious Anemia

A 32-year-old woman first had thyrotoxicosis and severe pernicious anemia (PA) in 1975. The initial serum thyroxine (T4) level, 14.5 microgram/dL, rose to 29.2 microgram/dL, with no other therapy except cyanocobalamin injection and blood tranfusions. She again had thyroid storm and PA in 1978. The serum T4 level was only slightly elevated, but the triiodothyronine (T3) level was normal. She received therapy for both diseases and recovered. Four months later, with a normal hematocrit reading, thyrotoxicosis recurred, with noticeable elevation of T4 and T3. These data suggest that first, thyroid storm can occur with excess T4 only, and its occurrence does not depend on the degree of thyroid hormone elevation; and second, thyroid hormone level may be depressed in severe PA, and a normal T3 level should not rule out thyrotoxicosis in this condition.

Widespread Pulmonary Lesions in a Cyanotic Woman

History A 16-year-old girl presented with digital clubbing and peripheral cyanosis. She was first seen at 12 years of age for evaluation of shortness of breath with exertion. Circumoral and peripheral cyanosis had appeared during the previous several years. No family history of cardiac or vascular lesions or other medical problems was elicited. The patient's medical history was unremarkable. Her physical examination was normal with the exception of the circumoral and digital cyanosis with clubbing. Cardiac and chest examinations were normal without murmur or bruit. The ECG was normal. Laboratory tests showed an RBC count of 5.5 million/cu mm; hemoglobin level, 17 g/dL; and hematocrit reading, 50%. Arterial blood gas values on room air were as follows: oxygen saturation, 83%; Po2, 41 mm Hg; and Pco2, 34 mm Hg. The patient had a chest roentgenogram (Fig 1), showing multiple pulmonary nodules. Dye dilution and catheterization were done. Diagnosis Pulmonary micro-arteriovenous

Corpus Luteum Hemorrhagicum: An Unusual Complication of Anticoagulant Therapy

Hemorrhagic complications of oral anticoagulant therapy are well known. The purpose of this communication is to report an unusual and potentially life-threatening complication of long-term anticoagulant therapy that, as far as we know, has not been previously reported in the pediatric literature. Report of a Case.—A 17-year-old girl was admitted to the hospital because of a rapidly decreasing hematocrit reading and abdominal pain. She was known to have rheumatic heart disease since age 7 years, and at 13 years of age, her mitral valve was replaced with a Bjork-Shiley artificial valve. Postoperatively, she was given daily penicillin G potassium and warfarin sodium. Two months prior to admission, the patient had a transient episode of cerebral ischemia after poor compliance with her warfarin regimen. Her warfarin dose was increased, and she subsequently did well, with prothrombin times that were 2½ times control values. One month prior to admission, she had

Histiocytic Medullary Reticulosis

To the Editor. —An unusually large number of cases of histiocytic medullary reticulosis (HMR) have been reported recently. We wish to describe an additional case. Report of a Case. —A patient was seen who had a three-week history of fever and a two-week history of nausea, vomiting, jaundice, and abdominal pain. He was found, on physical examination, to have hepatosplenomegaly, cervical lymphadenopathy, and moderate jaundice. The hematocrit reading was 30%; WBC count, 1,950/ cu mm, with 25% polymorphonuclear leukocytes and 75% lymphocytes; and platelet count, 2,000/cu mm. The results of liver function testing showed a bilirubin level of 16 mg/dL; SGOT level, 490 IU; SGPT level, 110 IU; and serum alkaline phosphatase level, 219 IU. The bone marrow study showed hypercellular marrow with mild megaloblastic change. The patient's condition was treated as a case of acute infectious hepatitis; three days later, signs and symptoms of hepatic encephalopathy and melena developed.

