A perviously healthy 11 year old girl presents with three days of oral mucosal bleeding and epistaxis. One week prior to the bleeding she had three days of fever, body aches, and malaise. On exam, vitals are stable, and also have slight macular rash on the arms and legs. Her platelet count was 39. What is the probable diagnosis?

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Reassurance to patient first Chech for oral clinical examination, if u get nothing I think u should go for INVESTIGATIONS Tests to detect dengue Complete blood picture (CBC) Bleeding time - Clotting time PTT /PT 1.)TILL the time ask the patient not to brush and avoid touching/pressing. Eating hard foods 2.)stopping fever related medication NSAIDS which would hamper platelet count. D/d 1.)Dengue (common manifestation along with fever suggestive of infection low platelets) 2.)thrombocytopenic purpura 3.)aplastic anaemia /leukemia 4.)vit b12/folate /iron deficiency 5.)auto immune condition 4.) spleen disorder 5.)viral infection Also refer to haematologist Platelet transfusion to earliest

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DHF / AML / Pancytopenia (?)

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Though detail investigations reqd Most likely Dengue fever

Refer her to hospital as son as possible. She may need platelet infusion. CBC can let us know whether it's thrombocytopenia or pancytopenia. High probability of dengue fever.

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Admit pletelet count less with bleeding pletelet drip repeat CBC 12 hrly

What about CBC(TLC,DLC spl.),?? ESR, Hs- CPR also rule out, but may be it's Erythromelalgia..not sure but only singn seen as skin, on a part of oral lesion also affected..

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DHF

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Looking like dengue shock syndrome with thrombocytopenia need immediate hospitalization

Vit K and C deficiency .....

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Dengue harmorrhagic fever

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