From the Guidelines
The patient's blood work showing neutrophilia, lymphopenia, and an elevated mixed cell differential is a common response to viral infections like gastroenteritis and is not concerning in this context, and I recommend continuing supportive care with plenty of fluids, rest, and over-the-counter medications for symptom relief. The patient's age and the fact that they have undergone a complete Blood Work (BW) showing neutrophilia, lymphopenia, and an elevated mixed cell differential are important factors to consider in determining the clinical significance of their condition. According to the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1, most acute diarrhea episodes in previously healthy, immunocompetent people are of short duration and self-resolving, and are of viral or unknown etiology.
The guidelines also state that laboratory investigation is generally not warranted for acute diarrhea, but may be justified in certain cases, such as in immunocompromised individuals or when there is suspicion of an outbreak situation 1. In this case, the patient's blood work is consistent with a viral infection, and the guidelines recommend supportive care as the mainstay of treatment. The patient should be monitored for signs of dehydration, such as dizziness or decreased urination, and should seek medical attention if they develop high fever, severe abdominal pain, bloody diarrhea, or other concerning symptoms.
The patient's follow-up plan should include a re-evaluation in one week to ensure that their symptoms are improving, as recommended by the guidelines 1. It is also important to note that the patient's age is a significant risk factor for complications from gastroenteritis, and they should be closely monitored for signs of dehydration and other complications 1. Overall, the patient's condition is consistent with a viral infection, and supportive care is the recommended treatment approach.
The total white blood cell count and differential may provide suggestion of a bacterial etiology when viral or parasitic etiologies also are being considered, but in this case, the patient's blood work is consistent with a viral infection 2. The patient's neutrophilia and lymphopenia are common responses to viral infections, and the elevated mixed cell differential is also consistent with a viral etiology 2. Therefore, the patient should continue with supportive care and be monitored for signs of complications, and a follow-up evaluation should be scheduled in one week to ensure that their symptoms are improving.
From the Research
Clinical Significance
The clinical significance of an 80-year-old male patient with viral gastroenteritis, who has undergone a complete Blood Work (BW) showing neutrophilia, lymphopenia, and an elevated mixed cell differential (MXD), can be understood by considering the following points:
- Viral gastroenteritis is a common condition that affects people of all ages, with norovirus being the leading cause in adults 3, 4.
- The patient's age and immunological status may put him at a higher risk for complications, such as severe dehydration and hypovolemia 5.
- The laboratory results, including neutrophilia, lymphopenia, and an elevated MXD, may indicate a viral infection, but further testing, such as stool samples, may be necessary to confirm the diagnosis 6, 7.
Recommended Follow-up Plan
The recommended follow-up plan for this patient may include:
- Symptomatic treatment, such as hydration and rest, to manage the symptoms of viral gastroenteritis 3, 5.
- Monitoring of the patient's vital signs and laboratory results to detect any potential complications 5.
- Further testing, such as stool samples, to confirm the diagnosis and identify the specific cause of the viral gastroenteritis 6, 7.
- Consideration of specific therapy, such as antiviral medications, if the patient is at high risk for complications or if the infection is severe 5, 4.