A 65 year old retired accountant with a 60 pack year smoking history presents for his annual physical examination. He was last seen 3 years ago, when he presented with an episode of acute bronchitis. He repos that he has been coughing over the past several months with productive green sputum. He denies any dyspnea or limitation in his daily activities. On physical examination, his blood pressure is 126/62 mm Hg, pulse is 80/min, and respirations are 24/min. He has diffuse bilateral expiratory rhonchi with a markedly prolonged expiratory phase. His cardiac examination reveals a second hea sound that increases in intensity with inspiration. The liver edge is 14 cm into the midclavicular line and mildly tender to palpation. There is bilateral lower extremity edema to the knees. A chest x-ray film reveals hyperinflation of both lung fields, and pulmonary function tests reveal a diminished forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio. Routine laboratories are sent. Which of the following would most likely be expected?
A hemoglobin of 17 g/dL would be expected. The question describes a patient with chronic obstructive pulmonary disease (COPD) confirmed by his physical examination, which also suggests right-sided hea failure, loud P2, and hepatic congestion and peripheral edema due to right-sided hea failure. The pulmonary function tests are consistent with the diagnosis of obstructive airway disease. Given the long history of smoking, this patient most likely has COPD. Because of chronic hypoxia, these patients also develop erythrocytosis in an effo to increase the oxygen carrying capacity. The first choice would be seen in anemia. There is no reason for this patient to develop thrombocytopenia or leukopenia. Ref: Bates C.G., Cydulka R.K. (2011). Chapter 73. Chronic Obstructive Pulmonary Disease. In J.E. Tintinalli, J.S. Stapczynski, D.M. Cline, O.J. Ma, R.K. Cydulka, G.D. Meckler (Eds), Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 7e.
A hemoglobin of 9 g/dL
A hemoglobin of 17 g/dL
A platelet count of 84,000
A platelet count of 102,000