A patient presents to the office with symptoms of a cough, a little tightness in his chest and complaints of a slight fever. The physician believes that the patient may have a respiratory infection. The physician orders a CBC to see if an antibiotic may be appropriate. The following is the results of the CBC... hgb $$ 13.4 \mathrm{~g} / \mathrm{dl} $$ (reference range male 13-18) $$ \quad $$ RBC count $$ 5.7 imes 10^{6} / \mathrm{mm}^{3} $$ (reference range male 4.6-6.2) hct $$ 43 \% $$ (reference range male 45-52) WBC count $$ 12,000 / \mathrm{mm}^{3} \quad $$ (reference range 4,3000-10,800) 450,000 ) platelet count $$ 320,000 / \mathrm{mm}^{3} $$ (150,000- Differential neutrophils $$ 48 \%(54-65 $$ ) lymphotcytes $$ 48 \%(25-40 $$ ) monocytes $$ 2 \%(2-8) $$ eosinophils $$ 1 \%(1-4) $$ basophils $$ 1 \%(0-1) $$ Discuss the patient's CBC results. Are they within normal limits? Do they support a respiratory infection? Would prescribing an antibiotic be an appropriate plan? Choose one question/statement and respond. Choose different information than that on previous posts to support your discussion.

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A patient presents to the office with symptoms of a cough, a little tightness in his chest and complaints of a slight fever. The physician believes that the patient may have a respiratory infection. The physician orders a CBC to see if an antibiotic may be appropriate. The following is the results of the CBC... hgb $$ 13.4 \mathrm{~g} / \mathrm{dl} $$ (reference range male 13-18) $$ \quad $$ RBC count $$ 5.7 	imes 10^{6} / \mathrm{mm}^{3} $$ (reference range male 4.6-6.2) hct $$ 43 \% $$ (reference range male 45-52) WBC count $$ 12,000 / \mathrm{mm}^{3} \quad $$ (reference range 4,3000-10,800) 450,000 ) platelet count $$ 320,000 / \mathrm{mm}^{3} $$ (150,000- Differential neutrophils $$ 48 \%(54-65 $$ ) lymphotcytes $$ 48 \%(25-40 $$ ) monocytes $$ 2 \%(2-8) $$ eosinophils $$ 1 \%(1-4) $$ basophils $$ 1 \%(0-1) $$ Discuss the patient's CBC results. Are they within normal limits? Do they support a respiratory infection? Would prescribing an antibiotic be an appropriate plan? Choose one question/statement and respond. Choose different information than that on previous posts to support your discussion.

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**Would prescribing an antibiotic be an appropriate plan?**

Based on the patient's CBC results, prescribing an antibiotic may **not** be the most appropriate course of action at this time. Here's why:

- **Leukocyte Differential:** The patient presents with a **total white blood cell (WBC) count of 12,000/mm³**, which is mildly elevated. However, the differential shows a **relative lymphocytosis (48% lymphocytes)** and a **relative neutropenia (48% neutrophils)**. Typically, bacterial infections are associated with an **absolute or relative neutrophilia**, whereas viral infections often present with **lymphocytosis**. This pattern leans more towards a viral etiology rather than a bacterial one.

- **Clinical Symptoms:** The patient's symptoms of cough, chest tightness, and slight fever are common in both viral and bacterial respiratory infections. However, the lack of more severe symptoms (such as high fever, productive cough with purulent sputum, or signs of consolidation on physical exam) alongside the CBC findings suggests a viral process.

- **Antibiotic Stewardship:** Prescribing antibiotics when they are not indicated can contribute to antibiotic resistance and expose the patient to unnecessary side effects. Given the likelihood of a viral infection, supportive care and symptomatic management would be more appropriate initially.

**Recommendation:** Monitor the patient's symptoms closely. If there is no improvement or if symptoms worsen, further evaluation may be necessary to rule out a bacterial infection or other complications that might warrant antibiotic therapy.
**Would prescribing an antibiotic be an appropriate plan?** No, based on the CBC results and the patient's symptoms, prescribing an antibiotic may not be appropriate. The elevated WBC count and the differential showing lymphocytosis suggest a possible viral infection rather than a bacterial one. It's better to monitor the patient's symptoms and consider antibiotics only if there's no improvement or if symptoms worsen.

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