A Nurse-Led Clinic to Optimise Ambulatory Oxygen Therapy - EMJ

We report the case of a 95-year-old man with a previous history of myocardial infarction, pulmonary oedema, and hypertension who developed recurrent collapse while undergoing ambulatory urological follow-up for a six-week history of macroscopic haematuria. Following a recent outpatient review, he had received oral antibiotics for a presumed urinary tract infection (UTI). Throughout this six-week ambulatory period, no full blood count or other blood tests were performed, leaving the extent of blood loss and its haematological consequences clinically occult. The patient subsequently experienced three episodes of sudden collapse within one week at home. The episodes were preceded by a prodrome of marked weakness. On assessment by ambulance clinicians, a profound postural blood-pressure drop was identified. Given the postural component and presumed recent urinary infection, dehydration was considered the initial explanation, and intravenous fluid resuscitation was commenced. However, hospital point-of-care investigations substantially changed the diagnostic picture. Venous blood gas analysis demonstrated a haemoglobin concentration consistent with profound anaemia. ECG demonstrated a r

AcknowledgementsThe authors thank Arcus Biosciences for providing AB680 and AB928 for the experiments. This research was supported [in part] by the Intramural Research Program of the National Institutes of Health (NIH), National Cancer Institute, CCR, CIL. The contributions of the NIH authors (S. T., C. I. K. C., F. J. G.) were made as part of their official duties as NIH federal employees, are in compliance with agency policy requirements, and are considered Works of the United States Government. However, the findings and conclusions presented in this paper are those of the authors and do not necessarily reflect the views of the NIH or the U. S. Department of Health and Human Services. Schematic diagrams (Figs. 1A, E, 2A, E, 5D, 6A, D and 7A, G) were created with BioRender.com. FundingThis work was funded by NIH grants R01CA148828, R01CA245546, R01DK095201, and UMCCC Core Grant P30CA046592 (Y. M. S.). R01AI152517 to C. A. P. R01CA248160 to C. A. L. R. S. was supported by a Postdoctoral Fellowship (032650) from the American Physiological Society and a Research Fellow Award (1003279) from the Crohn’s and Colitis Foundation. N. W. Z.