[Adult-hlh-mas] [SECUREMAIL] Parkland patient

Cory Smith Cory.Smith at UTSouthwestern.edu
Sat Aug 11 11:51:19 CDT 2018


Name: Celia Ramirez at Parkland, MRN 1204369, DOB 5/30/1957
Patient is a 61 year old with a history of lupus (Stage V lupus nephritis in 2016), DM type 2, and GERD who is presenting with a lupus flare and sepsis.

There is low suspicion for HLH, but want advice for if additional interventions are necessary for evaluation.


Vital signs on admission: Temp 103F, HR 123, RR 26, BP 110/56.
Last fever was 102.7 on 8/10 at 01:04.

::Labs:
- Liver panel mostly wnl: AST 51, ALT 10, Alk phos 43, Tbili 0.2
- CBC:  WBC 13.54, HGB 8.7 (baseline 11-12), HCT 26.7, platelets 208 (lowest 157), abs neutrophil lowest value: 9.74
DAT (+) IgG, DAT (-) C3, haptoglobin 317, LDH 683
Iron 25, Ferritin 14,182 , TIBC 215, UIBC 190, Pct sat 12%
Cr 1.7-->1.2-->0.9

SED >130,  CRP 14.9
C3: 79, C4: 5
Triglyceride 237
D-dimer 3,860
fibrinogen 336

::Micro
8/9 UCx: GU flora, >100,000 GNR

::Imaging
No abdominal imaging ordered


Thanks,
Cory Smith, MSIII
Medicine Team D


________________________________

UT Southwestern


Medical Center



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