On 31/1/2017 A 16 yrs Old Female Patient with c/o Breathless on exertion since week c/o Generalized weakness c/o Feverish Feeling since last 2-3days O/E TPR - N/80/Reg BP- 100/60mmHg Spo2 - 97% with reports Hb - 2.5 gm/dl TC - 5700 DC - 52/42/2/4 SGPT - 22 CBC was repeated hb - 2.4 MCV - 56 IRON PROFILE Hb electrophoresis was done attached USG abdomen and pelvis 1 unit PCV was Transfused after investigating in evening At night after 10pm pt had vomiting 7times till 3am antiemetic was given Greenish vomiting after 4am pt developed Icterus and yellowish Discoloration of all body with Reddish urination ix was done and Bill was found to be Total Bill - 17 Direct - 13.5 HbSAg - Neg HCV - Neg USG Screening was revised was found to be same. What may be the cause of raised bili.? o/e TPR - 100.4f /130/ 24 BP - 90/60mmHg spo2 - 97% @RA

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The bilirubin will not be direct in case of hemolysis..obstructive jaundice will more favour the diag however alp is not that high...the stone in the neck of gb can onst the chb and lead to obst jaundice....hepatitis is less on the cards becuz enzymes r normal althoght u should have also done hep a and e...in addition to b nd c wht u did...vomitting may have been caused by incompatible blood transf...the patient needs full work up for micycytic hypoch ananemia..blood trans to get hb atleast above 7 g /dl...and an mrcp +_ ercp to look for aby obst elements...in addition to lft send ggt and nuclotidase levels....although u mentioned the patient has been shifted to another centre try keepin the update if possible. Theirz also a faint possiblity of having conjugated hyperbilirubrnemia which include dubin johsons nd rotors but that needs a detailed workup

Severe iron deficiency anemia treated with incompatible blood transfusion. Indirect bilirubin would have increased if hemolytic anemia was present. May be some inbuilt error of bilirubin conjugation as there is direct hyperbilirubinemia and bs bp positive in urine. Presence of Liver injury or cholestasis is also unremarkable on seeing the lab reports. A case well shared sir. Do keep us updated regarding this case. Thank you.

Basically she is case of Anaemia due to Haematological causes like Von willebrant disease , thrombocytophenic purpura , Acute Leukaemia's . Needs through investigation to know primary cause of disease. Jaundice is because of mismatch blood transfusion.

With direct bilirubin of 13.5 and total being 17mgm hemolytic anaemia is ruled out Looking at iron profile it looks chro ic iron defi anaemia Jaundice sec to mismatched transfusion

Incompatible blood transfusion??? And rule out hemolytic anaemia... go for peripheral blood smear and coomb's test

Sir Already had done PS posted below
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Haemolysis anaemia. Must get urgent haemotology consultation as she may land up in CCF

Yeah hve referred to higher center
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Hemolytic anaemia with gall stone and pcod.

Haemolytic anaemia .Consult Haematologist.

HAEMOLYTIC ANAEMIA WITH GALL STONES.

Sudden rise in bilirubin that also after transfusion most likely due to hemolysis...though Indirect bilirubin is not raised ( may be error). Also what was the AST ALT ,LDH levels...

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