Age: 78.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Fatigue, Hypoxia, Laboratory test normal, Myelosuppression, Nasopharyngitis
Clinical narrative: Patient with history of COVID vaccines who admitted to hospital with COVID detected PCR.  Provider d/c note:  "79 YO  female  with history of CAD, DM type 2 IR, CKD and anemia of chronic disease who presented with increased fatigue, SOB, dizziness.  This started a couple of days ago.  She was seen today at the infusion clinic where she goes monthly for Aranesp injections.  She was noted to have worsening anemia, requiring blood transfusion, so she was sent to the ER.  Patient states that she had a very bad cold for 2 weeks and had gotten better from that when this new SOB occurred. She did have vomiting and diarrhea with that episode as well.  Currently she denies a cough, chest pain, fevers, or chills.  She states that she is having a little more edema.  She was hypoxic at home as well which caused her to come in as well. She had a MI in September and had 3 stents placed at that time.   Hospital Course:  She received transfusion for her acute on chronic anemia with appropriate response and stabilization of Hb. This acute on chronic anemia seems likely to be driven by viral infection (confirmed COVID +) leading to bone marrow suppression in an otherwise at risk patient with chronic EPO deficiency and pre-existing anemia of chronic disease in the setting of advanced CKD. She has been on Aranesp for anemia and this will be continued after discharge. Repeat CBC next week is planned for re-evaluation and for future Aranesp dosing guidance. She did exhibit mild CHF exacerbation (preserved EF) for which she received IV furosemide with good response and no supplemental oxygen requirement. She has been instructed to take double dose of her home torsemide for 3 days (through 1/16/23) then resume her home dosing. Her ECHO appears stable and her EF is normal, however diastolic function could not be assessed fully on available images. Instructions were given to both the patient and her daughter on day of discharge. Of note, she is still having intermittent fever, felt to be related to current COVID infection, resolves with tylenol. She had workup for potential superimposed bacterial infection but there were no signs on lab testing or clinical exam to suggest presence of bacterial infection or need for antibiotic therapy at this time but she has been told to monitor for any changing or new symptoms that would be suggestive of this potential. She was offered additional time in the hospital to monitor fever curve but she opted to go home home and declined additional hospital stay and this was also in collaboration with her daughter. She reports she will follow up with her PCP and nephrologist as well as the infusion clinic for follow up CBC and Aranesp. She understands that appointments could not be made on her behalf due to the offices being closed on the weekend and she will plan to make appointments when offices open again on Tuesday after the holiday weekend.    In regards to her other chronic medical conditions, they were noted to be stable and no changes were made in her medications. The noted "modified medications" list below indicates a change in her Lantus, however, this was only because there were duplicate orders present on her list. No changes were made to her insulin regimen this admission.