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A 44 year old lady who works as an interior decorator has undergone a mastectomy and axillary node clearance to treat breast cancer. Post operatively, she comments that her arm easily becomes fatigued when she is painting walls. What is the most likely explanation?
Reference Ranges
Full Blood Count
| Haemoglobin | Men: 135-180 g/L Women: 115-160 g/L |
| Mean Cell Volume | 82-100 fl |
| Platelets | 150-400 * 109/L |
| White Blood Cells | 4.0-11.0 * 109/L |
| Neutrophils | 2.0-7.0 * 109/L |
| Lymphocytes | 1.0-3.5 * 109/L |
| Eosinophils | 0.1-0.4 * 109/L |
Urea and Electrolytes
| Sodium | 135-145 mmol/L |
| Potassium | 3.5-5.0 mmol/L |
| Urea | 2.0-7 mmol/L |
| Creatinine | 55-120 µmol/L |
| Bicarbonate | 22-28 mmol/L |
| Chloride | 95-105 mmol/L |
Liver Function Tests
| Bilirubin | 3-17 µmol/L |
| Alanine Transferase (ALT) | 3-40 IU/L |
| Aspartate Transaminase (AST) | 3-30 IU/L |
| Alkaline Phosphatase (ALP) | 30-100 µmol/L |
| Gamma Glutamyl Transferase (γGT) | 8-60 U/L |
| Total Protein | 60-80 g/L |
Other Haematology
| Erythrocyte Sedimentation Rate (ESR) | Men: <(age/2) mm/hr Women: <((age+10)/2) mm/hr |
| Prothrombin Time (PT) | 10-14 secs |
| Activated Partial Thromboplastin Time (APTT) | 25-35 secs |
| Ferritin | 20-230 ng/mL |
| Vitamin B12 | 200-900 ng/L |
| Folate | 3.0 nmol/L |
| Reticulocytes | 0.5-1.5% |
| D-Dimer | <400 ng/mL |
Other Biochemistry
| Calcium | 2.1-2.6 mmol/L |
| Phosphate | 0.8-1.4 mmol/L |
| CRP | <10 mg/L |
| Thyroid Stimulating Hormone (TSH) | 0.5-5.5 mU/L |
| Free Thyroxine (T4) | 9-18 pmol/L |
| Total Thyroxine (T4) | 70-140 nmol/L |
| Amylase | 70-300 U/L |
| Uric Acid | 0.18-0.48 mmol/L |
| Creatine Kinase | 35-250 U/L |
Arterial Blood Gases
| pH | 7.35-7.45 |
| pCO2 | 4.5-6.0 kPa |
| pO2 | 10-14 kPa |
| Bicarbonate | 22-28 mmol/L |
| Base Excess | -2 to +2 mmol/L |
Lipids
| Total Cholesterol | <5 mmol/L |
| Triglycerides | <2 mmol/L |
| HDL Cholesterol | >1 mmol/L |
| LDL Cholesterol | <3 mmol/L |
Reference ranges vary according to individual labs.