Case Study 1: Yellowed Baby

A 9 day old nursing infant comes into the ER. The baby boy's skin has a yellow pigment. The mother says the baby is "fussy", refuses to eat, and has tan stool. The doctor orders a blood bilirubin level, a routine urinalysis, and a gallbladder ultrasound. The Doctor insists that the urine be sent through the pneumatic tube and protected from light. As part of the hospital policy and law babies younger than 14 days old must undergo a reduction substances screen.

Blood bilirubin levels elevated
Gallbladder ultrasound detected a calculus in the bile duct.
Clinitest: Negative

Physical
Color: Amber                              Protein: Negative                        Blood: Negative
Clarity: Clear / Frothy               Glucose: Negative                       Urobilinogen: 0.2 EU
SG: 1.020                                    Ketone: Negative                        Nitrate: Negative
pH: 6.2                                        Bilirubin: Large                           Leukocyte: Negative

Microscopic
RBC: 0-2/hpf
Few Squamous epithelial cells/hpf
Artifacts
0-1 hyaline cast/ lpf



Questions
1. Is this microscopic imagine abnormal in the urine?


Is this strange to you?
                                                                       400x

Answer 1

2. What could be a possible source for the artifacts?
Answer  2

3. What type of Jaundice could this most likely be?
Answer  3

4. If the urine had not been protected from light what is a possible outcome? What was the Doctor insuring by protecting the urine from light?
Answer  4

5. The clinitest is Negative. If it had been positive what could possibly be causing a positive clinitest when the glucose pad is negative?
Answer 5








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