Polycythemia in Renal Transplant Patients

<h3>To the Editor.</h3> —Erythrocytosis is a well-recognized complication of successful renal transplantation.¹The clinical importance of polycythemia in this setting is largely related to an increased incidence of thromboembolic phenomena.²This report describes a superior sagittal sinus thrombosis, a previously undescribed manifestation of posttransplant erythrocytosis <h3>Report of a Case.</h3> —A 36-year-old man had insulin-dependent diabetes mellitus of 22 years' duration. At age 35, he had undergone a cadaveric renal transplant because of progressive chronic renal insufficiency. The patient had an uneventful postoperative course and was discharged one month after grafting with a BUN level of 32 mg/dL, a serum creatinine level of 1.2 mg/dL, and a hematocrit reading of 29%. During the ensuing months, the patient was asymptomatic. However, his hematocrit reading rose progressively to 59%. He maintained normal renal function with no evidence of rejection. Thirteen months after his kidney transplant, he experienced a grand mal seizure

Thrombotic Thrombocytopenic Purpura

Freda Gardner, MD, Senior Assistant Resident, The Jewish Hospital of St Louis: A 42-year-old woman was in good health until four weeks prior to her admission, when she noted that minor trauma caused large ecchymotic lesions. One week prior to admission, she experienced the sudden onset of dysarthria, weakness and paresthesias of her right arm, light-headedness, and severe bifrontal headache. This episode lasted for 30 minutes and slowly resolved. At this time the patient also noted petechiae on both lower extremities. The patient had at least three more episodes of transient dysarthria and weakness of both legs. She also complained of transient visual field defects, occasional intermittent fevers (temperatures to 38.3 °C), weakness, and fatigue. There was no history of syncope, seizures, chills, night sweats, recent travel, or exposure. She was initially hospitalized elsewhere, where the laboratory data indicated a hematocrit reading of 28% and hemoglobin level of 9 g/dL;

Emergent or elective operation for symptomatic abdominal aortic aneurysm.

The patient with the symptomatic abdominal aortic aneurysm (AAA) presents a management dilemma, ie, emergent, urgent, or elective operation. The mortality for 38 patients with a ruptured AAA prior to 1972 was 61%. That year, a policy of immediate operation was instituted for patients with symptoms that might be referable to a ruptured AAA. It is concluded that an immediate operation on the patient with a symptomatic but intact AAA resulted in an excessively high mortality. Thus, the indications for an immediate operation on these patients should be based on clinical judgment; attempting to differentiate between the patient with the ruptured and the patient with the intact aneurysm. Hemodynamic data (blood pressure hematocrit reading) suggesting a decrease in blood volume dictate an immediate operation. An urgent operation on the well-prepared patient should be performed on all patients with a symptomatic aneurysm in which the clinical and hemodynamic findings do not suggest that it has ruptured.

Erythrocyte parameters in the elderly: an argument against new geriatric normal values.

Erythrocyte parameters in 292 unselected geriatric patients were studied retrospectively. Statistically significant mean decreases compared to the laboratories' normal mean values were found in the red blood cell count (RBC), hemoglobin level, hematocrit, and mean corpuscular hemoglobin concentration; there also was a slight increase in mean corpuscular volume and mean corpuscular hemoglobin. However, when 17 patients with a hemoglobin level less than 10 gm/dl or a hematocrit reading less than 35 percent were excluded, all of the mean values for erythrocyte parameters fell within the normal range. In 71 percent of these 17 patients the etiology of the anemia was documented. Although one cannot definitely exclude a slight change in erythrocyte parameters with aging, it is concluded that the establishment of so-called new geriatric norms is premature, as the population studied included patients with various diseases. Good medical practice dictates continued evaluation and monitoring of patients in whom erythrocyte values are outside the established normal ranges.

Early recognition of metabolic disturbances in trout ( Salmo gairdneri Rich.) stocks

A method is proposed for detecting metabolic disturbances or diseases in trout stocks before typical symptoms appear. The method involves determination of erythrocyte numbers, hemoglobin contents, and hematocrit readings for about 10 animals. The measured parameters are tested for independence. The results permit the stocks tested to be classified as “normal” or “not normal”.

Severe anemia. Clinical observations in 100 patients with very low hemoglobin levels.

One hundred consecutive patients with hemoglobin concentration less than 3.5 g/dL (hematocrit reading, less than 10%) were admitted to the University of Baghdad Teaching Hospital, Iraq, during a 30-month period. Twenty-eight patients had aplastic anemia, 27 had leukemia or other hemopoietic malignancies, 16 had chronic renal failure, eight had iron-deficiency anemia, eight had hemolytic anemia, seven had thalassemia major, and six had other conditions. Twenty-three patients died within seven days of admission, mostly due to the underlying disease or complications thereof. Heart failure developed in ten patients, and five had retinal exudates and hemorrhages attributed to severe anemia. Arrhythmias and ECG abnormalities were noted in 20 of 68 patients. Blood transfusion was instituted in all but three patients, whose anemia was corrected with specific therapy without blood transfusion. The tolerance of the 100 patients to such severe anemia was remarkable.

