What is the diagnosis for a patient with leukocytosis (White Blood Cell count 14.2), normocytic anemia (Red Blood Cell count 4.15, Mean Corpuscular Volume (MCV) 102), elevated Red Cell Distribution Width (RDW) 55.3, neutrophilia (Segmented Neutrophil absolute count 12.2), lymphopenia (Lymphocytes absolute count 0.7), monocytosis (Monocytes 1.3), impaired renal function (Blood Urea Nitrogen (BUN) 30, Creatinine 2.04, estimated Glomerular Filtration Rate (GFR) 33), hyperbilirubinemia (Bilirubin 1.5), and elevated C-Reactive Protein (CRP) 85.5?

From the Guidelines

You should seek immediate medical evaluation due to the presence of several concerning abnormalities in your lab results, including an elevated white blood cell count, neutrophilia, and significantly impaired kidney function, which collectively point to a serious systemic inflammatory process with kidney dysfunction. These lab results indicate several concerning abnormalities requiring prompt medical attention. You have an elevated white blood cell count (14.2) with neutrophilia (12.2), suggesting an active infection or inflammation, which is further supported by the markedly elevated C-reactive protein (85.5) 1. Your kidney function is significantly impaired with elevated BUN (30) and creatinine (2.04), resulting in a reduced GFR of 33, indicating stage 3 chronic kidney disease, and according to the 2023 guidelines, patients with an estimated glomerular filtration rate of <30 mL/min/1.73 m2 should be referred for evaluation by a nephrologist 1. The macrocytosis (MCV 102) and severely elevated red cell distribution width (RDW 55.3) suggest abnormal red blood cell production, possibly related to nutritional deficiencies or other underlying conditions. You also have lymphopenia (0.7), which could indicate immune dysfunction. The elevated bilirubin (1.5) suggests possible liver involvement. Some key points to consider in the management of your condition include:

• The need for a comprehensive evaluation to identify the underlying cause of your systemic inflammatory process and kidney dysfunction
• The potential need for antibiotics if an infection is confirmed
• The importance of managing your kidney disease, which may involve referral to a nephrologist
• The need to address any nutritional deficiencies that may be contributing to your abnormal red blood cell production
• The potential for other underlying conditions, such as liver disease, that may need to be evaluated and managed. Treatment should be guided by the results of a comprehensive evaluation and may include antibiotics, management of kidney disease, and addressing nutritional deficiencies. Given the complexity of your condition, it is essential to seek care from healthcare professionals who can provide comprehensive evaluation and management. Do not delay seeking care as these abnormalities require prompt attention to prevent further complications.

From the Research

Laboratory Results

The provided laboratory results show:

• Elevated white blood cell (WBC) count at 14.2
• Elevated red blood cell (RBC) count at 4.15
• High mean corpuscular volume (MCV) at 102
• Elevated red blood cell distribution width (RDW) at 55.3
• Elevated segmented neutrophil absolute count at 12.2
• Low lymphocyte absolute count at 0.7
• Elevated monocyte count at 1.3
• Elevated C-reactive protein (CRP) at 85.5
• Elevated blood urea nitrogen (BUN) at 30
• Elevated creatinine at 2.04
• Low sodium at 135
• Elevated bilirubin at 1.5
• Low glomerular filtration rate (GFR) at 33

Possible Infection and Treatment

The elevated WBC count, CRP, and segmented neutrophil absolute count suggest a possible bacterial infection 2, 3, 4, 5.

• Ceftriaxone is a potential treatment option for bacterial infections, including those caused by methicillin-susceptible Staphylococcus aureus (MSSA) 2, 4, 5.
• The effectiveness and safety of ceftriaxone compared to standard of care for treatment of bloodstream infections due to MSSA have been evaluated in several studies 4, 5.
• Ceftriaxone has been shown to be as effective as multiple dosing regimes of anti-staphylococcal antibiotics for the treatment of infections due to MSSA 4.

Inflammation and Rehabilitation

The elevated CRP and WBC count also suggest acute inflammation, which can hamper rehabilitation if not controlled early 6.

• Controlling inflammation and relieving pain are important for rehabilitation 6.
• Medical therapy, such as nonsteroidal anti-inflammatory drugs, can help control inflammation and relieve pain, but may have gastrointestinal side effects 6.

Key Findings

• The patient's laboratory results suggest a possible bacterial infection and acute inflammation.
• Ceftriaxone is a potential treatment option for bacterial infections, including those caused by MSSA.
• Controlling inflammation and relieving pain are important for rehabilitation.