Abnormal MDW 27.3 Changed Patient’s Trajectory

Patient Case Study

The inclusion of monocyte distribution width (MDW) biomarker in clinical thought process helped physicians to uncover an underlying infection, that could have otherwise been missed, leading to inappropriate therapeutic interventions. We can prevent sepsis by preventing evolution of infection to sepsis.

9:30 a.m.

Patient Arrives to ED

A 63-year-old male with a history of coronary artery disease, diabetes and lung cancer presents to the ED complaining of generalized body aches and weakness, which had started about one week prior.

Patient denies localized weakness or numbness, chest pain, shortness of breath, abdominal pain, headache, or urinary symptoms. His last chemotherapy was the month prior.
Patient is thrombocytopenic

Chief Complaint:
Fatigue, intermittent nausea, worsening chills mostly at night time.

9:35 a.m.

Vital Signs are Assessed

  • Temperature: 37.1°C (98.8°F)
  • Blood pressure: 122/73
  • Pulse: 88
  • Respiratory rate: 21
  • SpO2: 97% (RA)

Positive physical exam findings: Mildly dry mucous membranes and hemoccult-positive stool.

10:40 a.m.

CBC with differential and MDW results

Slightly elevated WBC at 12.3

Anemia with hemoglobin of 8.2, decrease from a previous measurement of 9.1 taken approximately two months prior.

MDW results of 27.3 come in.

10:45 a.m.

Severe infection and sepsis added to differential diagnosis and additional tests ordered

Based on the elevation of WBC and MDW levels, the physician adds severe infection and risk of sepsis to differential diagnosis. Ordered head to toe exam and sepsis panel: lactate, blood cultures and antibiotics.

What are we missing?

A head-to-toe exam reveals mild erythema and induration around the Portacath, suggesting a port site infection.

11:15 a.m.

Antibiotics are given

11:27 a.m.

Sepsis Time Zero - SEP-1 Metrics Met 

Lactate 3.2

  • Note: Days later, blood cultures grew gram-positive cocci in clusters, suggestive of staph from an infected port site

Recap:

Patient vitals were obtained at 9:35 a.m. At 10:40 a.m. CBC-diff results:

  • Mild elevation WCB, but abnormal MDW at 27.3
  • Decrease in Hemoglobin to 8.2 from 9.1 = Worsening anemia Rectal exam demonstrated blood in the stool + thrombocytopenia + fatigue and weakness →This explanation for patient's symptomatology can lead to blood transfusion without further investigation of other causes.
"By including MDW in our thought process, we can potentially uncover underlying sepsis that could have been otherwise missed, especially when other causes can explain patient's symptoms."
Dr. Nima Sarani, M.D.
University of Kansas Medical Center

 

Watch Dr. Sarani present this specific emergency department case study demonstrating the clinical utility of MDW in an acute care setting.

Interested in reading more MDW case studies similar to this one? Click here

 

Disclaimer: This trend is presented for educational purposes only and is not intended to promote any Beckman Coulter product or service.