60 year old female with MEGALOBLASTIC ANEMIA

 

60 year old female with MEGALOBLASTIC ANEMIA

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G. Pravallika 

Roll no 41 

2019 batch 

Date of admission: 27/11/23

A 60 yr old female came casualty with the chief compliants of 

- Fever since 10 days 

-Generalised weakness since 4 days 

-Chest pain and tightness since 4 days

-Blood in stool since 3 days 

-Pedal edema since 3 days 

     

History of presenting illness:

-Patient was apparently asymptomatic 10 days back and  developed fever which intermittent high grade not associated with chills and rigor. Fever relieved on medication.

-Palpitations since since one week associated with chest pain and discomfort.

-There's excertional shortness of breath(.grade2or 3)

-No orthopnoea,no PND.

-Generalized weakness since 4dys.

-Blood in stools since 3 days.

-No h/o vomiting, loose stools ,pain abdomen and giddiness.

PAST HISTORY :

no h/o HTN,DM, epilepsy thyroid,asthma.

TREATMENT HISTORY

no h/o significant treatment history.

PERSONAL HISTORY 

Diet VEG now  ( stopped consumption of non veg from four yrs but not completely)

Appetite is  normal

Bowel and baldder movements regular

Sleep is adequate

No h/o allergies

Occasional consumption of toddy 

FAMILY HISTORY

not significant

MENSTRUAL HISTORY:

attained menopause 30 yrs ago

GENERAL EXAMINATION:

Patient is conscious, coherent and cooperative

            pallor

Icterus

No cyanosis

No koilonychia

No lymphadenopathy

VITALS:

temperature:97 degrees F

Pulse rate: 96 beats per min

Respiratory rate: 2qcpm

Bp: 130/70 mm Hg

SYSTEMIC EXAMINATION:

CVS

S1S2 heard, S1 heard loud, systolic murmurs heard

Jvp raised

Respiratory system 

Trachea central

Normal vesicular breath sounds

 Per Abdomen 

Shape of the abdomen scaphoid

Non tender

No organomegaly

CNS 

no focal neurological deficits

Provisional diagnosis:

 PANCYTOPENIA secondary to megaloblastic Anemia/dengue /malaria

INVESTIGATIONS

CBP 

        27/11/23.     28/11/23

Hb.    4.2.                 6.0

Pcv   11.8.                17.3

TLC   6500.                5700

RBC  0.9.                  1.64

Esr. 1.5.                    1.20

RBS 125 on 27/11/23

Blood urea.   28

S.creatinine 0.6

S.Na+ 139

S.k+ 3.3

S.cl- 99

Clotting Profile

Pt tc 18

APTT TC  37

BT 2 mins

CT 4 mins

Bilirubin levels

T bilirubin 3.66

D bilirubin 0.81

Lft

SGOT 15

SGPT:80

ALP 63

Total proteins 7.1

AG ratio: 1.52

Lipid profile 

TG  227

LDL 62

VLDL 45.4

PERIPHERAL SMEAR:

Anisopoikilocytosis

With normocytes

Microcytes

Macrocytes teardrop cells 

Reticulocyte count 1.5%

ECG

Colordoppler

USG

TREATMENT

27/11/23

1) inj.pan 40mg 

2) 2 units PRBC transfusion 

3) need for sdp transfusion 

4) inj iron sucrose 200mg in 100ml NS iv OD

5) inj Vitcofol 1500 mg in 100ml IV OD

28/11/23

1) INJ iron sucrose 200mg in 100ml NS

2) inj Vitcofol 1500 mg in 100ml Ns IV OD

3)1unit  PRBC transfusion 

4)inj ceftriaxone 2gm iv OD

5) cap DOXYCYCLINE 100 mg iv OD