Case 47 – update 1

Here is our first update on our 60 year old gentleman, who only has childhood asthma in his pmh.
He initially presented with ankle swelling and despite 20mg furosemide he felt it was getting slightly worse at his second visit. He has no loss of appetite, and hasn’t lost any weight. He hasn’t had any rashes, or skin changes.
On examination, chest was clear, heart sounds normal, abdomen was soft and none tender with no hepatosplenomegally. He has bilateral pitting oedema up to his mid calf.
Bloods have revealed

Hb 115 plt 248 wcc 5.3 neut 2.5

na 141, k 4.0, urea 4.2, creat 105, bili 4, ggt 24, protein 50, alb 24

Urinalysis has shown prot +++ 

The patient come back to see you the following week to get his blood results. The peripheral oedema has gotten worse and he now has swelling up to his knees.

Are there any other things you want to ask in the history? How do you think he should be managed currently?

We have had the suggestion of nephrotic syndrome. What tests do we need to do to look into this further? What do you think about the fbc results?

Remember to use #teamhaem on all your posts to help us follow the case! Please note – all cases on TeamHaem are entirely fictional to protect patient confidentiality. TeamHaem are not a position of authority. It is an educational platform to allow discussion and learning.

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