Results of Specialty Exams

First of all, the radiographs clearly indicate a Type I Salter-Harris physeal Fracture of the distal metatarsal 
bone (cannon bone).  A radiolucent line (the fracture) can be seen on both dorsopalmar and lateral views of 
the right metatarsus. It appears to be recent but there has been some bone thickening and remodeling.

The Complete Blood Count (CBC) showed the following abnormalities:
Decreased values for hemoglobin and hematocrit: 	anemia
Decreased MCV:					microcytic
Increased MCHC:				hyperchromic
Decreased protein:				hypoproteinemia
Increased platelets:				thrombocytosis
Increased Total NCC in Joint			high cellularity in joint analysis
						Growth of K. pneumoniae

A true hyperchromic anemia does not exist, because erythrocytes only sequester a certain amount 
of hemoglobin, and you have a decreased number of circulating RBC. Hyperchromic anemia occurs in two 
situations: intravascular hemolysis or poor sampling technique. The sample should have been properly 
taken, so the hyperchromic anemia is due to RBC lysed inside the circulation due to crushing the limb 
when stepped on.  The anemia and hypoproteinemia are likely due to hemorrhage and blood loss. An 
increased number of platelets were released from the spleen to form plugs where tissue and vessels were 
damaged. The increased cellularity in the joint, and the presence of Klebsiella pneumoniae indicate a 
bacterial infection causing additional inflammation, swelling, and chemotaxis of small mononuclear cells to 
the site of infection.