Table 1.
Laboratory data
| Variable | Reference range | Day 1* | Day 9 | Day 12 | Day 16 | Day 19 | Approximately 6 months** |
|---|---|---|---|---|---|---|---|
| White cell count (× 109/L) |
6–14 |
10.89 |
16.72 |
13.2 |
11.59 |
|
2.82 |
| Hemoglobin (g/dL) |
11.5–15.5 |
8.7 |
9.4 |
8.6 |
10.4 |
|
12.1 |
| Platelets (× 109/L) |
150–400 |
118 |
642 |
725 |
576 |
|
214 |
| Mean cell volume (fl) |
80–95 |
87.5 |
89.6 |
93.8 |
90.3 |
|
85.0 |
| Mean cell hemoglobin (pg) |
27–34 |
29.5 |
28.8 |
26.6 |
29 |
|
28.9 |
| Mean cell hemoglobin concentration (g/dL) |
30–35 |
33.7 |
32.2 |
28.4 |
32.1 |
|
34.0 |
| Urea (mmol/L) |
3.2–6.7 |
7 |
16.8 |
21 |
|
14.9 |
3.8 |
| Creatinine (micromol/L) |
53–115 |
75 |
347 |
377 |
|
316 |
40 |
| Aspartate aminotransferase (IU/L) |
10–42 |
50 |
|
26 |
|
|
|
| Alanine aminotransferase (IU/L) |
6–28 |
20 |
|
12 |
|
|
|
| Direct bilirubin (micromol/L) |
0–3 |
18 |
|
3 |
|
|
|
| Albumin (g/L) |
23–38 |
18 |
|
22 |
|
|
|
| Total protein (g/L) | 67–82 | 49 | 77 |
There is a normochromic normocytic anemia consistent with acute blood loss with a possibly reactive thrombocytosis. The initial thrombocytopenia could have been caused by pre-eclampsia. Raised urea and creatinine are probably secondary to hypovolemia due to loss of fluid into the peritoneal cavity leading to pre-renal acute kidney injury. Aspartate aminotransferase is usually raised after cesarean section. Conjugated hyperbilirubinemia is attributed to intra-operative hemorrhagic shock. Because albumin is a negative acute phase reactant, the trauma of surgery may have contributed to the hypoalbuminemia which improved over time post-operatively. Hypoproteinemia was probably due to proteinuria and also possibly resulted from the period of starvation before and after surgery. Leucopenia at six months did not escape our attention. The patient was rhesus D positive.
* Days post-surgery.
** Different reference ranges may apply; there was no proteinuria.