| Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access |
| Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc |
| Journal website https://jmc.elmerpub.com |
Case Report
Volume 16, Number 5, May 2025, pages 187-193
A Case of High-Risk Myelodysplastic Syndrome With Cryoglobulinemia, Hemophagocytic Lymphohistiocytosis, and Progression to Multiple Organ Failure
Table
| Reference range | Hospital day 1 | Hospital day 2 | Hospital day 3 | Hospital day 4 | Hospital day 5 | Hospital day 6 | Hospital day 7 | Hospital day 8 | Hospital day 9 | |
|---|---|---|---|---|---|---|---|---|---|---|
| Summary of the patient’s laboratory workup over the course of hospitalization, highlighting key hematologic, inflammatory, autoimmune, and coagulation markers. Empty boxes indicate that no laboratory value was obtained on that day of admission. Table cells with more than one number represent more than one lab collection done that day. The numbers are listed in order from earliest collection to latest collection throughout the day. ANA: antinuclear antibody; ANCA: antineutrophil cytoplasmic antibody; IFA: immunofluorescence assay; INR: international normalized ratio; MPO: myeloperoxidase; PT: prothrombin time; PTT: partial thromboplastin time. | ||||||||||
| Cell lineages | ||||||||||
| Red blood cell count | 3.7 - 5.2 × 106/µL | 3.0 | 3.0 | 2.6 | 2.2 | 3.2; 2.8 | 2.5; 2.3; 2.1; 2.3 | 2.8; 2.5 | 2.3; 2.6 | 2.5 |
| Hemoglobin | 11.3 - 15.1 g/dL | 9.2 | 9.3 | 8.0 | 6.8; 7.7 | 9.5; 8.5 | 7.5; 6.9; 6.4; 7.0; 8.2 | 8.4; 7.7 | 7.0; 8.6; 7.9; 7.7 | 7.7 |
| Hematocrit | 34-45% | 28 | 28 | 25 | 21; 24 | 29; 26 | 24; 22; 20; 22; 25 | 25; 23 | 21; 26; 24; 24 | 24 |
| White blood cell count | 3.9 - 11.2 × 103/µL | 7.1 | 8.5 | 11.8 | 15.6 | 18.0; 34.8 | 30.2; 20.7; 18.6; 16.3 | 17.9; 14.9 | 13.4; 16.4; 18.6 | 18.3 |
| Platelet count | 165 - 366 × 103/µL | 32 | 28 | 25 | 30 | 38; 39 | 30; 22; 39; 59 | 51; 28 | 59; 42; 61 | 54 |
| Lipid profile | ||||||||||
| Triglycerides | < 150 mg/dL | 512 | ||||||||
| Proteins | ||||||||||
| B-hydroxybutyrate | 0.10 - 0.27 mmol/L | 0.8 | 6.71 | |||||||
| Free kappa | 7.2 - 27.5 mg/L | 85.3 | ||||||||
| Free lambda | 5.7 - 21.5 mg/L | 63.1 | ||||||||
| Kappa/lambda ratio | 0.40 - 2.58 | 1.35 | ||||||||
| Serology | ||||||||||
| ANCA IFA pattern | Negative | Negative | ||||||||
| ANCA IFA titer | < 1:20 | < 1:20 | ||||||||
| ANA interpretation | Negative | Not detected | ||||||||
| B2 G glycoprotein | ≤ 20 SGU | < 10 | ||||||||
| B2 M glycoprotein | ≤ 20 SMU | < 10 | ||||||||
| Cardiolipin IgG | ≤ 14 GPL | < 10 | ||||||||
| Cardiolipin IgM | ≤ 12 GPL | < 10 | ||||||||
| Complement C3 | 90 - 180 mg/dL | 176 | ||||||||
| Complement C4 | 10 - 40 mg/dL | 37 | ||||||||
| Creatine kinase | ≤ 170 U/L | 56 | ||||||||
| Cryoglobulins | None | Trace | ||||||||
| Ferritin | 18.0 - 340.0 ng/mL | 5,034 | 3,931 | 3,290 | 2,562 | |||||
| Glomerular basement membrane antibody | Negative | Negative | ||||||||
| Immunoglobulin G serum | 700 - 1,600 mg/dL | 953 | ||||||||
| Immunoglobulin A serum | 70 - 400 mg/dL | 284 | ||||||||
| Immunoglobulin M serum | 40 - 230 mg/dL | 148 | ||||||||
| Interleukin-2 receptor (CD25) soluble | 175.3 - 858.2 pg/mL | 4271.2 | ||||||||
| MPO antibody | 0 | 0 | ||||||||
| Nuclear antibody screen | < 1.0 AI | 0.2 | ||||||||
| Rheumatoid factor | ≤ 13 IU/mL | 12 | ||||||||
| Coagulation | ||||||||||
| ADAMTS13 activity | ≥ 67% | 34 | ||||||||
| D-dimer | 0.00 - 0.50 mg/L FEU | > 35.21 | ||||||||
| Fibrinogen | 193 - 507 mg/dL | 494 | 294 | |||||||
| Haptoglobin | 30 - 200 mg/dL | 446 | ||||||||
| INR | N/A | 1.5 | ||||||||
| Lupus anticoagulant panel | Negative | Positive | ||||||||
| PT | 9.5 - 11.8 s | 11.5 | ||||||||
| PTT | 23.0 - 30.0 s | 27.1 | ||||||||