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July 2018 — Blood Education

A 64-year-old male underwent general anesthesia for a primary coronary artery bypass graft (CABG) of his left anterior descending (LAD) artery using the left internal mammary artery (LIMA). His other medical history is insignificant. Intraoperative cell salvage was used throughout the case, including dissection of the IMA. The procedure itself was uneventful; however, while closing the wound, the autologous blood was reinfused resulting in immediate and profound hypotension (see figure).

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Allan Klompas, M.B., M.Ch., BAO
Fellow, Transfusion Medicine
Mayo Clinic
Paula Santrach, M.D.
Consultant, Transfusion Medicine
Mayo Clinic
Associate Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

July 2018 — Clinical Pathology

A 57-year-old female presented with easy bruising, hirsutism, and weight loss. Morning serum cortisol was 54.1 mcg/dL (reference interval (RI): 7-25 mcg/dL) with an adrenocorticotropic hormone (ACTH) of 35 pg/mL (RI: 7-63 mcg/dL). Following a high-dose dexamethasone suppression test, cortisol was 4.1 mcg/dL with an ACTH of 17 pg/mL. Inferior petrosal sinus sampling following administration of corticotropin-releasing hormone was performed. At baseline, the central-to-peripheral ACTH gradient was 2.8-to-1. After administering CRH, this central-to-peripheral ACTH ratio was 23-to-1.

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Kornelia Galior, Ph.D.
Fellow, Clinical Chemistry
Mayo Clinic
Stefan Grebe, M.D., Ph.D.
Consultant, Clinical Chemistry
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

July 2018 — Clinical Pathology

A 57-year-old female presented with easy bruising, hirsutism, and weight loss. Morning serum cortisol was 54.1 mcg/dL (reference interval (RI): 7-25 mcg/dL) with an adrenocorticotropic hormone (ACTH) of 35 pg/mL (RI: 7-63 mcg/dL). Following a high-dose dexamethasone suppression test, cortisol was 4.1 mcg/dL with an ACTH of 17 pg/mL. Inferior petrosal sinus sampling following administration of corticotropin-releasing hormone was performed. At baseline, the central-to-peripheral ACTH gradient was 2.8-to-1. After administering CRH, this central-to-peripheral ACTH ratio was 23-to-1.

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Kornelia Galior, Ph.D.
Fellow, Clinical Chemistry
Mayo Clinic
Stefan Grebe, M.D., Ph.D.
Consultant, Clinical Chemistry
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine

July 2018 — Anatomic Pathology; A Karolinska Institutet Case

This incidental miscroscopic finding is observed in both ovaries in a 40-year-old woman who has undergone prophylactic hystero-salpingo-oophorectomy.

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Yifan Zhang
Resident, Department of Pathology and Cytology
Karolinska Institutet
Joseph Carlson, M.D., Ph.D.
Senior Consultant, Department of Pathology and Cytology
Karolinska Institutet
Erika Fetterman

Erika Fetterman

Erika Fetterman, Editorial Assistant at Mayo Medical Laboratories, supports internal and client-facing communications.