35 yF vth anemia, ft3,ft4,TSH report attached.. plz discuss how to proceed..Hb-6.8,fbs-68,sr urea-25,cret-0.9.TLC-8400, DC-N73,L26. Thin built, 42 kgs....

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Dear Santosh, You need to repeat TFT as both T4 & TSH are subnormal. We can not even label this Hyperthyroidism too. Is the patient symptomatic ??? Tremors Palpitations Goitre. Order USG Thyroid FNAC Thyroid. As far as Anaemia is concerned, r/o causes of Anaemia. Treat with Blood transfusion.

Thanks Krishna Sir
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Dear Dr Santosh, As per available information, Your patient has Anaemia but is it of acute or chronic onset ? We shall have to investigate further to find the cause of Anaemia, first, by taking a good clinical history and physical examination. Then we can Ponder whether it is nutritional ? whether it is hemolytic or aplastic . Also enquire if she has been having heavy menstrual periods or any bleeding per anorectum. Patients usually hesitate to tell some details. If you can, Have a HEMOGRAM with all the parameters from a local pathologist and requesting him to have a personal look into the slides, not at all at those automated centres like Thyrocare , Lal paths etc. As for Thyroid, No need to panic at this stage. She might be in Subclinical hyperthyroidism or associated with non thyroidal illness. Do ask for A repeat complete Thyroid profile , if affordable comprising of T3, T4, FT3, FT4, TSH and also Anti TPO Antibodies . One has to consider Autoimmune Thyroiditis. Do not plan for blood transfusion as advised by Dr Krishna Mohan. Follow Dr Riya's advice .To investigate the cause of Anaemia, and never transfuse blood at the flimsiest indication because patients are always exposed to blood borne infections , no matter how hard we try to screen for them, for instance, HIV in window period is never detected through Tridot testing. We should think of transfusing only when the patient is in failure or shock or else we might be doing more harm than good , because Anaemia often becomes a compensated phenomenon in the body . We should desist going aggressively for the correction of hemoglobin levels Meanwhile , We have to rule out pregnancy, because this can complicate issues. You can reassure the patient. Treat her symptomatically for time being. Nothing for Thyroid till no new findings. Oral Hematinics initiated till then If possible have a Hematologist opinion . I think I have given you some news ideas to think. thanks for the opportunity.

Thank u Sir
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CAUSE OF ANAEMIA -------------------------------- Diet = veg diet = vit Bi2 low megaloblastic anaemia Poor diet = iron def anaemia appetite low = malignancy TB Family history =thalassaemia ( Hb electrophoresis ) GB srone Haemolytic Anaemia ( osmotic fragility/ combs test / raised indirect bilirubin ) f/ h = GB stone Pigment stones at surgery= haemolytic anaemia Splenomegaly + Osmotic fragility /coombs test.. Raised urobilinogen in urine haemoglobinuria haemosiderinuria H/O = blood loss ( menorrhagia bleeding peptic ulcer bleeding p/r haemoptysis Investigations Serum iron tibc ferritin Complete haemogram LFT Creatinine thyroid function = reported normal Stool = hookworm occult blood p/ pv exam If low appetite = ugi endoscopy colonoscopy cxr Usg abdomen

rule out cause of anaemia. tt accordingly with BT. iv iron sucrose in normal saline. nutritional supplements and vitamin supplements and health education. regular follow up with Hb estimation. ..

for the anaemia, kindly do the MCV, MCHC and the peripheral smear report. commonest cause of anaemia in pregnancy is iron deficiency. hence kindly do the serum ferritin and serum iron as well. if early pregnancy, can be effectively managed with oral iron supplementation. if approaching delivery, kindly give iv iron

sorry sir. I assumed she was as it was put up by an obstetrician. my apologies
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All 3 are low.. Could it be a case of.. Secondary/pituitary..hypothalamic/trophoprivic hypothyroidism?

REPEAT TFT WITH GOOD LAB, ,MEANWHILE FR ANAMIA PCV TRANSFUSION 2 UNIT, ,INJ OROFER -S IN 100 ML SALINE, ,INJ VITCOFOL ON A/L DAY, ,CP DEXORANGE OD, ,MULTIVITAMINS SUPPLEMENT ,,NUTRITIOUS DIET, ,

ask fr the symptoms of hypothyroidism if present repeat d profile.. den trt with eltroxin 100microgram per day.. fr anemia do cbc and trt accordingly with iron folic acid and mvt.. do diet cancelling if she is underweight.. do ecg check fr cardiac changes..

Dear Kumara Swamy, This is not a case of Hypothyroidism. Doesn't require Thyroxine.
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Hypothyroidism with anaemia

One general rule we follow in Haematology for a patient presenting with anaemia is we don't transfuse the patient unless the patient is in failure or has risk factors like IHD which can push the patient into CCF. We first work up d patient fr d cause of anaemia, then treat it accordingly.

Dr Riya Can you post absolute indications of Whole blood, platelet, clotting factor. And other such type of transfusion as per Court of law PL Regards
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