H/o-Migraine, presents with severe malaise

Chief Complaint A 54 y/o female presents with headache, fatigue, and malaise on exertion. History She has a history of migraine for which she takes Lamictal and 20 days back she had one episode of nausea, vomiting & diarrhea. Examination She looks pale on physical examination and has splenomegaly. Investigations Lab report revealed severe anemia b CBC shows pancytopenia with a hematocrit of 14%, a platelet count of 16,500, WBC: 1.61 k/mm3 Treatment What is your opinion on this case?




More likely a c/o leukemia Adv bone marrow

For pancytopenia you should have to go for bone marrow biopsy with csf examination

Ref to hematologist.

Bone marrow examination needed

Need to rule out myelofibrosis and aplastic anemia..splenomegaly suggest more towards fibrosis...Marrow biopsy ..JAK 2 mutation..blood immunohistochemistry will be needed

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