63 year old patient complaining of fatigue and shortness of breath, upper back pain and cough that has become productive the last 2 days. a chest Xray revealed pneumonia . rbc count is decrease, hemoglobin
Hi and thanks for the question, The symptoms are very compatible with pneumonia. Shortness of breath, raised ESR and chest X-ray findings. Hope an appropriate antibiotherapy has been prescribed. However, the low Hemoglobin levels have to be investigated. Low hemoglobin levels could be caused by the infection, but if very low, other causes should be considered. Other tests could be quite helpful in doing this assessment. Serum Egg is an indication that the infection is chronic, But Egg measurements are however very non-specific, and we cannot be conclusive. Knowing exactly for how long she has been coughing is too important. A chronic cough might warrant sputum exams and a tuberculin skin test to be done to exclude pulmonary tuberculosis. The back pain might require a spinal x-ray, ESR, alkaline phosphate levels, Complete blood count, serum electrolytes to exclude any bone malignancy. I suggest visiting an internist with these ideas in mind could help min a proper reevaluation and management of your patient. Thanks and hope this helps, Luchuo, MD.