50 yr old male wth ho of fever for3 days , on routine blood tests platelet count 2000. Hb 4.8 gm please comment management n treatment

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3 D/Ds: 1. Viral fever : leading to thrombocytopenia and neutropenia. Anemia cud be due to internal bleeding from thrombocytopenia. Look for activated lymphocytes in GBP. Get an IgM test for Chickengunya. 2. Complicated Malaria: leading to severe anemia and thrombocytopenia... Look for splenomegaly.. Go for MPQBC and MP smear.. Look for evidence of hemolysis, get LFT, LDH, GBP and reti done. 3. Lymphoproliferative disorder: leading to bone marrow suppression and lymphocytosis. Look for enlarged lymph nodes and splenomegaly. Get an LDH done for Non Hodgkin's lymphoma. Plan for Bone marrow biopsy
A case of macrocytic anemia with pancytopenia We need to look at morphology of RBCs WBCS and platelets Retics is important to know whether the anemia is hypoproliferative or otherwise. Bone marrow is a must in such cases.Preferably aspiration and biopsy . Regarding the pyrexia part we need serological tests to support and confirm the infective cause. Also advise blood culture and TFTs USG abdomen will let us know the organomegaly or lymph nodes.
Please send a peripheral smear, if required patient might need a bone marrow biopsy, Patient has pancytopaenia, acute leukemia is imp differential should be kept in mind Routine fever work up, take cultures and start broad spectrum antibiotics, platelets transfusion is needed and blood transfusion as well
acute onset pancytopenia...infectious ds h. should be ruled out. history of rash and insect bite...rickettsial ds could be a possibility. rapid malaria test to be done. if negative ANA to be zone . usg to look for splenomegaly.bone marrow examination.
blood test picture is suggestive of pancytopenia. it needs evualvation by bone marrow examination bcos possibility of myelosuppresion is there .it may be leukemia or aplastic anaemia megaloblastic anaemia is also possibility in view of high mcv
You may check NS 1 antigen...if positive treat only with paracetamol and fluid perhaps CRP is within normal limit. on day 6 check Dengue IgM. Daily platelet count to be checked. USG abdomen should not be missed.
ffp , bt , ivf , check for Dengue ns1
history of alchohal..??
no
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Dear sir First and Foremost a Peripheral blood smear examination should be done It is Pancytopenia - so any presence of atypical cells / blasts should be evaluated ; can be a case of Subleukaemic Leukaemia Next Hb is very low ; so any haemolysis has to be ruled out - presence of schistocytes , nucleated RBCs and polychromatophilic cells has to be seen although RDW is not too high - 19 Third MCV is on the higher side so causes of severe megaloblastic anaemia should also be kept in mind - evaluation of Folic acid and Vitamin b12 Leucopenia with thrombocytopenia and lymphocytic predominance if activated lymphocytes seen on pbf then evaluation of Dengue by ELISA is needed NS1 or Ig M ; rapid cards are not very sensitive If PBF doesnt clarify then further work up a bone marrow aspiration and trephine biopsy
CBC shows pancytopenia. Peripheral smear review is required to look for blast cells, dysolastic cells, haemolysis, polychromasia, platelet morphology etc. Tests like LDH, direct and indirect bilirubin, retic count, DCT, ANA, vit B12 can help. S. TG, fibrinogen, ferritin, LDH can help to exclude haemophagocytosis. BM examination will help to to exclude aplastic anaemia, haemophagocytic syndrome, leukaemia, ITP.
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