Sample LMED28001 Chemical Pathology Case Study 1

LMED28001 Chemical Pathology Case Study 1 Sample

The total word count for this case study report is between 2,000 to 2,500 words (excluding references). Reports should be typed in Word and adhere to the format of the given template (Arial, 12pt, Single spacing).

The report must be your own work and your name, student ID and page numbers should be included in the footer of all pages of the report.

Abstract: 10 marks (200 words max)

Criteria for High Distinction in this section:

The abstract should provide a clear and concise overview of your report and the findings of your biochemical tests. A clear but brief outline the case history is provided, along with the tests performed, rationale of the tests and how they can be used to diagnose the specific disease to reach a final conclusion in this case.

No references are included in the abstract.

Introduction: 15 marks (400 words max)

Criteria for High Distinction in this section:

The introduction should clearly outline the necessary background information, including signs or symptoms, underlying pathophysiology, clinical and the laboratory information of relevance.

A clear and concise explanation of aims and objectives of the tests are provided, with a brief conclusion to the section specifying the conclusion/diagnosis with no discussion.

Materials and Methods: 10 marks (no word limit)

Criteria for High Distinction in this section:

The methods that you have used or intend to use (further tests) to arrive at the provisional diagnosis are clearly and concisely summarised.

The sources to these methods need to be clearly referenced, even if it is simply the prescribed text/lecture material/laboratory manual. Reference is made to specific instrumentation that could be used to conduct these biochemical tests (e.g. biochemistry analyser) and the manual is sufficiently referenced. The written work is an original and brief summary of the method used and not a reproduction of text from these references.
Results: 20 marks (no word limit)

Criteria for High Distinction in this section:

The results section provides a clear summary of all data/results with reference ranges.
The layout is clear, legible and uncluttered. All figures or tables are labelled clearly with legends where appropriate. Units have been properly included.
Interpretation of results is limited to a description of how they compare to the normal reference ranges. The results are presented, however not discussed in this section. Further tests (if required) with expected results are outlined.

Discussion: 30 marks (No word limit)

Criteria for High Distinction in this section:

Provisional and differential diagnoses (if any) should be clearly stated and discussed with reasons provided in relation to the clinical and laboratory results.

Expected results of further tests must be included to support your provisional diagnosis and/or align with your differential diagnosis(es). Your conclusions reached and the evidence required to reach these conclusions is compared with existing literature on similar case studies.

The full text of the published articles forms the basis for this discussion (don’t draw comparisons from other abstracts without reviewing the full text of the articles). The pathophysiology of the diagnosis and possible treatment options (if any) are also discussed. Finish your discussion with a final concluding statement.

Solution

Abstract:

The report has been carried out focusing on the case study of an 80-year-old man who was admitted to the ER due to certain signs and symptoms which included chest pain, shortness of breath, and severe cough. After admission to the er the patient was provided with blood tests or serum biochemistry assessment where certain proteins and enzymes were evaluated in order to assess any underlying abnormality It was found that the patient sustained abnormality in anion gap, urea level as well as creatinine level. For Assignment Help, Based on these abnormalities the patient was provided with three diagnostic tests which included UEC tests, troponin test as well as CK-MB test. Each test was carried out based on their respective field of assessment as the UEC test was provided to evaluate urea level electrolyte level as well as creatinine level in the Serum. Further CK-MB test was carried out to evaluate any suspected risk of heart attack and a troponin test to analyze any threat of renal failure or cardiac muscle damage. After completion of the assessment of the selected three biochemical tests, it was found that the UEC test along with the anion gap test provided better insight into the underlying health condition. The biochemical test assessment highlighted the risk of renal failure in the patient which led to the state of shortness of breath, chest pain, and cough.

Introduction:

The report focuses on analyzing and evaluating the case study of a patient named Mr. David Gilmour who is 80 years old and was admitted to the ER Department of a local hospital. The patient was admitted with a major complaint of chest pain Cough as well as difficulty in breathing. After admission to the er blood Cup squad was conducted in order to analyze the vitals of the patient after 24 hours of the blood test a second work was initiated in order to sustain detailed information post admission to the ER and provided healthcare assistance. It has often been found that heart failure often leads the heart muscle towards deprived pumping of blood. In such conditions, fluid built up occurs within the lungs which causes shortness of breath in the suffering patient. Similarly in the case of renal failure, often flute retention in the lungs leads to chest pain and shortness of breath which were two of the main symptoms identified in the patient. It has also been found that often chronic kidney disease or anal failure leads to a heart attack as the heart withstands increased pumping of blood to deliver it to the kidney.

