14 years old female patient came with the chief complaint of decreased urine output since 1 week,cough without expectoration since 1 week. Hopi:decreeased urine output since 1 week Gradual in onset Pain during micturition No h/o abdominal pain H/o fever present H/o vomitings (2) episodes Past h/o :no similar illness in the past H/o learning difficulty On further evaluation patient said that she is having amenorrhea since past 6 months Investigations done: Cbp-hb 4.1gm% Tc-10600 cells/mm3 Platlets-4.9 lakhs Pcv-16% Blood sugar-143mg/dl Blood urea-20mg/dl S.creatinine-0.8mg/dl Lft normal Chest x ray normal study Peripheral smear -severe microcytic hypochromic anemia Reticulocyte count-4.1% Platlets-approx 5lakhs/mm3 Many polychromatophils Moderate anisopoikilocytes Family h/o non consanguinous marriage of parenting Patient has 2 sibilings,males,one male child has alopecia 2d echo done normal Usg abdomen done- normal Pt unable to afford for ANA,anti dna ab test. On examination pt conscious oriented afebrile Cbs s1 s2 heard no murmurs Rs bilateral air entry present Cns no focal neurological defects Pt has hypertelorism Low set ears Alopecia High arched palate Reverse mangolian slantpatients mother has similar features

(Edited)

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??autoimmune hemolytic anemia with SLE

The patient’s brother is also having similar features appearance sir,so male child involvement,so sle is doubtful?
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Hb electrophoresis to rule out iron deficiency anaemia or thalassemia.

Thank you ma’am
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Why SLE??Why ANA DSDNA etc... somebody please explain...

Iron deficiency anemia..dd- rule out thalasssemia

Thank you sir
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Ectodermal dysplasia anhidrotic type...

Next line of investigations sir?
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Autoimmune hemolytic anaemia with SLE.

Iron deficiency anaemia /thalassemia

Thank you ma’am
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I think the pt has one main illness that is sever anaemia all the other conditions are adding as sequel to it.one should do a culture and sensitivity of urine,and as it is microcytic anaemia so correct it by giving iron by dextrose drip but in this case urgent pack cell volume transfusion can be given if possible.and I/v transfusion frequently.once the anaemia is corrected pt will improve. I must congratulate for your excellent history I will give you full mark. I don't think you should worry about ANA AND DNA.improve her diet. Try getting medicines from jan aushdhi store if you have any nearby.

Thank you sir
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Anemia of cronic disease/ IDA/Thalassaemia/ syndomic ANA, anti DS DNA, bone marrow, karyotyping

Thank you sir
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