Effect of Parathyroidectomy on Anemia in Chronic Renal Failure

Fourteen patients with chronic renal failure underwent parathyroidectomy. Postoperatively, seven patients exhibited a rise in hematocrit reading, but seven others did not. Responders had more severe bone disease and lower initial hematocrit values than did nonresponders. Marrow fibrosis was slightly more prominent in responders. Current concepts of marrow erythropoietic inhibition in renal failure suggest a toxic serum factor as the cause. This report fails to support parathyroid hormone as the toxic agent directly responsible for marrow inhibition. Rather, parathyroid hormone may contribute to anemia in renal failure by causing marrow fibrosis, a process sometimes reversible by successful therapy of hyperparathyroidism.

Hypoplastic Anemia Associated With Metolazone

To the Editor.— Recently we followed up a patient who had transient hypoplastic anemia associated with metolazone. Report of a Case.— A 74-year-old woman had had mild hypertension for many years. In June 1977, 5 mg/day of metolazone was prescribed. There was resultant fair control of blood pressure. In August 1977, notable weakness developed. Moderate anemia was diagnosed, and the patient was given folic acid preparations in addition to other hematinies, including iron. Her condition worsened, and when referred to us in October, her hematocrit reading was 27.4%, with a reticulocyte count of 1.0%. The WBC, differential, and platelet counts were normal. Morphological examination of RBCs showed normochromia and normocytic pictures. Bone marrow aspiration showed hypoplastic marrow without suggestion of myeloproliferative disorders. Drug-induced marrow suppression was suspected, and metolazone therapy was stopped. The patient was given an anabolic agent (methandrostenolone) orally through mid-January 1978. Because of fluid retention, hypertension, and

The Effect of Infusion of Mannitol-Sodium Bicarbonate on the Clinical Course of Myoglobinuria

Twenty patients who had evidence of myoglobinuria were treated with intravenous infusions of mannitol and sodium bicarbonate. Nine patients (group 1) responded with higher urine output, and continued infusion improved renal function; none required dialysis and all survived. Eleven patients (group 2) did not respond to the infusion, and required an average of 5.3 (range, 0 to 11) dialyses; one patient died. There was no significant difference in initial BUN level, creatinine level, BUN/creatinine ratio, or fractional sodium excretion level between the two groups. However, group 2 patients had a significantly higher creatine phosphokinase (CPK) level, serum phosphate level, and hematocrit reading initially than did group 1, indicative of more severe muscle injury and hemoconcentration. These results demonstrate that some patients with myoglobinuria will respond to infusion of mannitol and sodium bicarbonate. This treatment may be effective in altering the clinical course of myoglobinuric acute renal failure.

“STRESS” POLYCYTHAEMIA AND PERIPHERAL FACIAL PALSY COMPLICATIONS OF SEVERE HYPERTENSION

An 11-month-old boy had an episode of generalized convulsions followed by a right peripheral facial palsy, which resolved gradually within 3 weeks. Three months later he had another similar episode of convulsions followed by a left peripheral facial palsy. On both occasions it was found that he had polycythaemia. A careful physical examination discovered that the child had severe hypertension. Extensive laboratory investigations did not reveal a cause for his hypertension. Haematologic investigations showed that the polycythaemia was due to a contracted plasma volume as a result of the hypertension. The peripheral facial palsy most probably was due to a blood clot in the facial canal, below the origin of the nerve to m. stapedius, as audiograms were normal and lacrimation preserved. Control of the hypertension resulted in resolution of the facial palsy within 4 weeks and normal haematocrit readings within 6 weeks. It should be stressed that every patient with peripheral facial palsy should be examined for hypertension.

