20 year old woman with Hypoproliferative anemia and hepatosplenomegaly
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Here is a case i have seen:
20 year old female studied upto 8th class and happily married 2years ago
Came with c/o yellowish discolouration of eyes since 1 year
SOB on exertion since 1year
Irregular menses since 1 year
Pt was apparently asymptomatic 1year ago
Then she developed yellowish discolouration of eyes 1year ago for which she used unknown medication(chetla mandu) and then she visited lb nagar kamineni and used medications, it subsided in 2months.At that time she was diagnosed with hypothyroid for which she used medication for 1month and stopped(no records available)
H/o amenorrhea for 5months, 1year back then f/b regular menses for 6months, now again amenorrhoea since 4months,upt came out to be negative 3months ago
There is history weight loss -
Almost 10 kgs from last year .it's unintentional weight loss
She said she was 45-50 kgs before marriage .and she started noticing loosening of clothes since the onset of jaundice( since 1 year )
Present weight -34kgs
1 Month AGO:yellowish discolouration of eyes recurred 1month ago, associated with fever which lasted for 10days,loose stools, nausea and pain Abdomen,yellowish discolouration of urine, generalised weakness and sob on exertion + for which she visited local hsptl 1month ago and used medications till 2days back, but the symptoms did not subside. So she came to our hospital
Outside usg (1month ago) hepatospeelnomegaly, mesenteric lymphadenopathy
Outside reports (1month ago) CUE alb ++, pus cells 12-14,hb 5.5,TLC 4,100.plt:2.76
TB 1.8,CRP Positive, widal mild positive
T3:3.34,T4:14.07,TSH:0.01
All 4limbs tingling, numbness present since 1year on and off
No h/o pain Abdomen, loose stools, vomiting,
no h/o any transfusions
Not a k/c/o HTN, DM,CAD
LMP 4months ago
O/E pt conscious coherent
PR 120bpm,regular,normal volume
Bp 110/70
RR 20/min
Pallor +
Icterus+
Jvp raised(initial interpretation) but was later told to be carotids
Cvs:
Apical impulse in 5th ICS on mid clavicular line
Parasternal heave+
Heaving apex+
Epigastric pulsations+
S1 s2 +, no murmurs
GIT
Shape of Abdomen normal
Umbilicus inverted,central
No local rise of temp
Tenderness+ on deep palpation in right and left hypochindrium
Hepatomegaly+
Spleenomegaly+
Bowel sounds +
RS: BAE+, NVBS
CNS:HMF intact, no FND
Neck:solitary thyroid nodule+
Investigations on the day of admission:
Hb:6.7
TLC 4,400
Plt 2.07
Mcv 63.0
Mch 20.4
Pcv 20.6
PBS report microcytic hypochromic
Retic count 0.5%
ARC 0.2%
RPI 0.1%
Serum LDH 251
Serum iron 93
Direct Coombs negative
Indirect Coombs negative
Serum ferritin 6
LFT
TB 2.6
DB 1.15
AST 73
ALT 40
ALP 557
TP 7.5
Alb 2.7
A/G 0.57
TFT:
Urea14
Creat0.4
Na 140,K 4.0,cl 105
Chest x ray done
Cue :alb+, sugar trace, pus cells 3-4
HbsAg, Hcv negative
Bgt :B positive
Ecg:
Day 2:
Hypoproliferative anemia under evaluation with hypoalbuminemia
no fresh complaints
O/E pt conscious coherent
PR 120bpm,regular,normal volume
Bp 110/70
RR 20/min
Pallor +
Icterus+
JVP raised
Cvs:
Apical impulse in 5th ICS on mid clavicular line
Parasternal heave+
Heaving apex+
Epigastric pulsations+
S1 s2 +, no murmurs
GIT
Shape of Abdomen normal
Umbilicus inverted,central
No local rise of temp
Tenderness+ on deep palpation in right and left hypochindrium
Hepatomegaly+
Spleenomegaly+
Bowel sounds +
2d echo:
Ultrasound abdomen:
Day 3:
No fresh complaints
o/e pt c/c/c
Afebrile
BP:110/70mmhg
PR:86/min
reports:
serum vit b12 levels done outside:201.6pg/ml(normal range 211 to 911)
rx:
1.oral fluids upto 1.5L/day
2.protein powder 2tsp in 100ml milk 1 PO/TID
3.tab.CARBIMAZOLE 5mg/PO/TID
day 4:
No fresh complaints
o/e pt c/c/c
Afebrile
BP:110/60mmhg
PR:110/min
grbs 102mg/dl
Bone marrow biopsy done
reports:
PT 1.8
INR 1.3
APTT 35
BT 2min 30sec
CT 4min 30sec
MP negative
Hb 6.3
TLC 4,000
plt 1.8 lakhs/cc
rapid dengue:negative
Rx:
1.tab carbimazole 5mg/po/tid
2.oral fluids upto 1.5L/day
3.protein powder 2tsp in 100ml milk po/tid
4.inj methylcobalamin 1000micro grams/im/od
day 5:
No fresh complaints
O/E pt c/c
Pallor+, icterus+
PR 96/min
BP 120/70mmHg
Cvs:parasternal heave+
S1 s2 +, no murmurs
RS BAE+
P/A - soft, Non tender
Hepatospleenomegaly+
Bowel sounds+
Reports:
CBP
HB - 6.8gm/dl
TLC - 6,200 cells/cumm
plt 2.06lakhs/cc
Rx:
1.Inj iron sucrose
2.Day 3 Inj methylcobalamin
3.oral fluids upto 1.5L/day
4.protein powder 2tsp in 100ml milk po/tid
5.tab carbimazole 5mg/po/tid
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