On analysis of the serum biochemistry of the patient, it was found that on Day One the anion gap counts 5 which was the same on the day to result. It was also found that the urea and creatinine levels also increased from their normal reference ranges. The urea level in the serum was 18.9 on day 1 and 17.5 on day 2 at the same time creatinine level was 0.18 and 0.16 on the respective day results. After evaluation of the blood test on Day 1 and Day 2, three tests were requested for the patient in order to identify and evaluate the underlying causeway of the signs due to which the patient was admitted to the ER. The tests include blood UEC, CK – MB, and proponent test which are used in order to suspect myocardial infarction for heart attack sustained by the patient. These tests are used in order to evaluate the risk of heart attack and kidney function in relation to abnormal Creatinine, Troponin as well as Urea levels in the Serum. The report does will focus on analyzing and evaluating the two chief suspected underlying health conditions; heart attack and renal failure with the use of 3 referred biochemical tests.
Materials and Methods:

Blood – UEC

UEC test is also known as the kidney function test but just carried out using the assessment of urea, electrolytes such as potassium, sodium, and chloride as well as creatinine. Electrolytes and urea are accounted to be the most frequently used biochemistry test which helps in the assessment of Renault failure or associated kidney health (Dhanani et al., 2018). Urea and electrolyte tests provide significant information in terms of hemostasis and excretion and the inclusion of a creatinine test supports the result with glomerular filtration rate within a patient (Bamanikar, Bamanikar & Arora, 2016). In order to conduct advanced electrolyte tests, often Anion Gap Blood Test is carried out in order to evaluate the acid-base balance or PH balance of a patient’s blood. This test indicates whether the blood is acidic or non-acidic in nature based on the electrically charged minerals present in the body which includes bicarbonate sodium and potassium (Yang et al., 2017).

CK-MB Test

The CK-MB test is a standard blood test that is used to analyze and measure certain enzymes released in the blood first of these enzymes includes the creatine kinase-myocardial band. This enzyme is generally released from the heart when the heart or muscle from other parts of the body sustains severe damage. Generally, creatine kinase is present in the heart but it releases creatine kinase-myocardial band after muscle damage (Kim & Hashim, 2016). It has also been found that in the case of renal failure, the creatine kinase-myocardial band is falsely elevated due to muscle damage in the kidney. ichroma™ CK-MB is known to be a fluorescent immune assay or FIA which is used as a diagnostic procedure for Creatine Kinase Isoenzyme-MB in the blood or serum of the human body (Lab Industries, 2016).

Cardiac Troponin Test

Cardiac troponin tests are used in order to measure the troponin T or troponin I protein level in the blood. It is used in order to assess heart attack or suspected renal failure as Troponin proteins are released in conditions where the heart muscle sustains damage. The test indicates the amount of damage that occurred within the heart as the greater the amount of released troponin proteins in the blood, the greater the damage cardiac-specific troponin biomarkers are generally used in relation to different symptoms along with abnormal ECG as well as suspected myocardial infarction in case of patients suffering from chronic kidney disorder (Mair et al., 2018). Cardiac Troponin assessment is carried out with the help of standard blood tests where blood samples are used in order to measure the amount of troponin raised in the blood.

Results:

In the case of a creatinine urine test, urine samples are corrected over a period of 24 hours in order to assess the creatinine released out of the body. The normal range of Serum creatinine is 0.04 – 0.12 mmol/L which when exceeds indicates an abnormality in kidney function or renal health (Delanaye, Cavalier & Pottel, 2017). The electrolyte test examines the sodium, manganese, and potassium level in the blood which actively maintains the acidic and nonacidic nature of the blood. It is also used in anion gap blood tests which helps in evaluating the pH of the blood. An increase or decrease in anion level or electrolyte level in blood leads to shortness of breath and heart attack. The condition was similar in the case of the patient as the anion gap was 5 which was below the normal range of 10 – 20 mmol/L. The urea test indicates the normal ability of the kidney to break down urea, of the level of urea in the blood is high then it indicates kidney failure or renal disease. The normal range of urea in serum is 2.5 – 8.6 mmol/L, but in the case of the patient, the range was 18.9 and 17.5 within a period of 24 hours indicating abnormality (Laville et al., 2023).

