A laboratory evaluation revealed a WBC count of
15.6 × 103/μL; hemoglobin, 8.4 g/dL;
hematocrit, 24.5%; and platelets,
33 × 103/μL. On urinalysis,
RBCs were 27/high power field (hpf). Her prothrombin time was
13.0 s (normal), and partial thromboplastin time was 27 s
(normal). Her aspartate aminotransferase level was elevated at 185 U/L.
Her amylase was 165 U/L (normal), and lipase was elevated at 1,183 U/L.
Serum albumin was 2.1 g/dL, and total bilirubin was 5.1 mg/dL.
Creatinine was 0.9 mg/dL, and her BUN was 21 mg/dL. The pleural fluid
analysis was repeated, revealing a pH of 7.5; glucose, 21 mg/dL; total
protein, 4.5 g/dL; lactic dehydrogenase, 17,310 U/L; WBC, 800/hpf; and
RBC, 1,790/hpf. The result of a qualitative test for cold
agglutinins performed at bedside was positive. (Two milliliters of
whole blood were placed into a blue-top sodium citrate tube and mixed.
The side of the tube was noted to have a uniform coat of blood against
a white background. The tube was then placed on ice for 3 to 5 min, and
removed. When held against a white background again, the granular
appearance of cold agglutinated blood was noted. The agglutination
resolved when the tube was rewarmed.)