This week’s case highlights the challenging aspects of determining potential sepsis in patients with complex conditions such as multiple sclerosis. We discussed differing clinical styles of how we determine if a patient is a “sepsis yellow”, “sepsis red” and “sepsis unlikely”. We also discussed how these terms can help establish a shared mental model for prioritization amongst the full clinical team.

Patients received 20 mL/kg NS bolus and ceftriaxone, with stable blood pressures. Labs showed WBC 18 and profound anemia (Hgb 3.4) with normal platelets, indirect hyperbilirubinemia (Tbili 4.6, Dbili 0.6). UA was unremarkable, and appendix ultrasound was negative. 

Hematology consulted and concern for possible G6PD due to acute hemoglobin drop in the setting of first-time nitrofurantoin usage vs other autoimmune hemolytic process. Recommend obtaining DAT, LDH, haptoglobin levels and transfuse with 3cc/kg of PRBCs. LDH 1,561. Uric acid 5.3. While awaiting lab results, the patient developed acute expressive aphasia without other focal deficits. CT head was negative, and Neurology attributed symptoms to critical anemia and sepsis, with low concern for stroke or MS flare. 

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