Case Study#1    1  2  3  4  5  6  7  8  9  10  11  12  13  14  15  16  17  18  19   Social History: non-smoker, no ETOH or drug abuse Physical Examination: pallor, cachexia, orthostatic hypotension, no thrush in oropharynx L small toe amputation Chest: CTA bilat CVR: S1,S2 CTA, 3/6 MSM apex to axilla ABD: soft, mild, tender L side, splenomegaly 4 cm below the costal margin, rectal: heme (-) Neuro: A and O x3 Vital signs: BP: 82/46 + orthostatic, HR:106, T:98.8, Sat:98% Initial Laboratory Evaluation: MCV:73, polychromasia/hypochromia, ovalocytes teardrop cells 26.3 Hct: 33.8% 2 months PTA, Hct: 41.6%3 months PTA Coags: PT: 13.3 (12.3 control) PTT: 24.5 Chemistry: Ca: 7.9, P:5.1, Mg:2.8 Baseline Cr: 2.5 on 2 months PTA and 1.7 3 months PTA Bili: 1.64 (1.15) SGOT:21, SGPT: 29, Al.Ph.: 341, LDH: 190 Chest X-Ray: cardiac silhouette: upper limit, subsegmental atelectasis at left base