Could Antibiotics Upon Presentation Have Prevented Asplenic Patient's Death?

The patient presented to the hospital emergency department (ED) with fever, body ache, headache, nausea and vomiting. She had a history of Idiopathic Thrombocytopenic Purpura (ITP) and splenectomy. Her vital signs at triage were T 101.6, P 166, R 66, B/P 114/62. Her acuity level was considered emergent/urgent. According to the nursing staff, the patient appeared to be very ill. Two hours later she was receiving IV fluids, labs had been drawn, and she had received Reglan, Pepcid and Toradol. At this point, the patient begged the ED physician for antibiotics. The lab results yielded: white blood count 14.4; hematocrit 50.9; platelet count 139,000; granulocytes 90.6%; lymphocytes 8.7%; albumin 3.0; and alkaline phosphatase 168.