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Pathology Mystery Case

Pathology Mystery Case. 15 year old Persian with hair loss. Chemistry Profile Results. ALKALINE PHOSPHATASE 35 u/L 12 - 53 AST 37 u/L 18 - 44 ALA AT 84 u/L 32 - 109

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Pathology Mystery Case

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  1. Pathology Mystery Case 15 year old Persian with hair loss

  2. Chemistry Profile Results • ALKALINE PHOSPHATASE 35 u/L 12 - 53 • AST 37 u/L 18 - 44 • ALA AT 84 u/L 32 - 109 • TOTAL BILIRUBIN 0.2 mg/dL 0.1 - 0.4 • CREATININE KINASE 117 u/L 73 - 426 • UREA NITROGEN 35 mg/dL 20 - 35 • CREATININE 1.2 mg/dL 0.9 - 2.2 • PHOSPHORUS 4.5 mg/dL 2.5 - 6.2 • CALCIUM 9.5 mg/dL 9.6 - 11.4 • MAGNESIUM 2.1 mEq/L 1.6 - 2 • GLUCOSE 187 mg/dL 79 - 160

  3. Chem Profile (cont’d) • TOTAL PROTEIN 7.3 g/dL 6.6 - 8.7 • ALBUMIN 3.4 g/dL 2.9 - 4.2 • GLOBULIN 3.9 g/dL 2.9 - 5.5 • CHOLESTEROL 160 mg/dL 94 - 258 • SODIUM 152 mEq/L 149 - 159 • POTASSIUM 3.8 mEq/L 2.9 - 4.3 • CHLORIDE 117 mEq/L 114 - 122 • BICARBONATE 19 mmol/L 13 - 21 • ANION GAP 19.8 17 - 26 • A/G RATIO 0.9 0.6 - 1.3

  4. CBC Results RBC 5.06 x10E6/uL 7.5 - 11.7 HCT 21.9% 34 - 48 HGB 7.7 g/dL 11.5 - 15.9 MCV 43.3 fL 36 - 46 MCH 15.2 pg 12.5 - 16.4 MCHC 35.2 g/dL 32.2 - 36.8 RDW 16.6% 13.7 - 17.2

  5. CBC Results (cont’d) WBC 15.2 x10E3/uL 4.7 - 15.3 ABS SEGS 14.11 x10E3/uL 2 - 9.2 ABS LYMPHS 0.52 x10E3/uL 1.05 - 8 ABS MONOS 0.32 x10E3/uL .08 - .32 ABS EOS 0.24 x10E3/uL .2 - 1.1 ABS BASOS 0.02 x10E3/uL 0 - .2 MPV 12.00 fL 10 - 19 TPP 8.0 g/dL 6.5 - 8.6 SEGS % 92.8% 29.5 - 74.5 LYMPH % 3.4% 20 - 61.2 MONO % 2.1% 0.2 - 5 EOS % 1.6% 3.4 - 11.4 BASO % 0.1% 0 - 1 PLT (EST) CLUMPED TOXIC CHANGE MILD POIKILOCYTOSIS 1 Comment: PLATELETS CLUMPED, APPEAR ADEQUATE, RARE BANDS ARE SEEN

  6. What’s your diagnosis?

  7. Paraneoplastic Alopecia • Associated with • Cholangiocellular carcinoma • Hepatocellular carcinoma • Pancreatic carcinoma • Why weren’t the liver enzymes elevated?

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