The CK MB test provides an inside regarding the serum level of the creatine kinase-myocardial band which generally remains under 4% in normal test results. It is due to the fact that a minimal amount of the enzyme often enters the bloodstream from the salty tissues. In conditions where the CK-MB level exceeds more than 4% of the total CK in serum, it indicates the condition of muscle damage in the heart. The test is known to lag the ability to differentiate between heart attack-associated muscle damage or another source of damage within the body (Chen et al., 2022). In such conditions, other diagnostic methods are generally used in order to identify the condition of an underlying heart attack. The normal range of the enzyme in the Serum is 0 – 3.8 ng/mL, and exceedingly more than the designated range indicates muscle damage.

The normal troponin level found in the body is 0.0 – 0.4 ng/mL but a slight increase in the level of Troponin often indicates heart muscle damage associated with myocardial infarction or heart attack. The blood troponin test helps in analyzing the troponin level within the blood as well as any indicated risk of a heart attack. In case of kidney failure, decreased glomerular filtration rate leads to elevated cardiac trouble in T level which is also identified with the help of cardiac troponin blood test.

Discussion:

A differential diagnosis often takes place when the signs and symptoms indicate more than one underlying health condition and thus demands additional examination and testing to provide an appropriate diagnosis. With the help of differential diagnosis, the test to evaluate the underlying health condition narrows down and précised health assessment is carried out (Webster et al., 2017). Focusing on the case study of the patient, the serum biochemistry as well as identified biochemical test. It has been found that a state of differential diagnosis develops due to the indicated science and symptoms. The signs and symptoms as well as the serum biochemistry of the patient indicate the chance of renal failure, as well as a heart attack as both health condition, indicates similar clinical indications. After collection of the biochemical tests, it has been found that the anion gap blood test, as well as the UEC test, was found as a differential diagnostic assessment as both the tests highlight the risk of renal failure as well as underline the threat of heart attack. A low anion gap in Serum Test indicates the state of alkalosis where the blood is considered to be less acidic than the normal range. It has been found that a low level of albumin in the blood often leads to a state of low anion gap and it serves as a major indication of underlying health conditions such as kidney disease or cardiac complications (Asahina et al., 2022). It was found from the case study that the patient sustained shortness of breath as well as chain which both indicate renal failure as well as a heart attack. After the connection of the anion test, it has been found that the patient had a low anion level in the blood which thus develops a state of differential diagnosis between heart attack and renal failure.

The UEC test includes three different assessments of electrolytes and creatinine with altogether indicate the function of the kidney or any state of renal failure. It has also been found that after the conduction of electrolyte and creatinine tests, a state of differential diagnosis developed as these three examinations often indicate the risk of acute heart failure as well as renal failure. Urea nitrogen is considered a waste product that is removed from the blood by the kidney (Peng et al., 2021). When the blood contains an increased level of urea it indicates that the kidney is not functioning appropriately and at the same time increases the risk of certain cardiovascular events which includes heart failure (Jujo et al., 2017). Also after evaluation, it has been found that abnormal level of an electrolyte such as sodium potassium or manganese in blood indicates the risk of mural health conditions which mainly includes renal disease, irregular heart rhythm as well as high blood pressure. Manganese is considered to have a major influence on cardiovascular events along with potassium and calcium it plays a necessary role in managing intracellular potassium concentration. The creatinine test is carried out using a standard blood test where the creatinine level in the blood or the serum creatinine is measured. Though it has been found that serum creatinine is considered in the case of patients with renal failure but increased creatine along with worsening of the renal condition is highly common in patients with heart failure which increases during any acute heart attack episode (Vassalotti et al., 2016). Thus based on the evidence it is necessary that further a well-calculated diagnostic test is recommended to the patient in order to evaluate the underlying cause of the health condition. Based on the above discussion it has been found that the patient is suspected to suffer from major chronic kidney disease which is associated with the occurrence of cardiac complications. Thus it will be necessary to provide the patient with an appropriate chronic kidney disorder diagnosis in order to evaluate the underlying renal condition and associated complications.

Conclusion:

After evaluating and analyzing the above evidence and the biomedical test results it has been found that the patient is suspected to suffer from venal failure which is the underlying cause of cardiac complications, abnormal serum level, and shortness of breath thus it will be necessary that the patient is provided with an appropriate diagnosis which identifies the cost and provides better treatment approach. The biochemical tests provided the patients with a state of differential diagnosis as the test indicated both the condition of renal failure as well as a heart attack.

