A young female aged 18 yrs presented with history of Fever with chills , breathlessness since 5-6 days and altered sensorium since 1 day.....On taking history from attendants, it was revealed that She has had 2-3 episodes of Jaundice in last 2 yrs and 3 PRBC transfusions were also done 8 months back due to severe anemia....She was foundto have clubbing...Discuss this interesting case and possible differentials...

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Patient has ascites so fluid examination should be done And rule out for focus of infection CBC,thallessemia,sickle cell anaemia ESR ,mountux test must be done Subacute bacterial endicarditis developed so patient presenting such sign and symptoms Treat patient symptomatically till reports come

I agree with Dr S C Annu

How about blood reports sir?

Since there is h/o 2 to3 episodes of jaundice she may have land as a c/o hepatic failur with encephalopathy. This can be associated rt lower lobe congestion with mild ascitis

Thanx dr Dr Malikender patel patel
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r/o Bacterial endocarditis or chronic hepatitis Adv- hepatitis serology, LFT, 2D ECHO, blood cultures.

DD are hemoglobinopaties, thalassemia,sickle cell disease in sicklecell anemia due to auto splenectomy pts are, susceptible to pneumococcal and salmonella infections.in hepatitis viral infection patients are prone to aplastic anemia.

Thank you doctor
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The patient is now having right lower love consolidation s/o pneumonia with septicemia, it may be due to decreases immunity as splenomegaly might be clearing all the b and t cells.routine blood with peripheral smear and reticulocyte count will help I think.is she having jaundice now?also some occult congenital heart disease might be there.

Thank you doctor
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Spleenpalpable? Needs further extensive investigation as described by above friends

Yes sir spleen is palpable
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Spleen size? Urine colour? H/o blood in stool, urine? Agree with Dr Sumit Gupta listed DDs. Peripheral blood picture, reticulocyte count, IEP, CUE, USG abdomen along with other mentioned. ICU admission and hydration is priority along with simultaneous evaluation. Involve hematologist.

Agree with @Dr Annu
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It may b malaria parasite. Severe a plastic anaemia.sickle cell anaemia or auto immune hemolytic anaemia so adv pt aptt kft.lft and iron profile and csf and ct scan and transfuse whole blood

Peripheral smear findings.. general blood picture.. should also be done..
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