Case Study Two: Follow-up

The blood count alone might be interpreted as reflecting infection, possibly supporting a diagnosis of acute appendicitis. However, the technologist performing the differential noted that more than 70% of the segmented neutrophils had bi-lobed or mono-lobed nuclei, strongly suggesting Pelger-Huet anomaly.

Since the peripheral blood smear did not support the diagnosis of appendicitis in this patient, and since abdominal pain localized to the right lower quadrant never developed, the boy was hydrated with intravenous fluid and observed. After hydration, his constitutional symptoms improved and the abdominal pain subsided. People entering high altitude where the humidity may be very low are susceptible to dehydration and may experience symptoms related to mountain sickness.