Group B Streptococcal Urinary Tract Infection in an Infant

To the Editor.— We read St Laurent-Gagnon and Weber's report of a 6-week-old infant with group B streptococcal urinary tract infection (240:1269, 1978). At the time of the article's publication, we were treating a 3-week-old infant with a similar infection. Report of a Case.— The baby was the product of a full-term, uncomplicated pregnancy, and his birth weight was 4,400 g. His neonatal course was uncomplicated, and he was discharged at the age of 3 days. He had done well until 24 hours before admission, when fever, vomiting, loose stools, and irritability developed. The 4.4-kg patient had a height and weight at the 50th percentile. His temperature was 39.2 °C; blood pressure was 80 mm Hg by palpation. The findings from his examination were otherwise unremarkable. Laboratory study values included a hematocrit reading of 38% and a WBC count of 15,600/cu mm, with two juvenile cells, 17 band forms,

Improved Oxygenation of Ischemic Myocardium by Hemodilution with Stroma-Free Hemoglobin Solution

Experiments were conducted in anesthetized open-chest dogs subjected to occlusion of the left anterior descending coronary artery for three hours. The oxygenation of myocardial tissue was monitored by a polarographic technique capable of recording simultaneously the oxygen tension (Po2) of myocardial tissue and electrograms. Ischemic injury was monitored by means of ST-segment elevations on myocardial and epicardial electrograms. The volume of the myocardial infarct was measured at the end of each experiment by incubation of transverse slices of left ventricle in a solution of nitroblue tetrazolium and by separation of the unstained (ischemic) from the stained (normal) portions. In one group of dogs, hemodilution was performed after 15 minutes of ischemia by exchanging blood with a stroma-free hemoglobin solution (from a hematocrit reading of 45 +/- 3 percent to 23 +/- 2 percent). Changes occurring in this group were compared with those occurring in dogs that did not undergo hemodilution, underwent hemodilution with dextran 75, or were transfused with whole blood. Hemodilution with hemoglobin reduced aortic and left ventricular filling pressures while increasing coronary blood flow, increased myocardial Po2 from 2 +/- 2 mm Hg to 8 +/- 2 mm Hg (P less than 0.005), lowered the ST-segment elevation of both myocardial and epicardial electrograms, and reduced the volume of the myocardial infarct. These effects were unmatched by hemodilution with dextran or infusion of whole blood.

Improvement in Pulmonary Function with Diuretic Therapy in the Hypervolemic and Polycythemic Patient with Chronic Obstructive Pulmonary Disease

Central hemodynamics and gas exchange were studied in six patients with chronic obstructive pulmonary disease (mean age, 60 years). Patients were selected for the study if the volume of blood was 1 L larger than the predicted normal value, if there was no history of infection, and if no drug assumed to influence pulmonary circulation had been given during the last four weeks. Measurements were first performed in the hypervolemic state. This was followed by a venesection of 0.5 L, and the measurements were repeated 15 minutes later (immediate effects of dehydration). After two weeks to two months of intensive diuretic therapy, new measurements were performed (long-term effects of dehydration). With hypervolemia, there was pulmonary hypertension, increased pulmonary vascular resistance, and normal cardiac output. The arterial oxygen tension (PaO2) was markedly reduced. The arterial carbon dioxide tension (PaCO2) was increased in two patients, and dead-space ventilation (VD/VT) increased in all. The sole immediate effect of venesection was a small increase in heart rate and a reduction in PaCO2. The long-term effects were a maintained low blood volume (on the average, 0.7 L less than before bloodletting) and lowered hematocrit reading (8 percent less than before bloodletting), a reduced and in some patients normalized pulmonary arterial pressure, a reduced pulmonary vascular resistance, and an unchanged cardiac output. The PaO2 improved, while PaCO2 did not change; neither did VD/VT. The changes correlated partly with the diminution in blood volume and partly with the reduction in hematocrit reading.

Ileocolic Lesions in Woman With Abdominal Pain

History A 64-year-old woman reported intermittent increasingly severe midabdominal crampy pain for two months. Gastrointestinal inquiry otherwise was unrevealing. The patient had been treated for pulmonary tuberculosis 35 years earlier. A firm mass was palpated to the right of the umbilicus. Several stool specimens were positive for occult blood. The hematocrit reading was normal. The roentgenogram in Fig 1 was obtained toward the conclusion of an antegrade small-bowel examination. Figure 2 shows a fluoroscopic spot film thereupon made of the ileocecal region. Diagnosis Carcinoid of the terminal ileum plus carcinoma of the cecum. Comment The small-bowel films (Fig 1 and 2) suggest, and a barium enema examination (Fig 3) subsequently verified, an abrupt irregular annular constriction of the cecum. In addition, as best observed on the ileocecal spot roentgenogram (Fig 2 and 4), the terminal ileum exhibits rigidity and narrowing, with medial angulation. Immediately proximal to this, the lumen, adjacent