hemolytic anemia by dr maaz seerat
TRANSCRIPT
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WARD CASE PRESENTATION
Dr. Maaz SeeratPGR-1West Medical Ward
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PATIENT BIO DATAName :- Ayesha Akhtar
Sex :- FemaleOccupation:- student Age:- 20yrs. Resident:- 259 Model colony, Sialkot.DOA: 28-10-13MOA: OPD
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PRESENTING COMPLAINTS
Progressive generalized Weakness- for last 6
months
Fever 10 days
Bodyaches 6 days
Vomiting 2 days
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HISTORY OF PRESENT ILLNESS
6 months back patient started feeling weakness,
malaise, which was on doing daily household work.
It has progressed since then (disability grade 3)
There is associated shortness of breath, which progresed
from NYHA class I to NYHA class II over past 6 months. It
was not associated with cough , whistling sounds on
breathing or blood from loss from any site of the body
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HISTORY OF PRESENT ILLNESS Fever started 6 days back, was low-grade,
not associated with rigors and chills, it was intermittent. Relieved only by taking anti pyretic. It was also associated with body aches, restlessness, decrease appetite. It was not associated with joint pain or swelling. There was no body rash associated with this fever
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HISTORY OF PRESENT ILLNESS
Vomiting for 2 days There have been 3,4 episodes, containing
food contents. It was non-projectile.it was relieved by anti-emetic drugs.
Vomiting was associated with intake of food and water
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SYSTEMIC REVIEW
No history of diarrhea, constipation No history of mental confusion, fits or any
disorientation or headache. No history of cough, sputum No history of burning micturition, pain flank,
yellowing of urine or stools. No history of rash, allergy, difficult in swallowing
food and discolouration of fingers with cold weather exposure
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PAST HISTORY
No evident past medical or surgical history
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SOCIOECONOMIC
Low middle class
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DRUG HISTORY
Patient taking steroids, left 2 months back
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EXAMINATION General Pysical Examination:- A young girl, lying comfortably. Well oriented
in place, person and time, having vitals of: BP 110/60 mm Hg pulse 92/min,regular no radioradial and radio
femoral delay R/R 19/min temp:98.4F GCS 15/15 Pallor ++ Cyanosis –ve Jaundice ++ no lymph node
palpable JVP not raised No Pedal Edema
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SPECIFIC EXAMINATION
GIT:- Umbilicus central inverted, flat Soft, Non-
tender abdomen.
On palpation Spleen is palpable 1-finger breadth
below left sub costal margin. No other viscera
palpable.
On percussion SD and FT are absent
Bowel sounds +ve.
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CVS:-
No visible pulsations, Apex beat in left 5th
intercostal space, medial to mid-clavicular
line.
No thrill, S1+S2+0. no murmur.
Heart rate is 93/min, regular.
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CNS:- Higher mental functions are normal Pupils are B/L equal and reactive to light and
accommodation Cranial nerve examination is normal Normal motor and sensory examination of
both the upper and the lower limbs Reflexes are normal
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RESPIRATORY SYSTEM
Normal on Inspection, palpation and
percussion.
Normal vesicular breathing with no added
sound
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DIFFERENTIAL DIAGNOSISAll types of hemolytic anemiasPortal hypertensionLeuemiasLymphomasMononucleosusMalaria
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INVESTIGATIONS
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INVESTIGATIONS
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INVESTIGATIONS
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LFT’S
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LFTS
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USG ABDOMEN
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ANA/ RA
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FURTHER INVESTIGATIONS Coomb’s test, direct and indirect to detect
IgG antibodies Hemoglobin electrophoresis
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TREATMENT Replace red cells by Pack cell volume
transfusion. Cortisteroids Plasmaphoresis in severe cases. Spleenectomy