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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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

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.

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

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

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

This is the report which is made by a layperson and not the pathologist... At least send your patients to the lab of qualified pathologist.. 2nd image plt is 6000 and he is reporting adequate...

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.

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.

Fever with pancytopenia 1.Megaloblastic Anarmia with sec.infection (MCV 100) 2.Drug induced pancytopenia with sec.infection 2.Acute Leukemia. 3.Myelodysplastic syndrome 4.Paroxsysmal Nocturnal Hburia

1) malaria 2)dengue 3)Lepto to rule out do M.P antigen,lepto,PT /INR XRAY CHEST, USG abd.now pt required icu care with FFP and platlets transfusion as per reperts.watch for any rash and bleeding. check patient previous CBC if he had history of pancytopenia then bone marrow biopsy but at firts icu care with supportive care.

what about MCV 112
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