19 yr female admitted with severe anemia hb 3.6 with severe menstrual bleeding., took 2 units of blood still hb not rising. recent history of admission in to another hospital and treated for malaria and hepatitis{ no records available}. no past history of such symptoms. examination revealed no specific findings. investigation reports attached. patient is now on blood transfusion. please suggest next line of management. reports showing pancytopenia, what may be the cause.


Her menorrhagia is the result of pancytopenia which includes thrombocytopenia. She should be managed as a case of pancytopenia after investigations to find out its causes such as hematological malignancies, immunological, drug indices etc. She should be given an ultrasound of uterus and adnexa to rule out a contributing cause to bleeding such as fibroids or hormone secreting adnexal rumours. But in the presence of pancytopenia, menorrhagia is totally explained by it alone.
drug induced (not indices)
its a case of pancytopenia...give her platelet concentrates first...get platelet count above 1 lac...vitamin k injections...to control the bleeding first...then start with PRC's...PBF report is essential in these cases as its not available...check for reticulocyte index( before transfusion and follow it weekly), s.LDH, Haptoglobulin levels...even though indirect bilirubin levels are with in normal limits...coagulation profile, Hb electrophorosis,Ana by IFand Bone marrow studies...check for sternal tenderness, hepatosplenomegaly...
Do a PBF and Bone Marrow and USG Rule out on going hemolysis Administer vitamin B12, folic acid and iron. CBC showing dual deficiency picture
complete hemogram suggested it's a microcytic hypochrome. .so nutritional deficiency very unlikely. ..

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agree wid dr. arya.. gentlemen she has pancytopenia ..wid low rbc indices..normal bilirubin n no suggestion of hemolysis.. wd like to knw abt spleenomegaly.. sternal tenderness.. peripheral smear... rule out concomitant B12 deficiency n work on lines of myelodysplasia..unlikely to hav uterine pathology leading yo menorrhagia n anemia
One unit of transfusion rise only 1 unit of haemoglobin level.so prefer packed cell 4 unit along with platelet one unit.one unit of platelet means not one bag.1 unit platelet= 4 bags.usually one unit increases upto 4000-8000 unit of platelet depends upon pts conditions. check APTT, PT,HEMATOCRIT LEVELS
It is due to dub investigate u/s of pelvis for dub control menorrhagia with progesterone and mefenamic acid transmanic like pause give pack cells transfusion and do plasma iron and ferritin test and rule out heamatological malignancy drug induced cause and come to proper diagnosis
anamia is due dub.first treat the dub by find the cause by usg of pelvis and whole abdomen and hormone level like progestron estrogen etc.and done blood transfusions for anamia and lv injection iron sucrose according deficiency of hb.
clinical and lab picture looks like acute aplastic crisis...most probably underlying aplastic anemia ..should undergo bone marrow first...correction of coagulopathy simultaneuosly and treatment according bone marrow reports...
cause of pancytopenia.. Multiple myloma blood cancer Exposer to radiation Chemical therapy Certain antibiotics drugs Other Factor Treatment.. Immunosuppression Medication. Blood forming drugs Bone Marrow transplant..
good work
may be a case of pancytopenia, go for Complete hemogram and bone marrow examination, there may be a suppression at bone marrow level which may be idiopathic or autoimmune etc, ask Complete history with family history
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