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

Thread view:

Enable EMail Alerts

Start New Thread

Thread rating:

alburma4u - 08 Mar 2004 01:00 GMT

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!

Reply to this Message

anon - 08 Mar 2004 02:08 GMT

> 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.

Reply to this Message

PF Riley - 08 Mar 2004 05:09 GMT

>I'd very much appreciate opinions on the following:
>
[quoted text clipped - 14 lines]
>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

Reply to this Message

alburma4u - 08 Mar 2004 11:45 GMT

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

Reply to this Message

anon - 09 Mar 2004 00:01 GMT

> 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.

Reply to this Message

Beachhouse - 08 Mar 2004 05:43 GMT

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.

> I'd very much appreciate opinions on the following:
>
[quoted text clipped - 16 lines]
>
> Thanks for any insight!

Reply to this Message