A 45 year old male, a non alcoholic with no major illness in past, presented with fever since 5 months( on and off, high grade, no joint pain) . Gen weakness since 5 month. Patient had a history of cavity in tooth and abscess there which was extracted locally near his residence.he was also prescribed antibiotics for the same. Now patient reffered to us with severe anaemia and blackish brown spotts over fingertips of all 4 extremeties. Pallor +++ Platelets low 58000 as mentioned. Spleen 2 cm below costal margins. Cva normal, no signs of SABE Bilirubin normal. He was earlier treated for enteric fever and megaloblastic anemia in some hospital where blood culture was normal and all other reports attached( white ones) Gbp is awaited. Marrow is planned once platelets are normal. Givin 2 units of prbc. What will be the dd and further management plan. Hb fall from 7 to 3 in three days duration. With no signs of hemolysis.



Thumb rule in ?Thrombocytopenia is .. Platlet tranfusion first...than rule out the cause.. ,weather caused by any broadspectrum Antibiotics,lead to blood descreasis.. Adequate fluid intake.....Hyponetremia shuld be takencare of....and to rule out bonemarrow suppression following any ideopathic reason

findings in the pic appears to be petechiae coz of thrombocytopenia...their is No report of Peripheral Smear....in view of pancytopenia BoneMarrow Studies are MUST....evaluate the patient completely for Infective endocarditis...Blood cultures of 5 sets before initiating antibiotics...auscultate for murmurs...2d echo can be diagnostic...start with emperical antibiotic therapy...check for hematuria and proteinuria....give a trial of anti malarials....till then manage conservatively wid Platelet concentrates and then PRC's...pls let us know Bone Marrow studies...

No murmurs, echo awaited, patient already had antibiotics in past 5 mnths and now blood culture is neg

Look for peripheral smear for spherocytes n rule out HUS History has to be eminent regarding previously having symptoms of AGE also. Take meticulous care in finding any other signs of Infective endocarditis.. Has he been treated previously with antibiotics which is leading to false blood culture report kindly let us know the progress

It is aplastic anaemia. He has splenomegaly .he has pancytopenia.pl go for ct abdomen. Is there any evidence of internal bleeding/ bleeding p/r .bone marrow should clarify the cause of aplastic anaemia

This patient probably has drug induced pancytopenia along with thrombocytopenia. Chloramphenicol use can sometimes give rise to a situation like this. The first priority is the restoration of his falling Hb and platelets. He should be adequately hydrated.As his LFT and renal functions are adequate, the first course should be to correct severe anaemia due to inadequate RBCs. Blood transfusion along with a high spectrum antibiotic to start with. If no evidence of infection then he should also receive iv steroids to support the affacted bone marrow. Bone marrow picture will also decide the other options. Steroids will prop up both RBCs and Platelets. Sequencial CBC will indicate the progress made. Watch for signs of internal haemorrhage.

infective carditis related gigivitis 2 dcecho will shows vegetations blood culture negative endocarditis to b rule out if not get PET CT done to look fr d focus bone marrow b12 def

This seems to be a case of Acute Myeloid Leukemia. Peripheral smear examination should be done n a bone marrow examination once platelet transfusion has been done. Occupational history n any history of exposure to radiation must be asked. Also the patient has post history of B12 def n sometimes severe Vitamin B 12 deficiency may present with splenomegaly , pancytopenia n leukoerythroblastosis.PBS should be done to look for nucleated RBC n immature Myeloid cells. Aplastic anemia can be ruled out as splenomegaly is present. Considering H/ o tooth abscess n extraction SABE should be ruled out. 3-5 blood samples must be taken within 60-90 minute n ECHO should be done. Broad spectrum antibiotic preferably Ceftazidime ( febrile neutropenia) should be started.

Dear doctor Your case sees to most like a marrow related disease....either A plastic Anaemia or Acute Leukaemia. Bone marrow picture will be a mandatory part in the background of pancytopenia. But I shall request you to consider some infective agent which can produce long spell of fever with splenomegaly and anaemia. Have you explored the occupation of the patient? Is he dealing with care of animals? if that is so...please keep Brucellosis in your d/d. It can cause infective endocarditis as well which carries grave prognosis. Packed red cell and platelet concentrate transfusion will be needed as most have suggested. An echocardiography , repeatvblood culture begore syarying any empirical antibiotic and Good general care will see you through this crisis period I hope.

Yes he is a milkman and has cows. Brucella antigens are sent. Reports awaited

View 1 other reply

just look for aplstic anaemia...purpuric patches are d/t thrombocytopenia...here pancytopenia....bilirubin WNL indicative of decreased production of RBCs... peripheral smear drug history bone marrow examination is important...also do ECHO as history of dental infection is there... d/d 1. bone marrow fibrosis 2. drug induced aplastic anaemia 3. extravascular haemolysis bcoz of infection...

Sir As from above reviews, I think as a case of Aplastic anaemia, BT, &platelets must given to fulfill damage. Kingen water of 11.5 will help full in this case.

Load more answers

Cases that would interest you