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.



seems a case of aplastic anaemia.

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

Pallor+means low hb, recurrent infection means low wbc, low platelet count , signs of purpura... Enlarged spleen in unlikely in aplastic anemia so it can be ruled out .. Most likely a case of leukaemia.. Go for pft,, bone marrow examination

check for hjv-aids


immediate blood transfusion n gud diet n proper care of d patient..

any unnecessary drug shud be stopped..

ask for Malena ND workup for systemic sclerosis...immediate bt 2 prbc wid broad-spectrum antibiotic coverage boss....

No malena

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Go for bone marrow sir it may be MDS or Aplastic anemia . Do PBF also

Needs immediate fresh platlet&PC transfusion. Go for bone marrow to r/I Aplastic ane/leukaemia

Aplastic would not result in this fast fall in hb sir

stool for r/m and occult blood

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