3. Social History, Phys. Exam., Lab Eval., Coags, Chem, Chest X-Ray

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:
Lab Results 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:
Chemistry Results
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