bicytopenia a...pcv and mcv are also low. lft normal... means no hemolysis. no b12 deficiency. look for blood loss and bone marrow. diarrhoea may be secondary to leucopenia. check for hiv status. rule out ulcerative colitis n celiac sprue. deworming is very necessary. do reticulocyte count, peripheral blood smear, stool for occult blood, ova n cyst, hiv, bone marrow examination...aspiration n biopsy, serum iron studies. if no conclusion then do ugi endoscopy, colonoscopy with biopsy, ANA, C-ANCA, P-ANCA
Commonest cause for this kind of intermittent diarrhoea and such a severe Fe Def anemia is due to Strongyloidis stercoralis infection. If the patient is in well compensated state. I. E no S/S of volume overload correction of Fe Def by IV iron sucrose may be sufficient in adequate doses at proper intervals. second important DD to r/o in our Indian patients is TB affecting intestine. think of conman problems first and then go for relatively rare diagnosis
Hb. Of 4.5gm% shows grossly anaemic pt. How is he surviving. My first suspicion will go for ulcerative colitis and crohn disease and if negative one will have to rule out all other causes of anaemia active bleeding haematamesis malaena occult blood haemorrhoids and bone marrow b12 folic acid. Full history is very important.
underlying occult malignancy , HIV, inflammatory bowel ( malabsorption syndromes) disease, pernicious anaemia, thallesemias, coagulation disorders and bleeding varices/ peptic ulcers all fall into the differential diagnosis... investigate accordingly
Protein losing enteropathy with anal fissures maybe. Check serum proteins and stool for occult blood. Blood transfusion is necessary as of now.
Kindly check Reticulocyte count also.Lok for H/O GI bleed! Hospitalization,replacement and Investigation for cause of Anaemia.
Likely to be HIV infected patient... Decrease Hb with TLC and history of diarrhoea ... May be side effect of Zidovudine .
thx for all this discussion, when pt will come back to me I have concluded final plan OF T/T from this discussion, stool for occult blood , ova,cyst to rule out any blood loss,AND will look for serum bilirubin, Hepatoglobin , pbf and usg whole abdomen to rule out any hemolysis, rt this time with nutritional supplementation as it it sure iron deficiency anaemia, if not corrected then bone marrow exam, as pt is already financial weak , is it okay
rule out coeliac disease. get anti ttg, ugie with biopsy done. thyroid profile and blood sugars to be checked. pt. is hvng bicytopenia. look for lymphadenopathy. bone marrow aspiration and biopsy to be done. Ldh, yric acid, calcium, phosphorus levels. haptoglobin and bilirubin for ruling out hemolysis. get pbf, rft, lft done.
He has anemia and leucopenia with hypochromic picture,generally macro cuticle picture would have made our job easier. Now young pt with chronic diarrhea and anemia,I would like to know more history like ppt factors gluten sensitivity
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ABC OF : NAIL DISORDERS. ( I ). MAY BE USEFUL. *** ANONYCHIA is the absence of nails, an anomaly, which may be the result of a congenital ectodermal defect, ichthyosis, severe infection, severe allergic contact dermatitis, self-inflicted trauma, Raynaud phenomenon, lichen planus, epidermolysis bullosa, or severe exfoliative diseases....... *** PSORIASIS can also affect the fingernails and toenails, leading to thick fingernails with pitting, ridges in the nails, nail lifting away from the nail bed, and irregular contour of the nail....... *** LICHEN PLANUS of the nails can cause brittle or split nails, and the affected nails may have ridges running lengthwise....... *** FUNGAL nail infections are common infections of the fingernails or toenails that can cause the nail to become discolored, thick, and more likely to crack and break. Infections are more common in toenails than fingernails.....by some dermatophytes, Candida (Monilia) species, etc....... 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