A 2-year-old male child was brought to the emergency room to determine why he was suddenly refusing to walk and complaining of pain in his right leg. There was no history of trauma. He had been seen by his pediatrician earlier in the day due to the presence of fever and with an upper respiratory infection; he was diagnosed with otitis media, prescribed an antibiotic, and sent home.
Physical tests in the emergency room revealed pain and tenderness of the right ankle. There was also some edema and erythema. X-ray tests of the lower extremities did not reveal any fractures or displacements. Laboratory tests were ordered on his peripheral blood and a fluid aspirate was taken from the ankle. Lab results on these samples are listed on the table below:
Peripheral Blood WBC Count
26,000/μL
Peripheral Blood Differential
Neutrophils 77%
Lymphocytes 19%
Monocytes 4%
Erythrocyte Sedimentation Rate
Elevated
Plasma Glucose
96 mg/dL
Ankle Fluid Physical Appearance
Yellow, purulent
Ankle Fluid WBC Count
22,000/μL
Ankle Fluid RBC Count
375,000/μL
Ankle Fluid Differential
Neutrophils 95%
Macrophages 5%
Ankle Fluid Glucose
39 mg/dL
What is the name for the fluid collected from the patientâs ankle, and what is the procedure used to collect that fluid called?
What collection tubes should the fluid be placed into, and to which laboratory department does each tube go?
Which lab results are abnormal?
What type of disorder do you suspect causing the illness in this patient? (More than one answer may be correct)
What additional testing could be performed to prove your suspected diagnosis?
A 2-year-old male child was brought to the emergency room to determine why he was suddenly refusing to walk and complaining of pain in his right leg. There was no history of trauma. He had been seen by his pediatrician earlier in the day due to the presence of fever and with an upper respiratory infection; he was diagnosed with otitis media, prescribed an antibiotic, and sent home.
Physical tests in the emergency room revealed pain and tenderness of the right ankle. There was also some edema and erythema. X-ray tests of the lower extremities did not reveal any fractures or displacements. Laboratory tests were ordered on his peripheral blood and a fluid aspirate was taken from the ankle. Lab results on these samples are listed on the table below:
| Peripheral Blood WBC Count | 26,000/μL |
| Peripheral Blood Differential | Neutrophils 77% Lymphocytes 19% Monocytes 4% |
| Erythrocyte Sedimentation Rate | Elevated |
| Plasma Glucose | 96 mg/dL |
| Ankle Fluid Physical Appearance | Yellow, purulent |
| Ankle Fluid WBC Count | 22,000/μL |
| Ankle Fluid RBC Count | 375,000/μL |
| Ankle Fluid Differential | Neutrophils 95% Macrophages 5% |
| Ankle Fluid Glucose | 39 mg/dL |
What is the name for the fluid collected from the patientâs ankle, and what is the procedure used to collect that fluid called?
What collection tubes should the fluid be placed into, and to which laboratory department does each tube go?
Which lab results are abnormal?
What type of disorder do you suspect causing the illness in this patient? (More than one answer may be correct)
What additional testing could be performed to prove your suspected diagnosis?