References:

Asahina, Y., Sakaguchi, Y., Kajimoto, S., Hattori, K., Doi, Y., Oka, T., ... & Isaka, Y. (2022). Time-updated anion gap and cardiovascular events in advanced chronic kidney disease: a cohort study. Clinical Kidney Journal, 15(5), 929-936. https://doi.org/10.1093/ckj/sfab277

Bamanikar, S. A., Bamanikar, A. A., & Arora, A. (2016). Study of Serum urea and Creatinine in Diabetic and nondiabetic patients in a tertiary teaching hospital. The Journal of Medical Research, 2(1), 12-15. Retrieved from: https://www.medicinearticle.com/JMR_201621_04.pdf

Chen, M., Wang, Y., Zhao, X., Zhang, J., Peng, Y., Bai, J., ... & Gao, Z. (2022). Target-responsive DNA hydrogel with microfluidic chip smart readout for quantitative point-of-care testing of creatine kinase MB. Talanta, 243, 123338. Retrieved from: https://doi.org/10.1016/j.talanta.2022.123338

Delanaye, P., Cavalier, E., & Pottel, H. (2017). Serum creatinine: not so simple!. Nephron, 136(4), 302-308. https://doi.org/10.1159/000469669

Dhanani, J. A., Barnett, A. G., Lipman, J., & Reade, M. C. (2018). Strategies to reduce inappropriate laboratory blood test orders in intensive care are effective and safe: a before-and-after quality improvement study. Anaesthesia and intensive care, 46(3), 313-320. Retrieved from: https://journals.sagepub.com/doi/pdf/10.1177/0310057X1804600309

Jujo, K., Minami, Y., Haruki, S., Matsue, Y., Shimazaki, K., Kadowaki, H., ... & Hagiwara, N. (2017). Persistent high blood urea nitrogen level is associated with increased risk of cardiovascular events in patients with acute heart failure. ESC heart failure, 4(4), 545-553. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695177/pdf/EHF2-4-545.pdf

Kim, J., & Hashim, I. A. (2016). The clinical utility of CK-MB measurement in patients suspected of acute coronary syndrome. Clinica Chimica Acta, 456, 89-92. https://doi.org/10.1016/j.cca.2016.02.030

Lab Industries (2016), Ichroma CK-MB. Retrieved on 13 April, 2023 from: http://www.labindustrias.com/web/wp-content/uploads/2018/05/INS-CK-EN-CK-MB_Rev.07_161216-1.pdf#:~:text=ichroma%E2%84%A2%20CK%2DMB%20is,acute%20coronary%20syndrome%20%28ACS%29

Laville, S. M., Couturier, A., Lambert, O., Metzger, M., Mansencal, N., Jacquelinet, C., ... & Massy, Z. A. (2023). Urea levels and cardiovascular disease in patients with chronic kidney disease. Nephrology Dialysis Transplantation, 38(1), 184-192. Retrieved from: https://doi.org/10.1093/ndt/gfac045

Mair, J., Lindahl, B., Hammarsten, O., Müller, C., Giannitsis, E., Huber, K., ... & Jaffe, A. S. (2018). How is cardiac troponin released from injured myocardium?. European heart journal: acute cardiovascular care, 7(6), 553-560. https://doi.org/10.1177/2048872617748553

Peng, R., Liu, K., Li, W., Yuan, Y., Niu, R., Zhou, L., ... & Wu, T. (2021). Blood urea nitrogen, blood urea nitrogen to creatinine ratio and incident stroke: the Dongfeng-Tongji cohort. Atherosclerosis, 333, 1-8. https://doi.org/10.1016/j.atherosclerosis.2021.08.011

Vassalotti, J. A., Centor, R., Turner, B. J., Greer, R. C., Choi, M., Sequist, T. D., & National Kidney Foundation Kidney Disease Outcomes Quality Initiative. (2016). Practical approach to detection and management of chronic kidney disease for the primary care clinician. The American journal of medicine, 129(2), 153-162. https://doi.org/10.1016/j.amjmed.2015.08.025

Webster, A. C., Nagler, E. V., Morton, R. L., & Masson, P. (2017). Chronic kidney disease. The lancet, 389(10075), 1238-1252. https://doi.org/10.1016/S0140-6736(16)32064-5

Yang, S. W., Zhou, Y. J., Zhao, Y. X., Liu, Y. Y., Tian, X. F., Wang, Z. J., ... & Hu, D. Y. (2017). The serum anion gap is associated with disease severity and all-cause mortality in coronary artery disease. Journal of geriatric cardiology: JGC, 14(6), 392. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540871/pdf/jgc-14-06-392.pdf