Does a WBC of 14000 With Left Shift require follow up?



A

Alburma4u

Guest
I'd very much appreciate opinions on the following:

A 60-year-old friend of mine feels sick and weak after being
placed on a diuretic. His doctor orders BMP & CBC. Results
show hyponatremia and a WBC of 14.2k with a left shift. The
doctor holds the diuretic and orders a repeat BMP for a week
later (but no CBC). The hyponatremia is resolved but the man
still feels sick and now complains of more congestion and a
cough. The doctor tell him that the hyponatremia is gone and
he should feel better soon.

The man presents in the ER 5 days later (12 days after first
tests) with a white count of 39,000. He is given high doses
of antibiotics but succombs to pneumonia and sepsis. (He did
have a long history of smoking but quit a year ago.)

Would you view the lack of follow-up on the initial WBC as a
breach in the standard of care? Can it be regarded as the
proximate cuase of death?

Thanks for any insight!
 
On 2004-03-07 20:00:58 -0500, [email protected] (alburma4u) said:

> Would you view the lack of follow-up on the initial WBC as
> a breach in the standard of care? Can it be regarded as
> the proximate cuase of death?

All I can say is that personally, I would've followed up a
WBC of 14K with a left shift in a 60 y/o complaining of
upper respiratory symptoms. I would've placed him on
antibiotics as well. I can't presume to say whether or not
that would've changed the outcome.
 
On 7 Mar 2004 17:00:58 -0800, [email protected] (alburma4u) wrote:

>I'd very much appreciate opinions on the following:
>
>A 60-year-old friend of mine feels sick and weak after
>being placed on a diuretic. His doctor orders BMP & CBC.
>Results show hyponatremia and a WBC of 14.2k with a left
>shift. The doctor holds the diuretic and orders a repeat
>BMP for a week later (but no CBC). The hyponatremia is
>resolved but the man still feels sick and now complains of
>more congestion and a cough. The doctor tell him that the
>hyponatremia is gone and he should feel better soon.
>
>The man presents in the ER 5 days later (12 days after
>first tests) with a white count of 39,000. He is given
>high doses of antibiotics but succombs to pneumonia and
>sepsis. (He did have a long history of smoking but quit a
>year ago.)
>
>Would you view the lack of follow-up on the initial WBC as
>a breach in the standard of care? Can it be regarded as the
>proximate cuase of death?

There's no way one could answer these two questions
without knowing more about the presenting symptoms (apart
from "feeling sick and weak"), his medical history, or
what was found on his physical exam at the time the
initial CBC was drawn.

PF
 
do attorneys read sci.med?

the issue isn't the follow-up of the white blood count...
it's whether the doctor failed to diagnose pneumonia.

"alburma4u" <[email protected]> wrote in message
news:[email protected]...
> I'd very much appreciate opinions on the following:
>
> A 60-year-old friend of mine feels sick and weak after
> being placed on a diuretic. His doctor orders BMP & CBC.
> Results show hyponatremia and a WBC of 14.2k with a left
> shift. The doctor holds the diuretic and orders a repeat
> BMP for a week later (but no CBC). The hyponatremia is
> resolved but the man still feels sick and now complains of
> more congestion and a cough. The doctor tell him that the
> hyponatremia is gone and he should feel better soon.
>
> The man presents in the ER 5 days later (12 days after
> first tests) with a white count of 39,000. He is given
> high doses of antibiotics but succombs to pneumonia and
> sepsis. (He did have a long history of smoking but quit a
> year ago.)
>
> Would you view the lack of follow-up on the initial WBC as
> a breach in the standard of care? Can it be regarded as
> the proximate cuase of death?
>
> Thanks for any insight!
 
On the initial physical exam the doctor noted in his chart
"common cold, leg weakness, cold. Lethargic and less alert
after being placed on dyazide."

He found the lungs to be "dry" and everything else normal.
He ordered a stat BMP & CBC. I think my question is as much
a medical one as a legal one. I'm just trying to get a
sense of whether this kind of thing is a "gray area" or
whether any of you would have clearly acted differently (ie
been concerned about possible infection) and excersised
more caution.

My thinking is -- had the doctor not ordered a CBC along
with the BMP he could be excused for not suspecting a
brewing infection. Once an initial CBC was ordered he was
obliged to at least follow it up with a second test a week
later (or tell my friend to come in for an exam, or both) if
the patient was still not feeling good.

Common sense seems to tell me that a white count of 14.2
likely would have been overcome with a bubble pack of
zithromax. How wroing am I?...

> There's no way one could answer these two questions
> without knowing more about the presenting symptoms (apart
> from "feeling sick and weak"), his medical history, or
> what was found on his physical exam at the time the
> initial CBC was drawn.
>
> PF
 
On 2004-03-08 06:45:20 -0500, [email protected] (alburma4u) said:

> Common sense seems to tell me that a white count of 14.2
> likely would have been overcome with a bubble pack of
> zithromax. How wroing am I?...

Again, there's no way to know what the outcome would have
been even if your friend had been given Zithromax. There are
plenty of azithromycin-resistant bacterial strains out
there, for example. I told you what I would've done with
those labs, but as someone else said, I wasn't the one who
saw the patient. Sorry, but medicine is rarely cut and dry.
It's *all* gray.
 
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